PBMC IP-10mRNA对慢性HBV感染相关肝衰竭预后的影响

摘要

目的 探讨外周血单个核细胞(PBMC) IP-10mRNA水平与HBV相关慢加亚急性肝衰竭患者预后的关系.方法 对2014年1月至2015年2月住院的HBV相关慢加亚急性肝衰竭患者50例,给予内科综合治疗并随访3个月,所有患者抽取外周静脉血检测单个核细胞IP-10mRNA水平;选取同时期20例慢性乙型肝炎(CHB)患者、20例乙肝后肝硬化患者和20例健康体检者作为对照,检测其PBMC中IP-10 mRNA表达水平,分析各组间的差异.同时分析肝衰竭生存组和死亡组IP-10mRNA表达的差异.结果 健康对照组、慢性乙型肝炎组、乙肝后肝硬化组和肝衰竭组患者PBMCIP-10mRNA水平分别为0.412 ±0.061,0.641 ±0.083,0.693±0.033,0.956±0.277.肝衰竭组患者PBMC IP-10mRNA水平显著高于其他三组(P＜0.01);慢性乙型肝炎组患者PBMC IP-10mRNA水平高于健康对照组(P＜0.01).肝衰竭死亡组PBMC IP-10mRNA水平为1.126±0.270,高于生存组的0.823±0.202,差异有统计学意义(t=-4.5296,P＜0.01).受试者工作特征曲线下面积为0.81,临界值为0.9255,大于界值组生存率为18.18％ (4/22),小于界值组生存率为85.71％(24/28),x2=22.803,P＜0.001.结论 HBV相关慢加急性肝衰竭患者PBMC IP-10mRNA水平与预后相关,检测患者PBMCIP-10mRNA,有助于评估HBV-ACLF的预后.%Objective To study the correlation between the levels of IP-10 mRNA in peripheral blood mononuclear cells (PBMCs) and prognosis of acute-on-chronic hepatitis B virus related liver failure (HBV-ACLF).Methods Fifty patients diagnosed with HBV-ACLF were administered a combined modality therapy and followed up until death or for 3 months.In addition,20 patients with chronic hepatitis B(CHB),20 patients with hepatitis B related cirrhosis and 20 healthy volunteers were matched for use as control.The levels of IP-10 mRNA in PBMCs were detected at baseline and last follow-up visit and compared between groups by statistical analysis.Results At baseline,the CHB group had a significantly higher level of IP-10 mRNA in PBNCs than the healthy control group(t =-6.972,P ＜0.01).However,the level of IP-10 mRNA in PBMCs of the liver failure group was significantly higher than that of boththe CHB group(t =2.510,P ＜ 0.05) and the healthy control group (t =8.648,P ＜ 0.01).When patients within the liver failure group were divided by survival and death occurring during the 3-month follow-up period,the patients who died were found to have a significantly higher level of IP-10 mRNA in PBMCs than the surviving patients(P ＜ 0.01).The area under the curve of ROC curve is 0.81,and cut off value is 0.9255.Conclusion The level of IP-10 mRNA in PBMCs is positively correlated with risk of death in patients with HBV-ACLF,and its detecting might predict the prognosis of HBV-ACLF.