自身免疫性肝炎伴幽门螺杆菌感染患者免疫因子的相关性研究

Study on the correlation of immune factors in patients with autoimmune hepatitis and helicobacter pylori infection

目的探究分析自身免疫性肝炎伴幽门螺杆菌感染患者免疫因子的相关性。方法回顾性分析2019年4月至2021年4月聊城市第三人民医院消化内科收治的102例首次诊断为自身免疫性肝炎患者的临床资料,男43例,女59例,年龄(54.11±5.20)岁,年龄范围为44~62岁。根据^(13)C尿素呼气试验检查结果将患者分为阳性组(n=58)与阴性组(n=44)。所有患者均行^(13)C尿素呼气试验,对幽门螺杆菌感染情况进行判断,采用酶联免疫吸附法检测患者的血清髓过氧化物酶抗体(MPO)、干扰素-γ、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)及肿瘤坏死因子-α(TNF-α)的含量,采用间接免疫荧光法检测抗核抗体、抗线粒体抗体(AMA)、抗平滑肌抗体(SMA)及抗中性粒细胞浆抗体(ANCA)的阳性率,同时采用全自动生化分析仪检测患者的肝功能指标,包括谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)及谷氨酰胺转胺酶(MTG)。结果阳性组患者的MPO[36.2%(21/58)]、抗核抗体[46.6%(27/58)]、AMA[43.1%(25/58)]、SMA[34.5%(20/58)]及ANCA阳性率[44.8%(26/58)]均高于阴性组[15.9%(7/44)、27.3%(12/44)、22.7%(10/44)、18.2%(8/44)、27.3%(12/44)],差异有统计学意义(P<0.05)。阳性组与阴性组的ALT、AST、ALP及MTG水平比较,差异无统计学意义(P>0.05)。阳性组患者的干扰素-γ[(17.42±5.44)μmol/L]、IL-6[(45.60±12.45)μmol/L]、IL-10[(35.88±7.65)μmol/L]及TNF-α水平[(13.45±4.11)μmol/L]均高于阴性组[(8.30±2.23)μmol/L、(24.43±10.25)μmol/L、(17.60±8.33)μmol/L、(6.57±2.60)μmol/L],差异有统计学意义(P<0.05)。经Pearson相关检验可见,幽门螺杆菌阳性与自身免疫性肝炎中MPO、抗核抗体、AMA、SMA及ANCA的阳性率,干扰素-γ、IL-6、IL-10及TNF-α水平具有正相关性,Pearson相关系数分别为0.25、0.54、0.58、0.65、0.88,0.65、0.42、0.43、0.35,差异有统计学意义(P<0.05)。结论自身免疫性肝炎患者的感染率较高,且其发生发展多与多种免疫性抗体阳性及细胞因子水平具有密切的相关性。

Objective To explore and analyze the correlation of immune factors in patients with autoimmune hepatitis and Helicobacter pylori infection.Methods A retrospective analysis of the clinical data of 102 patients diagnosed with autoimmune hepatitis in the Gastroenterology department of the Third People′s Hospital of Liaocheng City from April 2019 to April 2021,including 43 males and 59 females,age(54.11±5.20)years old,the age range is 44 to 62 years old.According to the results of 13 carbon urea breath test,patients were divided into positive group(n=58)and negative group(n=44).All patients underwent 13-carbon urea breath test to judge the Helicobacter pylori infection.The serum myeloperoxidase(MPO),interferon-γ(INF-γ),and interleukin-6(IL-6)were detected by enzyme-linked immunosorbent assay,interleukin-10(IL-10)and tumor necrosis factor-α(TNF-α)content,using indirect immunofluorescence method to detect anti-nuclear antibody,anti-mitochondrial antibody(AMA),anti-smooth muscle antibody(SMA)and anti-neutrophil cytoplasmic antibody(ANCA)positive rate.At the same time,an automatic biochemical analyzer is used to detect the patient′s liver function indicators,including alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP)and microbial transglutaminase(MTG).Results The patients in the positive group had MPO[36.2%(21/58)],antinuclear antibodies[46.6%(27/58)],AMA[43.1%(25/58)],SMA[34.5%(20/58)]and ANCA positive rate[44.8%(26/58)]are higher than the negative group[15.9%(7/44),27.3%(12/44),22.7%(10/44),18.2%(8/44),27.3%(12/44)],the difference was statistically significant(P<0.05).There was no significant difference in the levels of ALT,AST,ALP and MTG between the positive group and the negative group(P>0.05).Interferon-γ[(17.42±5.44)μmol/L],IL-6[(45.60±12.45)μmol/L],IL-10[(35.88±7.65)μmol/L]and TNF-αin the positive group The level[(13.45±4.11)μmol/L]is higher than the negative group[(8.30±2.23)μmol/L,(24.43±10.25)μmol/L,(17.60±8.33)μmol/L,(6.57±2.60)μmol/L],the difference was statistically significant(P<0.05).Pearson correlation test showed that helicobacter pylori positive and autoimmune hepatitis MPO,antinuclear antibody,AMA,SMA and ANCA positive rate,interferon-γ,IL-6,IL-10 and TNF-αlevels have positive correlation,Pearson′s correlation coefficients are 0.25,0.54,0.58,0.65,0.88,0.65,0.42,0.43,0.35,respectively.The difference is statistically significant,please be consistent with the main text,modify the main text first(P<0.05).Conclusion The infection rate of autoimmune hepatitis patients is relatively high,and the occurrence and development of the disease are mostly closely related to the positiveness of various immune antibodies and the level of cytokines.