CAJ | 학술논문

目的:探索核苷类似物早期病毒学应答慢性乙型肝炎患者(CHB)血清sTRAIL水平变化及意义.方法:60例CHB均接受核苷类似物抗病毒药物治疗(拉米夫定或替比夫定),根据治疗24周末HBV DNA水平将患者分为完全病毒学应答组、部分病毒学应答组、无病毒学应答组,设正常对照组.采集治疗前、治疗4、12、24周末患者的血清,检测血清sTRAIL水平,同时检测IFN-γ、ALT水平.结果:患者治疗前sTRAIL、IFN-γ及ALT水平均较正常对照组升高(P＜0.05或P＜0.01).sTRAIL水平在完全应答组治疗4周末、部分应答组治疗12周末下降.与治疗前比,差异均有统计学意义(P＜0.05),在治疗4周末完全应答组sTRAIL水平低于同期部分应答组(P＜0.05).IFN-γ水平在完全应答组治疗4周末、部分应答组治疗12周末升高,与治疗前比差异均有统计学意义(P＜0.05),但完全应答组IFN-γ水平在治疗4周末与同期部分应答组差异无统计学意义.ALT水平在三组的治疗过程中均逐步下降,各时间点间差异均有统计学意义(p＜0.05).完全应答组治疗前sTRAIL水平与IFN-γ水平、ALT水平呈正相关(P＜0.01),治疗后sTRAIL水平与IFN-γ水平呈负相关(P＜0.05).结论:CHB血清sTRAIL水平升高;核苷类似物抗病毒治疗早期病毒学应答者血清sTRAIL水平下降,尤其是完全应答者在疗程的第4周就有明显的变化.sTRAIL在CHB免疫损伤中起重要作用,在其核苷类似物抗病毒治疗免疫恢复中也起重要作用,可作为核苷类似物治疗CHB早期应答指标预测远期疗效.
목적:탐색핵감유사물조기병독학응답만성을형간염환자(CHB)혈청sTRAIL수평변화급의의.방법:60례CHB균접수핵감유사물항병독약물치료(랍미부정혹체비부정),근거치료24주말HBV DNA수평장환자분위완전병독학응답조、부분병독학응답조、무병독학응답조,설정상대조조.채집치료전、치료4、12、24주말환자적혈청,검측혈청sTRAIL수평,동시검측IFN-γ、ALT수평.결과:환자치료전sTRAIL、IFN-γ급ALT수평균교정상대조조승고(P＜0.05혹P＜0.01).sTRAIL수평재완전응답조치료4주말、부분응답조치료12주말하강.여치료전비,차이균유통계학의의(P＜0.05),재치료4주말완전응답조sTRAIL수평저우동기부분응답조(P＜0.05).IFN-γ수평재완전응답조치료4주말、부분응답조치료12주말승고,여치료전비차이균유통계학의의(P＜0.05),단완전응답조IFN-γ수평재치료4주말여동기부분응답조차이무통계학의의.ALT수평재삼조적치료과정중균축보하강,각시간점간차이균유통계학의의(p＜0.05).완전응답조치료전sTRAIL수평여IFN-γ수평、ALT수평정정상관(P＜0.01),치료후sTRAIL수평여IFN-γ수평정부상관(P＜0.05).결론:CHB혈청sTRAIL수평승고;핵감유사물항병독치료조기병독학응답자혈청sTRAIL수평하강,우기시완전응답자재료정적제4주취유명현적변화.sTRAIL재CHB면역손상중기중요작용,재기핵감유사물항병독치료면역회복중야기중요작용,가작위핵감유사물치료CHB조기응답지표예측원기료효.
Objective:To study the sTRAIL levels in chronic hepatitis B(CHB) patients upon nucleoside analogues therapy.Methods:Serial sera of 60 CHB patients before and after nucleoside analogues therapy were collected,among which there were 20 complete responding cases,20 partial responding cases,20 non-responding cases,and 10 healthy people.The level of sTRAIL,IFN-γ and ALT were detected.Results:The level of sTRAIL,IFN-γ and ALT of CHB patients were higher than that of normal group.The sTRAIL level of complete responding group at 4 weeks and partial responding group at 12 weeks were lower than those before therapy,while serum TRAIL of complete responding group were lower than those of partial responding group at 4 weeks.The IFN-γ level of complete responding group at 4 weeks and partial responding group at 12 weeks were higher than those before therapy.ALT levels of all groups in the course of therapy declined gradually and significant difference was observed at different time point.Conclusion:Serum TRAIL level can be used as an early marker for efficacy of nucleoside analogues therapy efficacy in CHB patients.sTRAIL may play a role in restoring immune injury of early anti-viral response in patients with hepatitis B.