肝硬化患者血清Th1/Th2细胞因子水平变化及临床意义

Changes of Serum Th1/Th2 Cytokine Levels in Patients with Cirrhosis and Their Clinical Significance

目的探讨Th1/Th2细胞因子在肝硬化发生、发展及早期筛查中的作用和临床意义。方法收集2019年9月—2020年3月收治的25例肝硬化作为病例组,同时选取31例健康人作为对照组,比较2组血清Th1型细胞因子白细胞介素-2、干扰素-γ(IFN-γ)、肿瘤坏死因子-α水平,以及Th2型细胞因子白细胞介素-4、白细胞介素-6(IL-6)、白细胞介素-10和白细胞介素-13(IL-13)水平差异,并分析细胞因子与肝功能指标的相关性,采用多因素Logistic回归分析探讨细胞因子对肝硬化发生的影响,采用受试者工作特征(ROC)曲线分析细胞因子对肝硬化的诊断价值和保护效能。结果病例组血清天冬氨酸转氨酶(AST)、γ-谷氨酰转肽酶(GGT)、总胆红素(TBIL)、IFN-γ、IL-6水平高于对照组,血清白蛋白(ALB)、IL-13水平低于对照组(P<0.05,P<0.01)。肝硬化患者血清IFN-γ与GGT呈负相关(P<0.05);血清IL-13与TBIL呈正相关(P<0.01);血清IL-6与ALB呈负相关,而与Child-Pugh分级评分呈正相关(P<0.05,P<0.01)。IFN-γ是肝硬化发生的独立危险因素,而IL-13是保护因素(P<0.01)。血清IFN-γ对肝硬化诊断价值的曲线下面积(AUC)为0.750,血清IL-13对肝硬化保护效能的AUC为0.794。结论肝硬化患者血清IFN-γ、IL-6水平升高及IL-13水平降低与肝功能损伤相关,对肝硬化的临床诊断和治疗有指导意义。

Objective To investigate the role and clinical significance of Th1/Th2 cytokine levels in the occurrence,development and early screening of cirrhosis.Methods A total of 25 patients with cirrhosis admitted from September 2019 to March 2020 were selected as the case group,and 31 healthy subjects were selected as the control group.Serum levels of Th1 cytokines interleukin-2(IL-2),interferon-γ(IFN-γ)and tumor necrosis factor-α(TNF-α),as well as the difference of Th2 cytokines interleukin-4(IL-4),interleukin-6(IL-6),interleukin-10(IL-10)and interleukin-13(IL-13)levels,were compared between the two groups.The correlation between cytokines and liver function indexes was analyzed,and the impact of cytokines on the occurrence of cirrhosis was analyzed by multivariate Logistic regression analysis.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value and protective efficacy of cytokines in liver cirrhosis.Results The serum levels of aspartate aminotransferase(AST),γ-glutamyl transpeptidase(GGT),total bilirubin(TBIL),IFN-γand IL-6 in case group were higher than those in control group,while the serum albumin(ALB)and IL-13 levels were lower than those in control group(P<0.05,P<0.01).Serum IFN-γwas negatively correlated with GGT in patients with cirrhosis(P<0.05),while serum IL-13 was positively correlated with TBIL(P<0.01).Serum IL-6 was negatively correlated with ALB,but positively correlated with Child-Pugh grading(P<0.05,P<0.01).IFN-γwas an independent risk factor for cirrhosis,while IL-13 was a protective factor(P<0.01).The area under ROC curve(AUC)of serum IFN-γfor the diagnosis of cirrhosis was 0.750,and the AUC of serum IL-13 for the protection of cirrhosis was 0.794.Conclusion The increased levels of IFN-γ,IL-6 and decreased levels of IL-13 in patients with cirrhosis are associated with liver function injury,which has guiding significance for the clinical diagnosis and treatment of cirrhosis.