血清颗粒蛋白前体在Ⅰ型自身免疫性肝炎预后评估中的价值

Role of serum progranulin in typeⅠautoimmune hepatitis prognosis evaluation

目的探讨血清颗粒蛋白前体(PGRN)在Ⅰ型自身免疫性肝炎(AIH)预后评估中的价值。方法选取活动期Ⅰ型AIH患者39例(AIH组)、健康体检者35名(正常对照组)。收集所有研究对象的一般资料和实验室指标[白细胞(WBC)计数、血清肝脏酶类、免疫球蛋白和自身抗体]检测结果,并检测血清PGRN、白细胞介素(IL)-17和IL-10水平。分析Ⅰ型AIH患者治疗前、后各项指标的差异和复发患者血清PGRN的变化。采用Spearman相关分析评估各项指标之间的相关性。采用受试者工作特征(ROC)曲线评价血清PGRN判断Ⅰ型AIH患者复发的效能。结果AIH组血清PGRN、IL-17水平显著高于正常对照组(P<0.05),血清IL-10水平显著低于正常对照组(P<0.05)。Ⅰ型AIH患者PGRN与IL-17、γ-谷氨酰基转移酶(GGT)、IgG和IgM均呈正相关性(r值分别为0.410、0.489、0.596、0.525,P<0.05)。Ⅰ型AIH患者治疗后血清PGRN水平均显著低于治疗前(P<0.01)。复发组血清PGRN水平显著高于未复发组(P<0.05)。ROC曲线分析结果显示,血清PGRN判断Ⅰ型AIH患者复发的曲线下面积(AUC)为0.78,以80.75 pg/mL为最佳临界值,敏感性为62.50%,特异性为83.33%。结论Ⅰ型AIH患者血清PGRN水平升高,且与AIH的疗效和复发有关,或可作为评价肝脏炎症损伤程度和疾病复发的指标之一。

Objective To investigate the expression of serum progranulin(PGRN)in the prognosis evaluation of patients with typeⅠautoimmune hepatitis(AIH).Methods Totally,39 active typeⅠAIH patients were enrolled as AIH group,and 35 healthy subjects were enrolled as control group.The general data and the determination results of white blood cell(WBC)count,serum liver enzymes,immunoglobulins and autoantibodies were collected.Serum levels of PGRN,interleukin(IL)-17 and IL-10 were determined.The changes in serum PGRN before and after treatment and its correlation with recurrence were analyzed.Spearman correlation analysis was used to analyze the correlations of serum PGRN with IL-17,IL-10 and clinical parameters.Receiver operating characteristic(ROC)curve was used to evaluate the efficiency of serum PGRN in the diagnosis of typeⅠAIH recurrence.Results Compared with healthy control group,serum PGRN and IL-17 were increased in AIH group(P<0.05),while IL-10 was decreased(P<0.05).Serum PGRN was positively correlated with IL-17,gammaglutamyltransferase(GGT),immunoglobulin G(IgG)and immunoglobulin M(IgM)(r values were 0.410,0.489,0.596 and 0.525,P<0.05).Serum PGRN level in AIH group after treatment was lower than that before treatment(P<0.01).Serum PGRN was higher in recurrence patients than that in non-recurrence patients(P<0.05).ROC curve results showed that the area under curve of serum PGRN was 0.78 for predicting typeⅠAIH recurrence.When the optimal cut-off value was 80.75 pg/mL,the sensitivity was 62.50%,and the specificity was 83.33%.Conclusions Serum PGRN is increased in typeⅠAIH patients,it is related to AIH treatment efficiency and recurrence,and it can be used as an indicator to evaluate liver inflammation,injury severity and recurrence.