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目的:研究慢性乙型、丙型肝炎患者体内炎性反应与铁代谢调节的相互作用机制.方法:纳入慢性乙型、丙型肝炎患者各45例、健康成人90例(各对照45例),分为慢性乙型肝炎患者组(HBV组)、慢性丙型肝炎患者组(HCV组)及对照组,ELISA法检测血清铁调素(hepcidin)、白介素-6(interleukin6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor alpha,TNF-α),全自动生化仪检测丙氨酸转氨酶(alanine transaminase,ALT)、天冬氨酸转氨酶(aspartate aminotransferases,AST)、血清铁(Fe).选取慢性丙型肝炎患者肝脏及十二指肠标本15例(HCV组)、慢性乙型肝炎患者肝脏及十二指肠标本12例(HBV组)和对照组12例,免疫组织化学检测肝脏铁调素(hepcidin)及十二指肠膜铁转运蛋白(ferroportin)表达情况,肝脏铁蓝染色检测肝脏铁蓄积情况.结果:与对照组比较,HBV、HCV组血清铁调素水平及肝脏铁调素表达均降低(P<0.05);十二指肠膜铁转运蛋白表达均升高(P<0.05),HCV组升高更明显(P<0.05),肝脏铁蓝染色的阳性表达均升高(P<0.05),HCV组升高更明显(P<0.05).HBV及HCV组十二指肠膜铁转运蛋白表达与肝脏铁调素表达均呈负相关(r=-0.638,P<0.05;r=-0.538,P<0.05),与血清铁调素均呈负相关(r=-0.407,P<0.05;r=-0.519,P<0.05),与血清Fe均呈正相关(r=0.611,P<0.05;r=0.637,P<0.05).在HBV组,血清铁调素与IL-6及TNF-α均呈负相关(r=-0.510,P<0.05;r=-0.450,P<0.05);在HCV组,血清铁调素与IL-6呈负相关(r=-0.620,P<0.05),与TNF-α呈正相关(r=0.243,P<0.05).结论:慢性乙型、丙型肝炎患者体内铁调素水平下调并通过上调膜铁转运蛋白的表达导致体内血清铁水平升高及肝铁蓄积,HCV组肝铁蓄积更明显.
Objective: To study the mechanism of the interaction between inflammatory response and iron metabolism in patients with chronic hepatitis B and C. Methods: Forty-five patients with chronic hepatitis B and C, 90 healthy adults (45 controls) The patients were divided into chronic hepatitis B group (HBV group), chronic hepatitis C group (HCV group) and control group. Serum hepcidin, interleukin 6 (IL-6) Tumor necrosis factor alpha (TNF-α) and alanine transaminase (ALT), aspartate aminotransferases (AST) and serum iron (Fe) Hepatic and duodenal specimens were collected from 15 patients with chronic hepatitis C (HCV group), 12 patients with chronic hepatitis B (hepatocytes and duodenal specimens) and 12 controls (control group). Immunohistochemistry was used to detect hepatic iron sensitivity Hepcidin and duodenal membrane ferroportin expression in the liver were detected by iron blue staining.Results: Compared with the control group, serum hepcidin level and liver hepcidin The expression was decreased (P <0.05); Duodenal membrane iron transporter (P <0.05). The positive expression of hepatic iron blue staining was increased in HCV group (P <0.05), while the expression in HCV group was higher (P <0.05). The expression of membrane iron transporter of duodenum in HBV and HCV groups was negatively correlated with hepcidin (r = -0.638, P <0.05; r = -0.538, P <0.05) (R = -0.407, P <0.05; r = -0.519, P <0.05), and had positive correlation with serum Fe (r = 0.611, Serum hepcidin was negatively correlated with IL-6 and TNF-α (r = -0.510, P <0.05; r = -0.450, P <0.05). In HCV group, serum hepcidin and IL- (R = -0.620, P <0.05), and positively correlated with TNF-α (r = 0.243, P <0.05) .Conclusion: The level of hepcidin in patients with chronic hepatitis B and C is down- The protein expression leads to elevated serum iron levels and hepatic iron accumulation in vivo, and liver iron accumulation in HCV group is more obvious.