酒精性肝硬化患者Th1/Th2型细胞因子的表达水平及临床意义

摘要

Objective To investigate the relationship of serum Th1/Th2 cytokine levels with liver function and their clinical significance in patients with alcoholic liver cirrhosis (ALC).Methods Thirty-four ALC patients,13 patients with viral liver cirrhosis (VLC),and 17 healthy controls were included in the study.Serum levels of Th1 cytokines (tumor necrosis factor (TNF)α,interferon (IFN)γ,and inter-leukin (IL)-12)and Th2 cytokines (IL-10,IL-4,IL-6,and IL-13)were measured by cytometric bead array,and their correlations with Child-Pugh classification,model of end-stage liver disease (MELD)score,and biochemical parameters of liver function were ana-lyzed.Comparison between multiple groups was made by Kruskal-Wallis H test,and comparison between two groups was made by Mann-Whitney U test.Correlation analysis was performed by Spearman rank test.Results The Th1 (TNFαand IFNγ)/Th2 (IL-10,IL-4, and IL-13)cytokine levels in ALC group were significantly lower than those in healthy control group (P<0.05),and these indices de-creased nonsignificantly as the Child-Pugh class increased.Compared with VLC patients,ALC patients had significantly increased Th1/Th2 cytokine levels except IL-4 level (P<0.05).In ALC patients,TNFα,IL-10,and IL-13 levels were positively correlated with pro-thrombin time activity (P<0.05)but negatively correlated with total bilirubin and MELD score (P<0.05);especially,the levels of IL-10,IL-13,IL-4,TNFα,and IFNγwere negatively correlated with daily alcohol consumption (P<0.05).Conclusion The expression of Th1/Th2 cytokines is significantly reduced in ALC patients and is correlated with alcohol intake and liver function damage.Monitoring se-rum Th1/Th2 cytokine levels in ALC patients is helpful for clinical treatment and prognostic evaluation.%目的：探讨酒精性肝硬化（ALC）患者血清Th1／Th2型细胞因子水平与肝功能的相关性以及临床意义。方法收集解放军302医院2011年4月至2012年12月收治的34例ALC住院患者，同时选取同期病毒性肝硬化（VLC）患者13例和健康人17例作为对照。采用流式微球阵列技术（CBA）法检测ALC患者血清Th1型细胞因子（TNFα、IFNγ、IL－12）和Th2型细胞因子（IL－10、IL－4、IL－6、IL－13）水平，分析其与ALC患者肝功能Child－Pugh分级、MELD评分及肝功能血清生化指标相关性。多组间比较采用Kruskal－Wallis H秩和检验，两组数据组间比较采用Mann－Whitney U检验。相关性分析采用Spearman rank检验。结果 ALC患者组Th1型细胞因子（TNFα和IFNγ）／Th2型细胞因子（IL－4、IL－10和IL－13）水平均低于健康对照组，差异有统计学意义（P＜0．05），其水平随着Child－Pugh分级逐渐降低，分级之间差异无统计学意义。与VLC患者组相比，除IL－4外，ALC患者Th1／Th2型细胞因子显著升高，差异有统计学意义（P＜0．05）。ALC患者TNFα、IL－10和IL－13水平与PTA呈正相关（P＜0．05），与TBil和MELD分值显著负相关（P＜0．05），特别是IL－10、IL－13、IL－4、TNFα、IFNγ水平与患者每日酒精摄入量呈显著负相关（P＜0.05）。结论 ALC患者Th1／Th2型细胞因子表达水平显著降低，与酒精摄入量和肝功能损害相关，对ALC患者临床治疗和预后判断有一定的指导作用。