乙肝肝硬化患者血清炎症因子水平与FibroScan参数相关性及对预后预测价值分析

Correlation betweenSerum Inflammatory Factors and FibroScan Parameters in Patients with Hepatitis B Cirrhosis and Its Predictive Value of Prognosis

目的:探讨乙肝肝硬化患者血清炎症因子水平与FibroScan参数相关性及对预后的预测价值。方法:选取2020年1月-2020年10月于某院就诊的60例乙肝肝硬化患者为A组,60例慢性乙型病毒性肝炎患者为B组,另选取同期体检的60例健康志愿者为C组。采集血清用酶联免疫吸附试法(ELISA)检测炎症因子[可溶性细胞间粘附分子-1(sICAM1)、干扰素-γ(IFN-γ)、白介素-21(IL-21)、巨噬细胞移动抑制因子(MIF)、可溶性P选择素(sP-selection)]水平,采用瞬时弹性成像技术(FibroScan)测定肝脏弹性值(LSM)。随访3个月,根据生存状况将60例乙肝肝硬化患者分为死亡组(n=11)、生存组(n=49),比较两组血清sICAM1、IFN-γ、IL-21、MIF、sP-selection水平及LSM值,采用Pearson法分析血清炎症因子水平与LSM值的相关性,采用多因素COX回归模型分析乙肝肝硬化患者近期死亡的独立危险因素。结果:A组、B组血清sICAM1、MIF、sP-selection水平及LSM值显著高于C组,血清IFN-γ、IL-21水平显著低于C组(P<0.05);A组血清sICAM1、MIF、sP-selection水平及LSM值显著高于B组,血清IFN-γ、IL-21水平显著低于B组(P<0.05)。死亡组血清sICAM1、MIF、sP-selection水平及LSM值显著高于存活组,血清IFN-γ、IL-21水显著低于存活组(P<0.05)。Pearson相关性分析显示:乙肝肝硬化患者的血清sICAM1、MIF、sP-selection水平与LSM值呈正相关(r>0,P<0.05),血清IFN-γ、IL-21水平与LSM值呈负相关(r<0,P<0.05)。多因素COX回归分析显示:血清sICAM1、IL-21、IFN-γ及LSM值是乙肝肝硬化患者近期死亡的独立危险因素(P<0.05)。结论:FibroScan参数LSM值可反映乙肝肝硬化患者病程中炎症程度,可为病情监测、疗效评估及预后预测提供依据。

Objective:To investigate the correlation between serum inflammatory factors and FibroScan parameters in patients with hepatitis B cirrhosis and predictive value of prognosis.Methods:60 patients with hepatitis B cirrhosis in a hospital from January 2020 to October 2020 were selected as group A,60 patients with chronic hepatitis B were selected as group B,and 60 healthy volunteers in a hospital during the same period were selected as group C.The serum was collected and the inflammatory factors[soluble intercellular adhesion molecule-1(sICAM1),interferon-γ(IFN-γ),interleukin-21(IL-21),macrophage migration inhibitory factor(MIF),soluble P selectin(sP-selection)]were detected by enzyme-linked immunosorbent assay(ELISA).The liver elasticity value(LSM)was measured by FibroScan.After 3 months of follow-up,60 patients with hepatitis B cirrhosis were divided into death group(n=11)and survival group(n=49)according to the survival status.The serum levels of sICAM1,IFN-γ,IL-21,MIF,sP-selection and LSM were compared between the two groups.The correlation between serum inflammatory factors and LSM was analyzed by Pearson method.The independent risk factors of recent death in patients with hepatitis B cirrhosis were analyzed by multivariate COX regression model.Results:The serum levels of sICAM1,MIF,sP-selection and LSM in group A and group B were significantly higher than those in group C,and the serum levels of IFN-γand IL-21 were significantly lower than those in group C(P<0.05).The serum levels of sICAM1,MIF,SP selection and LSM in group A were significantly higher than those in group B,and the serum levels of IFN-γand IL-21 were significantly lower than those in group B(P<0.05).The serum levels of sICAM1,MIF,sP-selection and LSM in the death group were significantly higher than those in the survival group,and the serum levels of IFN-γand IL-21 in the death group were significantly lower than those in the survival group(P<0.05).Pearson correlation analysis showed that the serum levels of sICAM1,MIF and sP-selection were positively correlated with LSM(r>0,P<0.05),and the serum levels of IFN-γand IL-21 were negatively correlated with LSM(r<0,P<0.05).Multivariate Cox regression analysis showed that serum sICAM1,IL-21,IFN-γand LSM were independent risk factors for recent death in patients with hepatitis B cirrhosis(P<0.05).Conclusion:The LSM value of FibroScan parameters can reflect the degree of inflammation in the course of hepatitis B cirrhosis,and provide the basis for disease monitoring,efficacy evaluation and prognosis prediction.