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目的观察慢性乙型肝炎患者血清可溶性细胞间粘附分子-1(sICAM-1)的变化,探讨其临床意义及在发病机制中的作用。方法采用酶联免疫吸附试验(ELISA)法测定56例慢性乙肝患者(其中慢性轻度20例、中度24例、重度6例、慢性重型6例)血清sICAM-1水平,同时检测血清肿瘤坏死因子-α(TNF-α)、肝功能,并以20例健康人员作对照。结果 (1)慢性乙肝患者血清sICAM-1水平(轻度682.56±267.39ng/ml,中度934.34±512.84ng/ml,重度1739.63±492.53ng/ml,慢性重型1753.40±197.79ng/ml)明显高于对照组(439.47±93.54ng/ml),按轻度、中度、重度、慢性重型的顺序依次升高。(2)随着慢性乙肝肝细胞受损程度的加重,血清sICAM-1水平逐渐升高,AST>110U/L组、ALT>280U/L组、SB>85.5μmol/L组血清sICAM-1水平明显高于肝功能轻度异常和正常组(P<0.01和P<0.05),且与AST呈显著正相关(γ=0.6673,P<0.01)。随着病情的好转,血清sICAM-1水平明显下降。(3)慢性乙肝患者血清TNF-α水平均高于对照组,且按轻度、中度、重度、慢性重型依次升高,血清sICAM-1水平与血清TNF-α呈正相关(慢性轻度γ=0.805,P<0.05;慢性中度γ=0.871,P<0.01;慢性重度γ=0.56,P<0.05;慢性重型γ=0.582,P<0.05)。结论 (1)慢性乙型肝炎患者血清sICAM-1水平明显高于对照组,并随着病情的发展逐渐升高,表明慢性乙肝患者血清sICAM-1水平升高,且与病情的严重程度相一致。(2)血清sICAM-1水平随着AST、ALT、SB水平的升高而逐渐增长,并与AST呈显著正相关,因此临床检测血清sICAM-1可以反映肝细胞受损程度,并对观察疗效、判断预后有一定价值。(3)慢性肝炎患者血清TNF-α水平高于正常对照,且随着其水平的升高,血清sICAM-1水平逐渐升高,二者具有相关性。提示TNF-α的升高与血清sICAM-1的产生和分泌有着密切关系。总之,慢性乙肝患者血清sICAM-1水平明显升高,其原因与炎症细胞因子关系密切,TNF-α等可直接或间接地提高sICAM-1分泌;血清sICAM-1水平与AST、ALT、SB关系密切,可反映肝细胞损伤程度和肝组织炎症活动程度;另外,血清sICAM-1水平可用于观察疗效、判定预后。
Objective To observe the changes of serum soluble intercellular adhesion molecule-1 (sICAM-1) in patients with chronic hepatitis B and to explore its clinical significance and its role in pathogenesis. Methods Serum levels of sICAM-1 in 56 chronic hepatitis B patients (including 20 with mild chronic disease, 24 with moderate disease, 6 with severe disease and 6 with severe chronic disease) were measured by enzyme linked immunosorbent assay (ELISA) Factor-α (TNF-α), liver function, and 20 healthy controls. Results The serum levels of sICAM-1 in patients with chronic hepatitis B (mild 682.56 ± 267.39ng / ml, moderate 934.34 ± 512.84ng / ml, severe 1739.63 ± 492.53ng / ml, chronic severe 1753.40 ± 197.79ng / ml) In the control group (439.47 ± 93.54ng / ml), according to mild, moderate, severe, chronic heavy order in turn increased. (2) Serum levels of sICAM-1 gradually increased with the degree of chronic hepatitis B damage. Serum levels of sICAM-1 were significantly higher in patients with AST> 110U / L, ALT> 280U / L and SB> 85.5μmol / L (P <0.01 and P <0.05), and had a significant positive correlation with AST (γ = 0.6673, P <0.01). With the improvement of the condition, serum sICAM-1 levels decreased significantly. (3) Serum levels of TNF-α in patients with chronic hepatitis B were higher than those in the control group, and their serum levels of sICAM-1 were positively correlated with serum TNF-α (mild mild, moderate, severe and chronic severe) = 0.805, P <0.05; Chronic moderate γ = 0.871, P <0.01; Chronic severe γ = 0.56, P <0.05; Chronic severe γ = 0.582, P <0.05). Conclusions (1) Serum levels of sICAM-1 in patients with chronic hepatitis B were significantly higher than those in controls, and gradually increased with the progression of the disease, indicating that serum sICAM-1 levels in patients with chronic hepatitis B were elevated and consistent with the severity of the disease . (2) Serum sICAM-1 levels gradually increased with the increase of AST, ALT, SB levels and had a significant positive correlation with AST, so clinical detection of serum sICAM-1 can reflect the degree of liver cell damage, and to observe the efficacy , To determine the prognosis of a certain value. (3) Serum levels of TNF-α in patients with chronic hepatitis were higher than those in normal controls, and with the increase of serum TNF-α levels, serum sICAM-1 levels gradually increased. Tip TNF-α and serum sICAM-1 production and secretion are closely related. In short, the serum levels of sICAM-1 in patients with chronic hepatitis B were significantly increased due to its close relationship with inflammatory cytokines. TNF-α, etc. can directly or indirectly increase the secretion of sICAM-1. The serum levels of sICAM-1 and AST, ALT, SB Close, can reflect the degree of liver cell damage and liver inflammation activity level; In addition, serum sICAM-1 levels can be used to observe the curative effect, to determine the prognosis.