【作者】 张先俊；

【导师】 胡建国；

【作者基本信息】 宁夏医科大学 ， 内科学， 2009， 硕士

【摘要】 目的探讨乙型肝炎肝硬化患者血清可溶性细胞间粘附分子-1(sICAM-1)、白细胞介素-18(IL-18)的变化及其临床意义。方法采用双抗体夹心酶联免疫吸附法(ELIAS)对60例乙型肝炎肝硬化患者和30例正常人血清sICAM-1、IL-18水平进行测定。对60例乙型肝炎肝硬化患者用ELISA法检测乙肝病毒学标志物、荧光定量PCR仪检测HBV-DNA含量、全自动生化分析仪检测肝功能(ALT、TBIL、ALB)、全自动血凝分析仪检测凝血酶原活动度(PTA)。结果(1)乙型肝炎肝硬化组患者血清sICAM-1水平明显高于健康对照组(P<0.01),肝硬化失代偿期组血清sICAM-1水平明显高于代偿期组(P<0.01)。乙型肝炎肝硬化组患者血清IL-18水平明显高于健康对照组(P<0.01),肝硬化失代偿期组血清IL-18水平明显高于代偿期组(P<0.01)。(2)乙型肝炎肝硬化患者Child C级组(C组)血清sICAM-1水平明显高于Child A级组(A组)、Child B级组(B组),B组高于A组,结果均有显著性差异(P<0.01)。乙型肝炎肝硬化患者C组血清IL-18水平明显高于A组、B组,B组高于A组,结果均有显著性差异(P<0.01)。(3)乙型肝炎肝硬化患者HBV-DNA阳性组血清sICAM-1水平与HBV-DNA阴性组相比较无显著性差异(P>0.05)。乙型肝炎肝硬化患者HBV-DNA阳性组血清IL-18水平与HBV-DNA阴性组相比较有显著性差异(P<0.01)。(4)乙型肝炎肝硬化患者血清sICAM-1水平与PTA、ALB呈显著负相关(r = -0.609、-0.373, P<0.01),与TBIL呈显著正相关(r = 0.635, P<0.01),与ALT无相关(r = 0.004, P>0.05)。乙型肝炎肝硬化患者血清IL-18水平与PTA、ALB呈显著负相关(r = -0.603、-0.392, P<0.01),与TBIL呈显著正相关(r = 0.591, P<0.01),与ALT无相关(r = 0.148, P>0.05)。血清sICAM-1水平与IL-18呈显著正相关(r = 0.432, P<0.01)。结论(1)sICAM-1、IL-18的高低在一定程度上反映肝细胞的损伤程度和肝硬化的严重程度,可为临床估计病情、判断预后、制定治疗方案提供参考指标。(2)sICAM-1水平变化与HBV的复制水平无关,继发性免疫反应导致sICAM-1表达,sICAM-1造成肝细胞损伤。IL-18水平变化与HBV复制活跃程度相关,临床上测定IL-18活性,在监测病毒复制状态及抗病毒治疗等方面都具有一定的实用价值。更多还原

【Abstract】 Objective To investigate the changes of serum soluble intercellular adhesion molecule-1 (sICAM-1) and interleukin-18 (IL-18) and their clinical significance in patients with hepatitis B cirrhosis. Methods The serum level of sICAM-1 and IL-18 in 60 hepatitis B cirrhosis patients and 30 normal persons were detected by double antibody sandwich ELISA. The serum level of HBV-DNA was detected by fluorescence quantitative PCR instrument and HBV marker was detected by ELISA in 60 hepatitis B cirrhosis patients. Automatic biochemistry analyzer was used for measuring the serum level of liver function in 60 hepatitis B cirrhosis patients. Automated coagulation analyzer was used to measure the serum level of prothrombin activity (PTA) in 60 hepatitis B cirrhosis patients. Results (1) The serum level of sICAM-1 in patients with hepatitis B cirrhosis was significantly higher than that in normal persons (P<0.01), the serum level of sICAM-1 in decompensated cirrhosis group was obviously higher than that in compensated cirrhosis group (P<0.01). The serum level of IL-18 in patients with hepatitis B cirrhosis was significantly higher than that in normal persons (P<0.01), the serum level of IL-18 in decompensated cirrhosis group was obviously higher than that in compensated cirrhosis group (P<0.01). (2) The mean level of serum sICAM-1 in Child-Pugh C cirrhosis group (group C) was significantly higher than that in Child-Pugh A cirrhosis group (group A) and Child-Pugh B cirrhosis group (group B), the mean level of serum sICAM-1 in group B was higher than that in group A, the results were significantly different (P<0.01). The mean level of serum IL-18 in group C was significantly higher than that in group A and group B, the mean level of serum IL-18 in group B was higher than that in group A, the results were significantly different (P<0.01). (3) There was no significant difference between the serum sICAM-1 level of the hepatitis B cirrhosis patients with HBV-DNA positive group and HBV-DNA negative group (P>0.05). There was significant difference between the serum IL-18 level of the hepatitis B cirrhosis patients with HBV-DNA positive group and HBV-DNA negative group (P<0.01). (4) The serum sICAM-1 level in patients with hepatitis B cirrhosis had a negative correlation with PTA (r = -0.609, P<0.01) and albumin (ALB) (r = -0.373, P<0.01), a positive correlation with total bilirubin (TBIL) (r = 0.635, P<0.01), no correlation with alanine aminotransferase (ALT) (r = 0.004, P>0.05). The serum IL-18 level in patients with hepatitis B cirrhosis had a negative correlation with PTA (r = -0.603, P<0.01) and ALB (r = -0.392, P<0.01), a positive correlation with TBIL (r = 0.591, P<0.01), no correlation with ALT (r = 0.148, P>0.05). The serum sICAM-1 level had a positive correlation with IL-18 (r = 0.432, P<0.01). Conclusions (1) The level of sICAM-1 and IL-18 reflected the degree of hepatocyte damage and the severity of hepatitis B cirrhosis, and can provide reference indicator to evaluate the state of an illness, judge the prognosis and establish the remedial project for clinic. (2) The change of serum level of sICAM-1 in patients with hepatitis B cirrhosis was not related to the replication of HBV, it suggested that secondary immune injury lead to expression of sICAM-1, which promoted the injury of liver. The change of serum level of IL-18 in patients with hepatitis B cirrhosis was related to the replication of HBV, it has some practical use in monitoring HBV replication and antiviral therapy by measuring the level of IL-18.更多还原