供体血清细胞因子水平与肝移植受者术后生存关系探讨

doi:10.3969/j.issn.1672-5069.2020.05.034

摘要/Abstract

摘要： 目的研究器官获取前供者血清细胞因子水平对肝移植受者术后生存的影响。方法 2015年3月～2017年3月在我院接受肝移植手术治疗的患者35例,在肝移植后3个月内生存28例,死亡7例。分别采集供者和受者血清,采用ELISA法检测血清白细胞介素1β(IL-1β)、IL-2、IL-6、IL-10、肿瘤坏死因子α(TNF-α)和脑钠肽(BNP)水平;采用电化学发光免疫分析法测定血清降钙素原(PCT)水平。采用受试者工作特征曲线(ROC)下面积(AUC)预测预后。结果在器官获取前生存组供者血清IL-6、IL-10、BNP和PCT水平分别为(76.9±13.5)pg/ml、(32.4±8.7)ng/L、(2806.1±357.5)ng/L和(7.4±1.8)ng/L,与死亡组供者血清指标比,无显著性差异【分别为(80.2±15.3)pg/ml、(28.6±7.9)ng/L、(2794.6±348.7)ng/L和(8.0±2.5)ng/L,P > 0.05】;生存组供者血清IL-1β、IL-2和TNF-α水平分别为(84.2±20.7)ng/ml、(95.1±17.6)pg/ml和(24.6±6.9)ng/L,显著低于死亡组供者【分别为(136.0±39.4)ng/ml、(119.2±31.1)pg/ml和(39.7±10.4)ng/L,P < 0.05】;在接受肝移植的受者中,生存组患者血清IL-1β、IL-2、IL-6、IL-10、TNF-α、BNP和PCT水平分别为(118.3±39.6)ng/ml、(104.3±25.9)pg/ml、(78.3±16.1)pg/ml、(29.7±8.9)ng/L、(32.2±8.1)ng/L、(2776.3±240.5)ng/L和(7.6±1.1)ng/L,与死亡组无显著性差异【分别为(122.8±35.5)ng/ml、(105.7±23.4)pg/ml、(81.2±17.8)pg/ml、(30.3±8.1)ng/L,(30.1±7.6)ng/L,(2801.4±238.6)ng/L和(8.2±1.9)ng/L,P > 0.05】;绘制ROC曲线结果显示血清TNF-α水平对判断不良预后具有一定的应用价值(AUC > 0.75);供体血清TNF-α≥33.5 pg/ml者17例,受者在肝移植术后2年死亡6例,生存11例(64.7%),血清TNF-α<33.5 pg/ml者18例,死亡1例,生存17例(94.4%,Log rank x²= 9.272,P = 0.002)。结论在器官获取前检测供者血清细胞因子可能对肝移植后患者预后作出预判,其中供者血清TNF-α水平检测将有助于准确地选择器官供者,并为改善患者预后提供依据。

关键词: 肝移植, 供者, 细胞因子, 预后 , ,

Abstract: Objective The aim of this study was to investigate the prediction of survival by donor’s serum cytokines in recipients of liver transplantation (LT). Methods Thirty-five patients underwent LT in our hospital between March 2015 and March 2017, and both the donor’s and recipients’ sera were obtained. Serum interleukin-1β(IL-1β), IL-2, IL-6, IL-10, tumor necrosis factor-alpha (TNF-α), brain natriuretic peptide (BNP) and procalcitonin (PCT) were assayed. The area under ROC (AUC) was drawn to predict the survivals by serum cytokines. Results At the end of three months of LT, 28 recipients survived, and 7 died; donors’ serum IL-6, IL-10, BNP and PCT levels in survived recipients were (76.9±13.5) pg/ml,(32.4±8.7)ng/L,(2806.1±357.5)ng/L and (7.4±1.8)ng/L, not significantly different as compared to 【(80.2±15.3) pg/ml,(28.6±7.9)ng/L,(2794.6±348.7)ng/L and (8.0±2.5)ng/L, respectively,P > 0.05】 of donors’ in the died recipients; serum IL-1β,IL-2 and TNF-α levels of donors’ in the survived recipients were (84.2±20.7)ng/ml,(95.1±17.6)pg/ml and (24.6±6.9)ng/L, significantly lower than 【(136.0±39.4)ng/ml,(119.2±31.1)pg/ml and (39.7±10.4)ng/L, respectively, P < 0.05】 of donors’ in died recipients; serum IL-1β,IL-2,IL-6,IL-10,TNF-α,BNP and PCTlevels in survived recipients were (118.3±39.6)ng/ml,(104.3±25.9)pg/ml,(78.3±16.1)pg/ml,(29.7±8.9)ng/L,(32.2±8.1)ng/L,(2776.3±240.5)ng/L and (7.6±1.1)ng/L], all not significantly different compared to 【(122.8±35.5)ng/ml,(105.7±23.4)pg/ml,(81.2±17.8)pg/ml,(30.3±8.1)ng/L,(30.1±7.6)ng/L,(2801.4±238.6)ng/L and (8.2±1.9)ng/L, respectively, P > 0.05】 in died recipients; the ROC analysis showed that theAUC of serum TNF-α in predicting the prognosis of LT were greater than 0.750 (0.612～0.907), and in 17 recipients with serum TNF-α≥33.5 pg/ml, 11 (64.7%) survived in 2-year follow-up, while in 18 with serum TNF-α<33.5 pg/ml, 17 (94.4%) survived (Log rank x²=9.272,P=0.002). Conclusion The detection of serum cytokine levels in donors might predict the survival of LT recipients, and monitoring serum TNF-α levels is recommended in this settings.

Key words: Liver transplantation, Donors, Cytokines, Survival

李琛, 阚建英. 供体血清细胞因子水平与肝移植受者术后生存关系探讨[J]. 实用肝脏病杂志, 2020, 23(5): 739-742.

Li Chen, Kan Jianying. Prediction of survival by donor’s serum cytokines in recipients of liver transplantation[J]. Journal of Practical Hepatology, 2020, 23(5): 739-742.

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