乙型肝炎肝硬化并发自发性细菌性腹膜炎患者血清MCP-1、TNF-α和IL-10水平变化及其与病情复发的关系研究OACSTPCD
Changes of serum MCP-1,TNF-α and IL-10 levels in patients with hepatitis B cirrhosis and spontaneous bacterial peritonitis
目的 分析慢性乙型肝炎(CHB)肝硬化并发自发性细菌性腹膜炎(SBP)患者血清单核细胞趋化蛋白-1(MCP-1)、肿瘤坏死因子-α(TNF-α)和白细胞介素-10(IL-10)水平变化及其与病情复发的关系.方法 2018 年1 月～2022 年1 月我院诊治的63 例乙型肝炎肝硬化并发SBP患者和82 例乙型肝炎肝硬化患者,给予SBP患者抗生素抗感染治疗.采用双抗体夹心ELLSA法检测血清MCP-1、TNF-α和IL-10 水平.采用多因素二元Logistic回归分析影响病情复发的危险因素,应用受试者工作特征曲线(ROC)下面积(AUC)评估各指标预测病情复发的效能.结果 治疗前,SBP组血清MCP-1、TNF-α和IL-10 水平分别为(354.7±73.9)pg/mL、(13.4±3.1)pg/mL和(11.4±1.7)pg/mL,均显著高于肝硬化组[分别为(193.8±42.3)pg/mL、(8.8±2.4)pg/mL和(8.1±1.2)pg/mL,P<0.05],治疗后SBP组血清细胞因子水平仍然显著高于肝硬化组(P<0.05);治疗后随访 2 年,31 例(49.2%)SBP 患者病情复发;复发组消化道出血发生率为41.9%,显著高于未复发组(6.3%,P<0.05);复发组血清MCP-1、TNF-α和IL-10 水平均显著高于未复发组(P<0.05);Logistic回归分析显示,血清MCP-1、TNF-α、IL-10 和ALB水平均是影响致SBP复发的独立危险因素(P<0.05);ROC曲线分析显示,首次SBP治疗后血清MCP-1、TNF-α、IL-10 和ALB水平预测SBP复发均具有一定的应用价值,其AUC分别为0.91、0.91、0.92 和0.76,应用细胞因子水平预测显著优于血清ALB水平(P<0.05).结论 乙型肝炎肝硬化并发SBP患者病情可能复发,而检测治疗后血清MCP-1、TNF-α和IL-10 水平可能具有预测病情复发的作用,值得进一步研究.
Objective The aim of this study was to investigate the changes of serum monocyte chemoattractant protein-1(MCP-1),tumor necrosis factor-α(TNF-α)and interleukin-10(IL-10)levels in patients with hepatitis B-induced liver cirrhosis(LC)and with complicated spontaneous bacterial peritonitis(SBP).Methods 63 patients with hepatitis B-induced LC and SBP,and 82 patients with hepatitis B-induced LC were enrolled in our hospital between January 2018 and January 2022,and the patients with SBP were treated with antibiotics for two weeks.Serum MCP-1,TNF-α and IL-10 levels were detected by ELISA.The multivariate Logistic regression analysis was applied to reveal the risk factors for the relapse of SBP,and the area under receiver operating characteristic curve(AUROC)was conducted to predict the efficacy of parameters for relapse of SBP.Results At admission,serum MCP-1,TNF-α and IL-10 levels in patients with SBP were(354.7±73.9)pg/mL,(13.4±3.1)pg/mL and(11.4±1.7)pg/mL,all significantly higher than[(193.8±42.3)pg/mL,(8.8±2.4)pg/mL and(8.1±1.2)pg/mL,respectively,P<0.05]in patients with LC,and at the convalescent stage,serum cytokine levels in patients with SBP were still much higher than in patients with LC(P<0.05);during two-year follow-up period,the SBP relapsed in 31 cases(49.2%),and the incidence of esophageal variceal bleeding in relapsed patients was41.9%,much higher than 6.3%in patients without relapsed SBP(P<0.05);serum MCP-1,TNF-α and IL-10 levels in relapsed SBP patients were significantly higher than in those without relapsed SBP(P<0.05);the multivariate Logistic regression analysis showed that serum MCP-1,TNF-α,IL-10 and albumin levels were all the independent risk factors for SBP relapse(P<0.05);the ROC analysis demonstrated that serum MCP-1,TNF-α,IL-10 and albumin levels at the convalescent stage could predict the relapse of SBP,with the AUCs of 0.91,0.91,0.92 and 0.76,respectively,suggesting serum cytokine levels superior to albumin(P<0.05).Conclusion The surveillance of serum MCP-1,TNF-α and IL-10 levels might predict the relapse of SBP,which is worthy of further clinical investigation.
邢世磊;李之慧;宁秀景
252600 山东省聊城市 山东第一医科大学附属聊城第二医院消化内科
肝硬化自发性细菌性腹膜炎单核细胞趋化蛋白-1肿瘤坏死因子-α白细胞介素-10复发
Liver cirrhosisSpontaneous bacterial peritonitisMonocyte chemoattractant protein-1Tumor necrosis factor-αInterleukin-10Relapse
《实用肝脏病杂志》 2024 (004)
563-566 / 4
山东省科技厅科研基金资助项目(编号:2021KL031011)
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