目的：观察乙型肝炎病毒（HBV）相关慢加急性肝衰竭（ACLF）患者血清细胞因子水平的变化，探讨细胞因子在疾病预后中的作用。方法收集HBV相关ACLF患者24例（治愈者13例，死亡者11例）、慢性乙型肝炎（CHB）患者30例和正常对照者15名，采用 Luminex液相芯片技术检测血清白细胞介素IL-2、IL-4、IL-6、IL-8、IL-10、粒细胞-巨噬细胞刺激因子（GM-CSF）、γ干扰素（IFN-γ）和肿瘤坏死因子α（TNF-α）等细胞因子水平，并结合临床指标进行相关分析。结果 ACLF组IL-6、IL-8和TNF-α水平高于CHB组和对照组（P＜0．01），CHB组亦高于对照组（P＜0．05）；ACLF 死亡组IL-6、TNF-α水平和终末期肝病模型（MELD）评分明显高于治愈组（P＜0．05）；TNF-α、IL-6与凝血酶原活动度（PTA）之间呈明显负相关（r＝-0．712，P＜0．001；r＝-0．521，P＝0．009）；TNF-α、IL-6与MELD评分之间呈明显正相关（r＝0．491，P＜0．015；r＝0．379，P＝0．048）。细胞因子与HBV DNA和乙型肝炎表面抗原（HBsAg）之间无明显相关性。结论 HBV相关ACLF患者血清中多种细胞因子明显升高，其中IL-6和TNF-α水平随疾病严重程度的增加而增加，检测其血清细胞因子水平有助于疾病严重程度和预后转归的判断。%Objective To observe the changes of serum cytokine levels in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF ),and investigate the role of cytokines in the prognosis of HBV-related ACLF.Methods A total of 24 HBV-related ACLF patients(1 3 cured cases and 1 1 dead cases),30 patients with chronic hepatitis B(CHB)and 1 5 healthy controls were enrolled.The serum levels of interleukin(IL)-2,IL-4,IL-6, IL-8,IL-1 0,granulocyte-macrophage colony stimulating factor (GM-CSF ),gamma interferon (IFN-γ) and tumor necrosis factor alpha(TNF-α)were detected by Luminex liquid chip technology,and the relative results were analyzed. Results The levels of IL-6,IL-8 and TNF-αin ACLF group were higher than those in CHB group and healthy control group (P<0.01 ),and those in CHB group were higher than those in healthy control group (P<0.05).IL-6,TNF-αand model for end stage liver disease (MELD)score in ACLF dead group were significantly higher than those in ACLF cured group(P<0.05).The levels of TNF-αand IL-6 were negatively correlated with prothrombin activity(PTA)(r=-0.71 2,P<0.001;r=-0.521 ,P=0.009).Furthermore,the levels of TNF-αand IL-6 were positively correlated with MELD score(r=0.491 ,P<0.01 5;r=0.379,P=0.048).There was no correlation among cytokines,HBV DNA and hepatitis B surface antigen(HBsAg).Conclusions In HBV-related ACLF patients,various serum cytokines increase significantly.Furthermore,the levels of IL-6 and TNF-αincrease with the severity of disease,and they are helpful in disease progression and prognosis.
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