乙型肝炎肝硬化并发自发性细菌性腹膜炎患者CD64指数及血清sTREM-1和IL-6水平变化与肠黏膜屏障功能关系研究

doi:10.3969/j.issn.1672-5069.2022.01.020

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)患者外周血簇分化抗原64(CD64)指数、血清可溶性髓样细胞触发受体-1(sTREM-1)和白细胞介素-6(IL-6)水平变化及其与肠黏膜屏障功能的相关性。方法 2015年10月～2020年2月我院收治的失代偿期乙型肝炎肝硬化患者86例,其中并发SBP患者54例。使用流式细胞仪检测外周血CD64⁺细胞百分比,并根据中性多形核白细胞、淋巴细胞和单核细胞平均荧光强度计算CD64指数,采用ELISA法检测血清sTREM-1和IL-6水平,检测血清内毒素(EXT)和尿甘露醇/乳果糖,计算其比值(L/M)评判肠黏膜屏障功能。结果治疗前,乙型肝炎肝硬化并发SBP患者血清IL-6、sTREM-1、D-Lac、DAO、EXT及CD64指数和L/M比值分别为(122.1±37.9)ng/L、(60.3±12.4)μg/mL、(5.1±1.6)μg/mL、(14.2±2.2)μg/mL、(0.2±0.0)U/mL及(12314.3±324.3)mol/cell和(0.2±0.1),均显著高于乙型肝炎肝硬化患者【分别为(78.6±28.2)ng/L、(51.4±10.6)μg/mL、(2.5±0.8)μg/mL、(9.8±1.6)μg/mL、(0.1±0.0)U/mL及(6376.52.5±0.3)mol/cell和(0.1±0.0),均P<0.05】;治疗后, SBP患者血清IL-6、sTREM-1、D-Lac、DAO、EXT及CD64指数和L/M比值分别为(71.2±23.9)ng/L、(17.5±5.1)μg/mL、(2.9±0.8)μg/mL、(14.2±2.2)μg/mL、(0.1±0.0)U/mL及(3398.2±258.2)mol/cell和(0.1±0.0),仍显著高于乙型肝炎肝硬化患者【分别为(52.1±21.6)ng/L、(10.8±2.5)μg/mL、(2.3±0.5)μg/mL、(8.7±1.2)μg/mL、(0.0±0.0)U/mL及(2541.0±266.2)mol/cell和(0.0±0.0),均P<0.05】;治疗后,33例肠粘膜功能障碍的SBP患者血清IL-6和sTREM-1水平及外周血CD64指数为(75.2±24.1)pg/mL和(19.5±4.9)μg/mL及(3642.2±242.1)mol/cell,显著高于21例肠粘膜功能正常患者【分别为(65.2±21.3)pg/mL和(14.8±4.3)μg/mL及(3123.2±168.4)mol/cell,P<0.05】。结论乙型肝炎肝硬化并发SBP患者存在肠粘膜屏障功能障碍,可能对SBP的发生起了关键作用。

关键词: 肝硬化, 自发性细菌性腹膜炎, CD64指数, 可溶性髓样细胞触发受体-1, 白细胞介素-6, 肠粘膜屏障功能

Abstract: Objective The aim of this study was to explore the correlation of blood cluster differentiation (CD) antigen 64 (CD64) index, serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and interleukin-6 (IL-6) levels to intestinal mucosal barrier functions in patients with hepatitis B liver cirrhosis (LC) and spontaneous bacterial peritonitis (SBP). Methods Eighty-six cirrhotics were admitted to our hospital between October 2015 and February 2020, and fifty-four had SBP. The peripheral blood CD64 positive polymorphonuclear neutrophils, lymphocytes and monocytes were detected by flow cytometry and CD64 index was calculated automatically. Serum sTREM-1 and IL-6 levels were detected by ELISA. Blood endotoxin (ETX) and urine lactulose/mannitol (L/M) ratio were detected and calculated to determine intestinal mucosal barrier functions. Results At presentation, serum IL-6, sTREM-1, D-Lac, DAO, EXT as well as blood CD64 index and urine L/M ratio in patients with SBP were(122.1±37.9)ng/L,(60.3±12.4)μg/mL, (5.1±1.6)μg/mL, (14.2±2.2)μg/mL, (0.2±0.0)U/mL as well as (12314.3±324.3)mol/cell and (0.2±0.1), all significantly higher than [(78.6±28.2)ng/L,(51.4±10.6)μg/mL,(2.5±0.8)μg/mL,(9.8±1.6)μg/mL,(0.1±0.0)U/mL as well as (6376.52.5±0.3)mol/cell and (0.1±0.0), respectively, all P<0.05] in LC patients without SBP; after treatment, serum IL-6, sTREM-1, D-Lac, DAO, EXT as well as CD64 index and urine L/M ratio in patients with SBP were (71.2±23.9)ng/L, (17.5±5.1)μg/mL, (2.9±0.8)μg/mL, (14.2±2.2)μg/mL, (0.1±0.0)U/mL as well as (3398.2±258.2)mol/cell and (0.1±0.0), also all significantly higher than[(52.1±21.6)ng/L,(10.8±2.5)μg/mL,(2.3±0.5)μg/mL,(8.7±1.2)μg/mL,(0.0±0.0)U/mL as well as (2541.0±266.2)mol/cell and (0.0±0.0), respectively, all P<0.05] in cirrhotics without SBP; after treatment, serum IL-6 and sTREM-1 levels as well as blood CD64 index in 33 SBP patients with disabled intestinal mucosal barrier functions were(75.2±24.1)pg/mL and (19.5±4.9)μg/mL as well as (3642.2±242.1)mol/cell, all significantly higher than [(65.2±21.3)pg/mL and (14.8±4.3)μg/mL as well as (3123.2±168.4)mol/cell, respectively, P<0.05] in 21 patients with normal intestinal mucosal barrier functions. Conclusion The LC patients with SBP have abnormal intestinal mucosal barrier functions, which might take part in the pathogenesis of bacterial translocation.

Key words: Liver cirrhosis, Spontaneous bacterial peritonitis, CD64 index, Soluble triggering receptor expressed on myeloid cells-1, Interleukin-6, Intestinal mucosal barrier functions

王菁, 毕宁, 方亮, 田园. 乙型肝炎肝硬化并发自发性细菌性腹膜炎患者CD64指数及血清sTREM-1和IL-6水平变化与肠黏膜屏障功能关系研究[J]. 实用肝脏病杂志, 2022, 25(1): 79-82.

Wang Jing, Bi Ning, Fang Liang, et al. Correlation of blood CD64 index to intestinal mucosal barrier functions in patients with hepatitis B cirrhosis and spontaneous bacterial peritonitis[J]. Journal of Practical Hepatology, 2022, 25(1): 79-82.

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