乙型肝炎肝硬化并发自发性细菌性腹膜炎患者外周血单个核细胞NLRP3和Caspase-1水平变化及其临床意义探讨*

doi:10.3969/j.issn.1672-5069.2023.05.020

摘要/Abstract

摘要： 目的探讨乙型肝炎肝硬化并发自发性细菌性腹膜炎(SBP)患者外周血单个核细胞(PBMCs)核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)和半胱氨酸蛋白酶1(caspase-1)水平变化及其预测预后的价值。方法 2018年1月～2020年5月我院诊治的乙型肝炎肝硬化并发SBP患者65例,采用PCR法检测PBMCs NLRP3和Caspase-1 mRNA水平,采用ELISA法检测血清血白介素-1β(IL-1β)和IL-18水平。应用受试者工作特征曲线并计算曲线下面积(AUC)分析各指标对患者预后的预测价值。结果 21例重症组PBMCs NLRP3和Caspase-1 mRNA水平及血清IL-1β和IL-18水平分别为(1.5±0.3)和(2.0±0.4)、(11.7±2.1)pg/mL和(17.4±1.6)pg/mL,显著高于44例轻症组【分别为(1.1±0.2)和(1.6±0.3)、(8.6±1.3)pg/mL和(12.1±1.3)pg/mL,P<0.05】;应用PBMCs NLRP3联合Caspase-1水平评估SBP患者病情严重程度的AUC为0.899,SE(95%CI)=0.036(0.828～0.971);15例死亡组PBMCs NLRP3和Caspase-1 mRNA水平及血清IL-1β和IL-18水平分别为(1.7±0.3)和(2.3±0.5)、(12.5±2.2)pg/mL和(18.2±3.1)pg/mL,显著高于50例生存组【分别为(1.1±0.2)和(1.6±0.3)、(8.9±1.8)pg/mL和(12.7±2.5)pg/mL,P<0.05】;应用PBMCs NLRP3联合Caspase-1水平预测患者预后的AUC为0.916,SE(95%CI)=0.043(0.831～0.999)。结论乙型肝炎肝硬化并发SBP患者PBMCs NLRP3和Caspase-1水平升高,可能与病情严重程度相关,其机制仍需要研究。

关键词: 肝硬化, 自发性细菌性腹膜炎, 外周血单个核细胞, 核苷酸结合寡聚化结构域样受体蛋白3, 预后

Abstract: Objective The aim of this study was to explore the predictive efficacy of peripheral blood mononuclear cells (PBMCs) nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) and cysteine protease-1 (caspase-1) mRNA levels in patients with hepatitis B cirrhosis and complicated spontaneous bacterial peritonitis (SBP). Methods 65 patients with hepatitis B cirrhosis complicated by SBP were enrolled in our hospital between January 2018 and May 2020. The PBMC NLRP3 and caspase-1 mRNA levels were detected by real-time fluorescence quantitative PCR and serum interleukin-1β (IL-1β) and IL-18 levels were detected by ELISA. The predictive performance was evaluated by the area under receiver operating characteristic curve (AUC). Results The PBMCs NLRP3, caspase-1 mRNA and serum IL-1β and IL-18 levels in 21 patients with severe SBP were (1.5±0.3), (2.0±0.4), (11.7±2.1)pg/mL and (17.4±1.6)pg/mL, all significantly higher than [(1.1±0.2), (1.6±0.3), (8.6±1.3)pg/mL and (12.1±1.3)pg/mL, respectively, P<0.05] in 44 patients with mild SBP; the AUC was 0.899, with SE(95%CI) of 0.036(0.828-0.971), when predicting severe disease by the combination of PBMCs NLRP3 and caspase-1 levels; the PBMCs NLRP3, caspase-1 mRNA and serum IL-1β and IL-18 levels in 15 dead patients at presentation were (1.7±0.3), (2.3±0.5),(12.5±2.2)pg/mL and (18.2±3.1)pg/mL, all significantly higher than [(1.1±0.2), (1.6±0.3), (8.9±1.8) pg/mL and (12.7±2.5)pg/mL, respectively, P<0.05] in 50 survivals; the AUC was 0.916, with SE(95%CI) of 0.043(0.831-0.999), when predicting the prognosis of patients with SBP by the combination of PBMCs NLRP3 and caspase-1 mRNA levels. Conclusion The PBMCs NLRP3 and caspase-1 levels increase in patients with hepatitis B cirrhosis complicated by SBP, which might be related to the severity of the entity and needs further investigation.

Key words: Liver cirrhosis, Spontaneous bacterial peritonitis, Peripheral blood mononuclear cells, Nucleotide-binding oligomerization domain-like receptor protein 3, Cysteine protease-1, Prognosis

冯冬霞, 奚晶, 杨振斌, 刘亚芹, 胡茜莹. 乙型肝炎肝硬化并发自发性细菌性腹膜炎患者外周血单个核细胞NLRP3和Caspase-1水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2023, 26(5): 682-685.

Feng Dongxia, Xi Jing, Yang Zhenbin, et al. Predictive performance of peripheral blood mononuclear cell NLRP3 and caspase-1 mRNA levels in patients with hepatitis B cirrhosis and complicated spontaneous bacterial peritonitis[J]. Journal of Practical Hepatology, 2023, 26(5): 682-685.

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乙型肝炎肝硬化并发自发性细菌性腹膜炎患者外周血单个核细胞NLRP3和Caspase-1水平变化及其临床意义探讨^*

Predictive performance of peripheral blood mononuclear cell NLRP3 and caspase-1 mRNA levels in patients with hepatitis B cirrhosis and complicated spontaneous bacterial peritonitis

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