目的：探讨各类型的乙型病毒性肝炎患者血清白细胞介素-Ⅱ(IL-2)、可溶性白细胞介素-Ⅱ受体(sIL-2R)和肿瘤坏死因子-α(TNF-α)水平的变化规律和临床意义，以及重症肝炎患者进行人工肝支持系统(ALSS)治疗后上述指标的变化规律。方法：应用酶联免疫吸附实验(ELISA)测试了126例标本，并结合乙型肝炎病毒e抗原(HBeAg)、乙肝病毒脱氧核糖核酸(HBV-DNA)、血清谷丙转氨酶(ALT)进行分析研究。结果：慢性乙肝和重症乙肝患者的血清IL-2水平明显低于急性乙肝患者和正常对照组(P<0.01)，急性乙肝、慢性乙肝和重症乙肝患者的slL-2R、TNF-a水平显著高于正常对照组(P<0.01)，且重症肝炎组和其他肝炎组也存在显著差异(P<0.01)。HBeAg阳性组sIL-2R水平高于HBeAg阴性组(P<0.05)，HBV-DNA阳性组slL-2R、TNF-a水平高于HBV-DNA阴性组(P<0.05,P<0.01)。IL-2与slL-2R、TNF-a呈负相关(P<0.01,P<0.05);sIL-2R、TNF-a与ALT三者间呈正相关(P<0.01)；在人工肝治疗24 h后，重症肝炎患者的血清IL-2水平回升，slL-2R及TNF-a水平下降(P<0.01)，但在72 h后又有不同程度反弹。结论：乙肝患者血清IL-2、slL-2R和TNF-a水平的不正常是由于乙肝病毒持续存在，病情不断加重的结果；采用人工肝支持系统治疗只能暂时改善患者的免疫功能。%Objectives: To investigate the clinical significance of the levels of IL-2, sIL-2R and TNF-α in serum in patients with various types of viral hepatitis B (VHB), and the changing regularity of the levels ofthose three indexes in patients with severe VHB following treatment with artificial liver supporting system (ALSS). Methods: The levels of IL-2, sIL-2R and TNF-a in serum in patients with VHB (n=99) and controls (n= 27) were determined by ELISA. HBeAg, hepatitis B virus-DNA (HBV-DNA) and alanine aminotransferase (ALT) in patients with VHB were determined. Results: ①The level of IL-2 were significantly lower in patients with chronic and severe VHB than in patients with acute VHB and controls (P<0. 01). ②The levels of slL-2R and TNF-α were significantly higher in patients with VHB than in controls (P<0.01). ③In patients with severe VHB, the levels of sIL-2R and TNF-α were higher and the level ofIL-2 were lower than those in acute and chronic VHB (P<0. 01). ④The level of slL-2R were higher inpatients with positive HBeAg than in patients with negative HBeAg (P<0. 05). ⑤The levels of sIL-2Rand TNF-α were higher in patients with positive HBV-DNA than in patients with negative HBV-DNA (P<0. 05, P<0.01). ⑥The levels of slL-2R and TNF-α correlated negatively with the level of IL-2 (P<0.01, P<0. 05), and correlated positively with the level of ALT (P<0. 01), respectively. ⑦In patients with severe VHB, the level of IL-2 increased (P<0. 01), while the levels of slL-2R and TNF-a decreased (P<0. 01) 24h after treatment with ALSS. All of the above indexes resumed 72h after the treatment.Conclusions: ①The abnormal changes of the levels of IL-2, sIL-2R and TNF-α in serum in patients with VHB are due to the continuously expression of hepatitis B virus, and advancement of the state of VHB. ②The treatment by ALSS for patients with severe VHB could improve the immune function just for a short time.
展开▼
