细胞因子与病毒性肝炎相关慢加急性肝衰竭预后的关系

Relationship Between Cytokines and Prognosis of Acute-on-chronic Liver Failure in Patients With Viral Hepatitis

目的探讨白介素等多种细胞因子,对提示乙型病毒性肝炎(hepatitis B virus,HBV)相关慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)患者预后的作用。方法收集我院HBV相关ACLF患者24例(ACLF组)、慢性乙型肝炎(chronic hepatitis B,CHB)患者25例(CHB组)和健康体检志愿者25例(健康对照组)。检测血清白细胞介素2(interleukin-2,IL-2)、白细胞介素4(interleukin-4,IL-4)、白细胞介素6(interleukin-6,IL-6)、白细胞介素8(interleukin-8,IL-8)、白细胞介素10(interleukin-10,IL-10),白细胞介素12(interleukin-12,IL-12),γ干扰素(γinterferon,IFN-γ)和肿瘤坏死因子α(tumor necrosis factorα,TNF-α)水平并进行相关分析。结果ACLF组IL-6、IL-8、IL-12和TNF-α显著高于CHB组(P<0.05),CHB组与健康对照组间水平比较,差异无统计学意义(P>0.05)。ACLF患者中,死亡患者IL-6、TNF-α水平和终末期肝病模型(model for end-stage liver disease,MELD)评分明显高于治愈患者(P<0.05)。IL-6、TNF-α水平和MELD评分的ROC曲线下面积(area under curve,AUC)分别为0.684、0.733、0.687,通过比较,TNF-α水平的AUC显著高于IL-6水平和MELD评分。结论HBV相关ACLF患者外周血中IL-6和TNF-α水平能一定程度上提示疾病严重程度,有助于判断预后转归,其中TNF-α水平预测效能最高。

Objective To investigate the effect of interleukin and other cytokines on the prognosis of patients with hepatitis B virus(HBV)relevant acute-on-chronic liver failure(ACLF).Methods A total of 24 patients with HBV related ACLF(ACLF group),25 patients with chronic hepatitis B(CHB group)and 25 health examination volunteers(healthy control group)were collected.Serum interleukin-2(IL-2),interleukin-4(IL-4),interleukin-6(IL-6),interleukin-8(IL-8),interleukin-10(IL-10)and interleukin-12(IL-12)were detected,the levels ofγinterferon(IFN-γ)and tumor necrosis factorα(TNF-α)were detected and analyzed.Results The levels of IL-6,IL-8,IL-12 and TNF-αin ACLF group were significantly higher than those in CHB group(P<0.05),and there was no significant difference between CHB group and healthy control group(P>0.05).Among ACLF patients,the level of IL-6 and TNF-α,the score of model for end-stage liver disease(MELD)in dead patients were significantly higher than those of the cured patients(P<0.05).The areas under the ROC curve(AUC)of IL-6,TNF-αlevels and MELD scores were 0.684,0.733,and 0.687 respectively.AUC of TNF-αlevel was significantly higher than IL-6 level and MELD score.Conclusion IL-6 and TNF-αin peripheral blood of patients with HBV related ACLF The level of TNF-αcan indicate the severity of the disease to a certain extent and is helpful to judge the prognosis,The level prediction efficiency is the highest.