论文部分内容阅读
目的:探讨肿瘤坏死因子相关凋亡诱导配体(TRAIL)在重型肝炎发病机制中的作用以及血浆置换治疗前后变化的意义.方法:采用实时荧光定量PCR反应检测30例重型肝炎患者外周血单个核细胞(PBMC)TRAILmRNA的水平,采用ELISA法检测其血清可溶性TRAIL(sTRAIL)的水平,并与肝功能相关指标进行相关性分析.观察血浆置换(PE)治疗前后TRAIL的变化,比较治疗有效组和治疗无效组之间TRAIL水平差异.结果:重型肝炎患者PBMCTRAILmRNA的水平及血清sTRAIL的水平均明显高于健康对照组(0.0622±0.0227vs0.0059±0.0023,P<0.05;9.1058±3.2260vs2.4552±1.7485,P<0.01).mTRAIL和sTRAIL与肝功能相关指标总胆红素(TB)、白蛋白(ALB)以及凝血酶原时间(PT)均无直线相关性,膜型TRAIL(mTRAIL)和sTRAIL之间也无直线相关性.PE治疗后,肝功能相关指标改善;PBMCTRAILmRNA水平下降,治疗前后有显著性差异(0.0622±0.0227vs0.0214±0.0140,P<0.001);而血清sTRAIL水平在PE治疗前后无明显变化.治疗有效组PBMCTRAILmRNA水平、血清sTRAIL水平均低于治疗无效组,差异显著(0.0154±0.0076vs0.0320±0.0178,P<0.01;8.0476±3.5599vs11.0479±2.6694,P<0.05).结论:TRAIL介导的细胞凋亡在重型肝炎病理损害过程中起着重要的作用,TRAIL的水平在一定程度上能反映患者的肝脏损伤程度.从近期观察,PE治疗能降低患者PBMCTRAILmRNA水平,但不能降低血清sTRAIL水平.
Objective: To investigate the role of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) in the pathogenesis of severe hepatitis and the significance of plasma exchange before and after treatment.Methods: Real-time fluorescent quantitative PCR was used to detect the levels of peripheral blood mononuclear cells (TRAILmRNA, PBMC) were detected by enzyme-linked immunosorbent assay (ELISA) .Serum soluble TRAIL (sTRAIL) was detected by ELISA and correlation analysis was performed with liver function related indexes.Analysis of the changes of TRAIL before and after plasma exchange (PE) The levels of TRAIL in patients with severe hepatitis were significantly higher than those in healthy controls (0.0622 ± 0.0227 vs 0.0059 ± 0.0023, P <0.05; 9.1058 ± 3.2260 vs 2.4552 ± 1.7485, P <0.01). There was no linear correlation between mTRAIL and sTRAIL and liver function related indexes of total bilirubin (TB), albumin (ALB) and prothrombin time (PT) There was no linear correlation between the two groups.Effect of PE on liver function was improved, PBMCTRAIL mRNA level was decreased, there was significant difference before and after treatment (0.0622 ± 0.0227vs0.0214 ± 0.0140, P <0.001) The levels of PBMCTRAIL mRNA and sTRAIL in the effective group were significantly lower than those in the ineffective group (0.0154 ± 0.0076 vs 0.0320 ± 0.0178, P <0.01, 8.0476 ± 3.5599 vs 11.0479 ± 2.6694, P <0.05) .Conclusion: TRAIL-mediated apoptosis plays an important role in the pathogenesis of severe hepatitis, and the level of TRAIL can reflect the degree of hepatic injury to a certain extent.Recently, PE treatment can reduce the patients’ PBMCTRAIL mRNA levels but not serum sTRAIL levels.