内毒素对肝硬化患者可溶性CD14的影响

Influence of endotoxin on soluble CD14 in cirrhotics

目的 研究肝硬化时外周血单个核细胞 (PBMC)在内毒素刺激后可溶性CD14 (sCD14 )的变化。方法 选择肝炎后肝硬化患者 5 9例 ,分为伴有内毒素血症 (IETM ,A组 ) 2 9例和不伴有IETM (B组 ) 30例 ,19名健康人作为对照组。采用梯度离心法得到PBMC ,按每 2× 10 6个细胞给予内毒素 1ng的比例刺激 ,于 0、3、6h抽取培养液 ,分别检测sCD14和肿瘤坏死因子 (TNF) α。结果 肝功能分级 :Child PughC级者血浆sCD14水平为 (4 .79± 1.91) μg/ml,明显高于Child pughA级者的 (2 .91± 0 .14 ) μg/ml和Child PughB级者的 (3.6 8± 0 .91) μg/ml。A组血浆sCD14水平为 (4 .85± 1.11) μg/ml,其PBMC在内毒素刺激 6h后所释放的sCD14及TNF α的浓度分别为 (10 1.5 4± 7.6 3)和 (4 33.2 5± 12 3.4 5 )ng/ml;而B组分别为 (3.6 8± 0 .91)、(73.84± 6 .94 )和 (2 10 .18± 81.0 1)ng/ml;对照组分别为 (2 .31± 0 .2 1)、(70 .82± 5 .16 )和 (12 2 .2 1± 0 .34)ng/ml。在培养后第3、6小时 ,A组sCD14、TNF α水平与对照组相比 ,差异有显著性 (P <0 .0 5 )。结论 肝硬化伴IETM的PBMC对内毒素的敏感性增加 。

Objective To investigate the changes of plasma levels and culture supernatant of soluble CD14 (sCD14) produced in vitro by lipopolysaccharide stimulated peripheral blood mononuclear cells (PBMC) in patients with liver cirrhosis. Methods A total of 59 patients with liver cirrhosis were enrolled in this study. They were divided into two groups, one with endotoxemia consisting of 29 patients and the other without endotoxemia consisting of 30 patients. The peripheral blood mononuclear cells were separated and stimulated by lipopolysaccharide. Soluble CD14 and TNF α in plasma and the cultured supernatant were determined by ELISA.Results Plasma soluble CD14 in patients with Child Pugh C was (4.18±0.94) μg/ml, while the sCD14 in Child Pugh A and B were (3.07±0.88) μg/ml and (2.15±0.37) μg/ml, respectively. The supernatant levels of sCD14 and TNF α at 6th hour in patients with endotoxemia were (101.54±4.11) ng/ml and (433.25±23.34) ng/ml respectively, while in patients without endotoxemia they were (70.84±12.05) ng/ml and (211.50±87.88) ng/ml respectively.Conclusion PBMC from cirrhotic patients with endotoxemia were more sensitive to lipopolysaccharide, indicating that these PBMC were presensitized.