摘要
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.
AIM：To investigate the role of TNF-related apoptosis-inducing ligand（TRAIL）in the pathogenesis of severe hepatitis and to detect the impact of plasma exchange therapy on the levels of TRAIL. METHODS：The expression of membrane-bound TRAIL in peripheral blood mononuclear cells（PBMCs）was examined by real-time fluorescence quantitative PCR,while serum levels of soluble TRAIL（sTRAIL）were measured by ELI-SA.Correlation analysis was performed among serum TBIL,ALB and PT.Furthermore,the levels of TRAIL in patients after plasma exchange （PE）therapy were determined. RESULTS：The levels of TRAIL mRNA in PBMCs and sTRAIL in serum were significantly higher in patients with severe hepatitis than in normal controls（P0.05,0.01）.The levels of TRAIL mRNA in PBMCs and sTRAIL in serum had no significant association with serum TBIL, ALB and PT,and the levels of TRAIL mRNA in PBMCs had no significant association with serum sTRAIL.The levels of TRAIL in PBMCs were significantly lower in patients with severe hepatitis after PE therapy than before PE therapy （P0.001）,while serum sTRAIL levels showed no significant changes between before and after therapy.The levels of TRAIL mRNA in PBMCs and sTRAIL in serum were significantly lower in patients with a positive treatment response than in those with a negative treatment response（P 0.01,0.05）. CONCLUSION：TRAIL-mediated apoptosis probably plays a key role in the pathogenesis of severe hepatitis.TRAIL level can be used as a marker for evaluation of the degree of liver damage in patients with severe hepatitis.
出处
《世界华人消化杂志》
CAS
北大核心
2011年第19期2063-2067,共5页
World Chinese Journal of Digestology
关键词
肿瘤坏死因子相关凋亡诱导配体
外周血单个核细胞
重型肝炎
血浆置换
Tumor necrosis factor-related apoptosis-inducing ligand
Peripheral blood mononuclear cells
Severe hepatitis
Plasma exchange
