巨细胞病毒性肝炎患儿血清IFN-γ和IL-18水平变化及其与预后的关系探讨

doi:10.3969/j.issn.1672-5069.2021.02.015

摘要/Abstract

摘要： 目的探讨巨细胞病毒(CMV)肝炎患儿血清干扰素-γ(IFN-γ)和白细胞介素-18(IL-18)水平变化及其与预后的关系。方法 2017年1月～2019年6月我院收治的95例CMV肝炎患儿(轻症66例,重症29例)和90例健康儿童,给予CMV肝炎儿童更昔洛韦治疗6 w,采用ELISA法检测血清IFN-γ和IL-18水平。应用受试者工作特征曲线下面积(AUROC)分析血清细胞因子预测CMV肝炎患儿的转归。结果轻症CMV肝炎患儿血清IFN-γ、IL-18、ALT和TBIL水平分别为(7.7±2.9)mmol/L、(56.9±5.7)pg/L、(69.8±11.3)U/L和(75.4±16.7)μmol/L,重症CMV肝炎患儿分别为(16.6±4.1)mmol/L、(89.5±8.3)pg/L、(104.7±13.2)U/L和(235.7±20.4)μmol/L,均显著高于健康儿童【分别为(2.1±1.1)mmol/L、(33.7±4.9)pg/L、(19.6±3.1)U/L和(8.3±2.7)μmol/L, P<0.05】;在治疗后,轻症CMV肝炎患儿血清IFN-γ、IL-18、ALT和TBIL水平分别为(2.2±0.9)mmol/L、(34.1±5.4)pg/L、(21.2±4.3)U/L和(13.4±4.1)μmol/L,显著低于重症CMV肝炎患儿【(4.1±0.6)mmol/L、(40.6±7.9)pg/L、(46.5±7.5)U/L和(26.5±3.4)μmol/L,P<0.05】;在95例患儿中,痊愈80例,未恢复15例;有效患儿血清IFN-γ、IL-18、ALT和TBIL水平显著低于无效患儿,差异有统计学意义(均P<0.05);以血清IFN-γ预测CMV肝炎不良转归(无效)的敏感度为86.7%,特异性为96.3%,血清IL-18预测的敏感度为93.3%,特异性为73.8%。结论 CMV肝炎患儿血清IFN-γ和IL-18水平明显升高,在治疗后其血清水平下降缓慢者,可能预后不良,值得进一步监测。

关键词: 巨细胞病毒肝炎, 干扰素-γ, 白细胞介素-18, 预后, 儿童

Abstract: Objective The aim of this study was to investigate the changes of serum interferon-γ (IFN-γ) and interleukin-18 (IL-18) levels in children with cytomegalovirus (CMV) hepatitis and their implications with prognosis.Methods A total of 95 children with CMV hepatitis (including mild hepatitis in 66 and severe hepatitis in 29) and 90 healthy children were recruited in our hospital between January 2017 and June 2019, and children with viral hepatitis were treated with ganciclovir for six weeks. Serum IFN-γ and IL-18 levels were detected by enzyme linked immunosorbent assay. The prognosis of the children with CMV hepatitis was analyzed with the area under ROC (AUC).Results At presentation, serum IFN-γ, IL-18, ALT and bilirubin levels in mild group were(7.7±2.9)mmol/L, (56.9±5.7)pg/L, (69.8±11.3)U/L and (75.4±16.7)μmol/L, and in severe hepatitis children were (16.6±4.1)mmol/L, (89.5±8.3)pg/L, (104.7±13.2)U/L and (235.7±20.4)μmol/L, all significantly higher than 【(2.1±1.1)mmol/L, (33.7±4.9)pg/L, (19.6±3.1)U/L and (8.3±2.7)μmol/L, respectively, P<0.05】 in healthy children; at the end of six week treatment, serum IFN-γ, IL-18, ALT and bilirubin levels in mild hepatitis children were(2.2±0.9)mmol/L, (34.1±5.4)pg/L, (21.2±4.3)U/L and(13.4±4.1)μmol/L, all significantly lower than 【(4.1±0.6)mmol/L, (40.6±7.9)pg/L, (46.5±7.5)U/L and (26.5±3.4)μmol/L, respectively, P<0.05】 in severe group; out of the 95 children with CMV hepatitis, 80 recovered, and 15 didn’t; serum IFN-γ, IL-18, ALT and bilirubin levels in recovered children were significantly lower than those in children with abnormal liver function tests or serum CMV DNA positive (all P<0.05); the sensitivity and specificity of serum IFN-γ level in predicting undesirable outcome of children with CMV hepatitis were 86.7% and 96.3%, and those of serum IL-18 level were 93.3% and 73.8%.Conclusion Serum IFN-γ and IL-18 levels are significantly elevated in children with CMV hepatitis, and the children with CMV hepatitis having an increased serum cytokines might have a bad prognosis.

Key words: Cytomegalovirus hepatitis, Interferon-γ, Interleukin-18, Prognosis, Children

张维娜, 丁传刚, 赵红英, 李丽, 张曼军, 卢旭. 巨细胞病毒性肝炎患儿血清IFN-γ和IL-18水平变化及其与预后的关系探讨[J]. 实用肝脏病杂志, 2021, 24(2): 208-211.

Zhang Weina, Ding Chuangang, Zhao Hongying, et al. Changes of serum IFN-γ and IL-18 levels in children with cytomegalovirus hepatitis[J]. Journal of Practical Hepatology, 2021, 24(2): 208-211.

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