乙型肝炎肝硬化并发自发性细菌性腹膜炎患者血清MCP-1、TNF-α和IL-10水平变化及其与病情复发的关系研究*

doi:10.3969/j.issn.1672-5069.2024.04.018

摘要/Abstract

摘要： 目的分析慢性乙型肝炎(CHB)肝硬化并发自发性细菌性腹膜炎(SBP)患者血清单核细胞趋化蛋白-1(MCP-1)、肿瘤坏死因子-α(TNF-α)和白细胞介素-10(IL-10)水平变化及其与病情复发的关系。方法 2018年1月～2022年1月我院诊治的63例乙型肝炎肝硬化并发SBP患者和82例乙型肝炎肝硬化患者,给予SBP患者抗生素抗感染治疗。采用双抗体夹心ELLSA法检测血清MCP-1、TNF-α和IL-10水平。采用多因素二元Logistic回归分析影响病情复发的危险因素,应用受试者工作特征曲线(ROC)下面积(AUC)评估各指标预测病情复发的效能。结果治疗前,SBP组血清MCP-1、TNF-α和IL-10水平分别为(354.7±73.9)pg/mL、(13.4±3.1)pg/mL和(11.4±1.7)pg/mL,均显著高于肝硬化组【分别为(193.8±42.3)pg/mL、(8.8±2.4)pg/mL和(8.1±1.2)pg/mL, P<0.05】,治疗后SBP组血清细胞因子水平仍然显著高于肝硬化组(P<0.05); 治疗后随访2年,31例(49.2%)SBP患者病情复发;复发组消化道出血发生率为41.9%,显著高于未复发组(6.3%,P<0.05);复发组血清MCP-1、TNF-α和IL-10水平均显著高于未复发组(P<0.05);Logistic回归分析显示,血清MCP-1、TNF-α、IL-10和ALB水平均是影响致SBP复发的独立危险因素(P<0.05);ROC曲线分析显示,首次SBP治疗后血清MCP-1、TNF-α、IL-10和ALB水平预测SBP复发均具有一定的应用价值,其AUC分别为0.91、0.91、0.92和0.76,应用细胞因子水平预测显著优于血清ALB水平(P<0.05)。结论乙型肝炎肝硬化并发SBP患者病情可能复发,而检测治疗后血清MCP-1、TNF-α和IL-10水平可能具有预测病情复发的作用,值得进一步研究。

关键词: 肝硬化, 自发性细菌性腹膜炎, 单核细胞趋化蛋白-1, 肿瘤坏死因子-α, 白细胞介素-10, 复发

Abstract: Objective The aim of this study was to investigate the changes of serum monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor -α (TNF-α) and interleukin-10 (IL-10) levels in patients with hepatitis B-induced liver cirrhosis (LC) and with complicated spontaneous bacterial peritonitis (SBP). Methods 63 patients with hepatitis B-induced LC and SBP, and 82 patients with hepatitis B-induced LC were enrolled in our hospital between January 2018 and January 2022, and the patients with SBP were treated with antibiotics for two weeks. Serum MCP-1, TNF-α and IL-10 levels were detected by ELISA. The multivariate Logistic regression analysis was applied to reveal the risk factors for the relapse of SBP, and the area under receiver operating characteristic curve (AUROC) was conducted to predict the efficacy of parameters for relapse of SBP. Results At admission, serum MCP-1, TNF-α and IL-10 levels in patients with SBP were (354.7±73.9)pg/mL,(13.4±3.1)pg/mL and (11.4±1.7)pg/mL, all significantly higher than [(193.8±42.3)pg/mL, (8.8±2.4)pg/mL and (8.1±1.2)pg/mL, respectively, P<0.05] in patients with LC, and at the convalescent stage, serum cytokine levels in patients with SBP were still much higher than in patients with LC (P<0.05); during two-year follow-up period, the SBP relapsed in 31 cases (49.2%), and the incidence of esophageal variceal bleeding in relapsed patients was41.9%, much higher than 6.3% in patients without relapsed SBP (P<0.05); serum MCP-1, TNF-α and IL-10 levels in relapsed SBP patients were significantly higher than in those without relapsed SBP (P<0.05); the multivariate Logistic regression analysis showed that serum MCP-1, TNF-α, IL-10 and albumin levels were all the independent risk factors for SBP relapse (P<0.05); the ROC analysis demonstrated that serum MCP-1, TNF-α, IL-10 and albumin levels at the convalescent stage could predict the relapse of SBP, with the AUCs of 0.91, 0.91, 0.92 and 0.76, respectively, suggesting serum cytokine levels superior to albumin (P<0.05). Conclusion The surveillance of serum MCP-1, TNF-α and IL-10 levels might predict the relapse of SBP, which is worthy of further clinical investigation.

Key words: Liver cirrhosis, Spontaneous bacterial peritonitis, Monocyte chemoattractant protein-1, Tumor necrosis factor-α, Interleukin-10, Relapse

邢世磊, 李之慧, 宁秀景. 乙型肝炎肝硬化并发自发性细菌性腹膜炎患者血清MCP-1、TNF-α和IL-10水平变化及其与病情复发的关系研究^*[J]. 实用肝脏病杂志, 2024, 27(4): 563-566.

Xing Shilei, Li Zhihui, Ning Xiujing. Changes of serum MCP-1, TNF-α and IL-10 levels in patients with hepatitis B cirrhosis and spontaneous bacterial peritonitis[J]. Journal of Practical Hepatology, 2024, 27(4): 563-566.

参考文献

[1] Weng WZ, Chen JF, Peng XH,et al. Risk factors for underlying comorbidities and complications in patients with hepatitis B virus-related acute-on-chronic liver failure. Epidemiol Infect, 2022,150(1):e147.
[2] Tu B, Zhang YN, Bi JF,et al. Multivariate predictive model for asymptomatic spontaneous bacterial peritonitis in patients with liver cirrhosis. World J Gastroenterol, 2020,26(29):4316-4326.
[3] Kang J, Postigo-Fernandez J, Kim K,et al. Notch-mediated hepatocyte MCP-1 secretion causes liver fibrosis. JCI Insight, 2023,8(3):e165369.
[4] 陈攀丽,张炳勇,付雪琴,等. 肝硬化合并自发性细菌性腹膜炎患者血清和腹水中固有淋巴样细胞亚群的变化. 中华医学杂志,2022,102(2):141-146.
[5] Liu L, Xiao N, Chen P,et al. IL-10 predicts the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure combined with spontaneous bacterial peritonitis. Front Med (Lausanne), 2023,10(1):1188300.
[6] García-Peñarrubia P, Ruiz-Alcaraz AJ, Ruiz-Ballester M,et al. Recent insights into the characteristics and role of peritoneal macrophages from ascites of cirrhotic patients. World J Gastroenterol, 2021,27(41):7014-7024.
[7] 中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南. 实用肝脏病杂志,2018,21(1):21-31.
[8] 中华医学会肝病学分会. 肝硬化诊治指南.实用肝脏病杂志,2019,22(6):770-792.
[9] 张继明,翁心华. 自发性细菌性腹膜炎的诊断及防治. 中华肝脏病杂志,2005,13(6):459-460.
[10] Biggins SW, Angeli P, Garcia-Tsao G,et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American association for the study of liver diseases. Hepatology, 2021,74(2):1014-1048.
[11] Marciano S, Díaz JM, Dirchwolf M, et al. Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies. Hepat Med, 2019,11(1):13-22.
[12] Samonakis DN, Gatselis N, Bellou A,et al. Spontaneous bacterial peritonitis: a prospective Greek multicenter study of its epidemiology, microbiology, and outcomes. Ann Gastroenterol, 2022,35(1):80-87.
[13] Xu L, Sharkey D, Cantley LG. Tubular GM-CSF promotes late MCP-1/CCR2-mediated fibrosis and inflammation after ischemia/reperfusion injury. J Am Soc Nephrol, 2019,30(10):1825-1840.
[14] Janssens P, Decuypere JP, De Rechter S, et al. Enhanced MCP-1 release in early autosomal dominant polycystic kidney disease. Kidney Int Rep, 2021,6(6):1687-1698.
[15] Moloi MW, Rusch JA, Omar F,et al. Urinary MCP-1 and TWEAK as non-invasive markers of disease activity and treatment response in patients with lupus nephritis in South Africa. Int Urol Nephrol, 2021,53(9):1865-1873.
[16] 刘玉玲,甄增国,王慧娟,等. 益生菌制剂对肝硬化并发自发性细菌性腹膜炎患者肠道屏障功能的影响. 实用肝脏病杂志,2021,24(6):867-870.
[17] Queck A, Bode H, Uschner FE,et al. Systemic MCP-1 levels derive mainly from injured liver and are associated with complications in cirrhosis. Front Immunol, 2020,11(1):354.
[18] 吴成勇,陈冲,刘文艳,等. 慢加急性乙型肝炎肝衰竭患者并发细菌感染及其预测模型效能评价. 实用肝脏病杂志,2023,26(1):59-62.
[19] Wu X, Luo J, Huang W,et al. Role of ascitic endocan levels in the diagnosis of spontaneous bacterial peritonitis in decompensated cirrhosis. Biomarkers, 2020,25(4):360-366.
[20] Qian D, Zhang Y. Influence of xuebijing injection combined with cefoperazone sodium and sulbactam sodium in treating hepatitis B-induced liver cirrhosis complicated by spontaneous bacterial peritonitis: TNF-α, IL-18, IL-6, and hepatic function. Am J Transl Res, 2021,13(4):2907-2914.
[21] Wang Z, Wang A, Gong Z,et al. Plasma claudin-3 is associated with tumor necrosis factor-alpha-induced intestinal endotoxemia in liver disease. Clin Res Hepatol Gastroenterol, 2019,43(4):410-416.
[22] Zhao S, Xu W, Xie YX,et al. CXCR5⁺CD4⁺ T cell subsets and their relationship to immune dysfunction in chronic hepatitis B-associated liver cirrhosis. J Gastroenterol Hepatol, 2020,35(4):689-695.
[23] Chan PC, Cheung KWA, Chan CH,et al. Patterns and infection outcomes of bacterial colonization in patients with indwelling abdominal drains for malignant ascites. Ann Palliat Med, 2020,9(6):4490-4501.

乙型肝炎肝硬化并发自发性细菌性腹膜炎患者血清MCP-1、TNF-α和IL-10水平变化及其与病情复发的关系研究^*

Changes of serum MCP-1, TNF-α and IL-10 levels in patients with hepatitis B cirrhosis and spontaneous bacterial peritonitis

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