慢性乙型肝炎患者外周血IL-17细胞因子水平及其临床意义
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摘要
目的探讨外周血Th17的细胞因子IL-17在不同临床分型慢乙肝患者中的水平及临床意义。方法选取慢乙肝患者轻度30例、中度34例、重度29例、乙肝肝硬化38例、慢加急性肝衰竭21例,另外选取30例同期健康体检者为对照。检测各组外周血IL-17水平,同时检测肝功能及HBV DNA载量(对照组除外),并对各检测结果进行统计学分析。结果 1外周血IL-17水平在健康对照组及慢乙肝轻度、中度、重度和慢加急性肝衰竭组分别为(8.103±2.061)ng/mL、(25.551±7.078)ng/mL、(45.442±18.358)ng/mL、(75.378±19.05)ng/mL、(97.16±17.066)ng/mL,5组间及每两两比较差异有统计学意义(P<0.01);2健康对照组、乙肝肝硬化代偿组、乙肝肝硬化失代偿组外周血IL-17水平分别为(8.103±2.061)ng/mL、(34.517±8.905)ng/mL、(45.615±15.623)ng/mL,3组间及每两两比较差异均有统计学意义(P<0.01),且失代偿期组较代偿期组有所增高;3152例试验对象的外周血IL-17水平与ALT、AST、TBIL、HBV-DNA正相关;与血清PTA、ALB负相关;421例慢加急性肝衰竭患者e抗原阳性组与阴性组中外周血IL-17水平比较差异无统计学意义(P=0.654);5慢加急性肝衰竭患者外周血IL-17水平与MELD评分呈正相关(r=0.533,P=0.013)。结论慢性乙型肝炎患者外周血IL-17水平随炎症加重而升高,且可能对肝硬化、慢加急性肝衰竭的疾病进展有促进作用。
Objective To explore the changes of serum cytokine interleukin-17(IL-17)in patients with chronic hepatitis B of different clinical types and its clinical significance.Methods We selected 30 cases of mild chronic hepatitis B,34 cases of moderate one,29 cases of severe one,38 cases of liver cirrhosis,and 21 cases of acute on chronic liver failure.Another 30 cases over the same period served as the healthy control group.Cytokine IL-17 level in peripheral blood was detected in each group,and all the groups except the control group were detected for liver function and HBV-DNA.These related serum markers were detected and the results were statistically analyzed.Results 1IL-17 in the peripheral blood was(8.103±2.061)ng/mL in healthy control group;(25.551±7.078)ng/mL,(45.442±18.358)ng/mL and(75.378±19.05)ng/mL in the groups with mild,moderate and severe chronic hepatitis B;and(97.16±17.066)ng/mL in acute on chronic liver failure group.Its levels gradually increased with the severity;and there were significantly different among the five groups and between every two groups(P<0.01).The peripheral blood level of IL-17 was(8.103±2.061)ng/mL in the healthy control group,(34.517±8.905)ng/mL in compensatory cirrhosis group,and(45.615±15.623)ng/mL in the decompensated cirrhosis group.These three groups had pairwise comparison,and the difference between every two groups was significant(P<0.01).The peripheral blood level of IL-17 in the decompensated cirrhosis group increased compared with that in the compensatory group.3 In the 152 cases detected,serum IL-17 level and serum ALT,AST,TBIL,HBVDNA levels were positively correlated,and serum PTA had negative correlation with the level of IL-17.4In the 21 cases of acute on chronic liver failure,the peripheral blood level of IL-17 did not significantly differ between antigen-e positive and negative groups(P=0.654).5In21 patients with chronic on acute liver failure,the level of IL-17 in peripheral serum and MELD scores showed a positive correlation by Pearson correlation analysis(r=0.533,P=0.013).Conclusion In patients with chronic hepatitis B,the level of IL-17 in peripheral serum increased with disease severity.Moreover,the level of IL-17 in peripheral blood may play a role in promoting the progression of cirrhosis and the development of acute on chronic liver failure.
Objective To explore the changes of serum cytokine interleukin-17(IL-17)in patients with chronic hepatitis B of different clinical types and its clinical significance.Methods We selected 30 cases of mild chronic hepatitis B,34 cases of moderate one,29 cases of severe one,38 cases of liver cirrhosis,and 21 cases of acute on chronic liver failure.Another 30 cases over the same period served as the healthy control group.Cytokine IL-17 level in peripheral blood was detected in each group,and all the groups except the control group were detected for liver function and HBV-DNA.These related serum markers were detected and the results were statistically analyzed.Results 1IL-17 in the peripheral blood was(8.103±2.061)ng/mL in healthy control group;(25.551±7.078)ng/mL,(45.442±18.358)ng/mL and(75.378±19.05)ng/mL in the groups with mild,moderate and severe chronic hepatitis B;and(97.16±17.066)ng/mL in acute on chronic liver failure group.Its levels gradually increased with the severity;and there were significantly different among the five groups and between every two groups(P<0.01).The peripheral blood level of IL-17 was(8.103±2.061)ng/mL in the healthy control group,(34.517±8.905)ng/mL in compensatory cirrhosis group,and(45.615±15.623)ng/mL in the decompensated cirrhosis group.These three groups had pairwise comparison,and the difference between every two groups was significant(P<0.01).The peripheral blood level of IL-17 in the decompensated cirrhosis group increased compared with that in the compensatory group.3 In the 152 cases detected,serum IL-17 level and serum ALT,AST,TBIL,HBVDNA levels were positively correlated,and serum PTA had negative correlation with the level of IL-17.4In the 21 cases of acute on chronic liver failure,the peripheral blood level of IL-17 did not significantly differ between antigen-e positive and negative groups(P=0.654).5In21 patients with chronic on acute liver failure,the level of IL-17 in peripheral serum and MELD scores showed a positive correlation by Pearson correlation analysis(r=0.533,P=0.013).Conclusion In patients with chronic hepatitis B,the level of IL-17 in peripheral serum increased with disease severity.Moreover,the level of IL-17 in peripheral blood may play a role in promoting the progression of cirrhosis and the development of acute on chronic liver failure.
引文
[1]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2010年版)[J].中华肝脏病杂志,2011,19(1):13-24.
[2]赵丽,王琦霞,邱德凯,等.Th17细胞相关因子在慢性乙型肝炎肝组织中的表达[J].胃肠病学,2010,15(6):326-329.
[3]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2010年版)[J].中华肝脏病杂志,2011,19(1):13-24.
[4]中华医学会传染病与寄生虫病学分会和肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志,2000,8(6):324-329.
[5]中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊疗指南[J].中华肝脏病杂志,2006,14(9):643-646.
[6]占国清,郑二菊,朱琳,等.365例重型肝炎预后影响因素的临床分析[J].临床肝胆病杂志,2008,24(4):251-253.
[7]高洪元,黄泽民.Th17细胞在乙型肝炎中的作用[J].免疫学杂志,2014,30(3):262-266.
[8]VOLPE E,SERVANT N,ZOLLINGER R,et al.A critical functioning for transforming growth factor-beta,interleukin23and proinflammatory cytokines in driving and modulating human TH17 responses[J].Aat Immunol,2008,9(6):650-657.
[9]KOLLS JK,LINDEN A.Interleukin-17 family members and inflammation[J].Immunity,2004,21(4):467-476.
[10]朱华芳,王秀丽,张建琴,等.慢性乙型肝炎患者外周血Th17细胞检测及意义[J].山东医药,2010,50(51):81-82.
[11]金磊,张纪元,孙红启,等.Th17细胞在乙肝肝硬化患者中的免疫致病机制研究[J].解放军医学杂志,2013,38(1):62-65.
[12]邹同.不同HBV-DNA载量慢性乙肝患者血清MIF和IL-17的表达意义[J].中国实用医药,2013,8(9):7-8.
[13]SPAMA T,RETEY J,SCHMICH K,et al.Genome-wide comparison between IL-17 andcombined TNF-alpha/IL-17induced genes in primary murine hatocytes[J].BMC Genomics,2010,11(1):226.
[14]SARIN SK,KUMAR A,ALMEIDA JA,et al.Acute-on-chronic liver failure consensus recommendations of the Asian Pacific Association for the study of the liver(APAsL)[J].Hepatol Int,2009,3(1):269-282.
[15]KAMATH PS,WIESNER RH,MALINCHOC M,et al.A model to predict survival in patients with end-stage liver disease[J].Hepatology,2001,33:464-470.
[16]赵清,姚宏昌.MELD评分体系在慢性重型肝炎预后分析中的应用[J].山东医药,2006,46(11):49-50.
[17]周存金,赵建妹,沈云志,等.终末期肝病模型及CTP评分和分级判断食管静脉曲张破裂大出血患者预后的价值[J].中华消化内镜杂志,2008,25(6):290-294.
[2]赵丽,王琦霞,邱德凯,等.Th17细胞相关因子在慢性乙型肝炎肝组织中的表达[J].胃肠病学,2010,15(6):326-329.
[3]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2010年版)[J].中华肝脏病杂志,2011,19(1):13-24.
[4]中华医学会传染病与寄生虫病学分会和肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志,2000,8(6):324-329.
[5]中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊疗指南[J].中华肝脏病杂志,2006,14(9):643-646.
[6]占国清,郑二菊,朱琳,等.365例重型肝炎预后影响因素的临床分析[J].临床肝胆病杂志,2008,24(4):251-253.
[7]高洪元,黄泽民.Th17细胞在乙型肝炎中的作用[J].免疫学杂志,2014,30(3):262-266.
[8]VOLPE E,SERVANT N,ZOLLINGER R,et al.A critical functioning for transforming growth factor-beta,interleukin23and proinflammatory cytokines in driving and modulating human TH17 responses[J].Aat Immunol,2008,9(6):650-657.
[9]KOLLS JK,LINDEN A.Interleukin-17 family members and inflammation[J].Immunity,2004,21(4):467-476.
[10]朱华芳,王秀丽,张建琴,等.慢性乙型肝炎患者外周血Th17细胞检测及意义[J].山东医药,2010,50(51):81-82.
[11]金磊,张纪元,孙红启,等.Th17细胞在乙肝肝硬化患者中的免疫致病机制研究[J].解放军医学杂志,2013,38(1):62-65.
[12]邹同.不同HBV-DNA载量慢性乙肝患者血清MIF和IL-17的表达意义[J].中国实用医药,2013,8(9):7-8.
[13]SPAMA T,RETEY J,SCHMICH K,et al.Genome-wide comparison between IL-17 andcombined TNF-alpha/IL-17induced genes in primary murine hatocytes[J].BMC Genomics,2010,11(1):226.
[14]SARIN SK,KUMAR A,ALMEIDA JA,et al.Acute-on-chronic liver failure consensus recommendations of the Asian Pacific Association for the study of the liver(APAsL)[J].Hepatol Int,2009,3(1):269-282.
[15]KAMATH PS,WIESNER RH,MALINCHOC M,et al.A model to predict survival in patients with end-stage liver disease[J].Hepatology,2001,33:464-470.
[16]赵清,姚宏昌.MELD评分体系在慢性重型肝炎预后分析中的应用[J].山东医药,2006,46(11):49-50.
[17]周存金,赵建妹,沈云志,等.终末期肝病模型及CTP评分和分级判断食管静脉曲张破裂大出血患者预后的价值[J].中华消化内镜杂志,2008,25(6):290-294.