本文選題：重型肝炎 + 內(nèi)毒素��； 參考：《河北聯(lián)合大學(xué)》2014年碩士論文

【摘要】：目的檢測重型乙型肝炎患者血清中內(nèi)毒素（LPS）、腫瘤壞死因子（TNF-α）和白細(xì)胞介素-6（IL-6）水平，并同慢性乙型肝炎患者與正常對照組比較，探討它們與乙型肝炎重型化關(guān)系，為慢性肝炎臨床治療和預(yù)后判斷提供理論和臨床依據(jù)。 方法病例取自唐山市傳染病院2012年6月至2013年10月住院患者和健康體檢者共120例，其中慢性重型乙型肝炎患者40例（男：34例，女：6例），年齡：22~44歲（平均年齡：33.4±12.0歲）、慢性乙型肝炎患者40例（男：33例，女：7例），年齡：26~48歲（平均年齡：36.1±8.3歲）和40例非乙型肝炎患者(健康體檢者)為正常對照組，，（男：35例，女：5例），年齡：25~46歲（平均年齡：35.3±10.2歲）。入院后未進(jìn)行治療前抽取清晨空腹靜脈血，檢測血清總膽紅素（TBil）和谷丙轉(zhuǎn)氨酶（ALT）；并分別用鱟三肽基質(zhì)顯色法和酶聯(lián)免疫吸附測定法檢測各組LPS、TNF-α及IL-6的含量。應(yīng)用SPSS13.0版統(tǒng)計(jì)軟件處理數(shù)據(jù)。計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差（x s）表示，采用方差分析。內(nèi)毒素與細(xì)胞因子間及與患者預(yù)后之間關(guān)系采用Pearson積矩相關(guān)分析。 結(jié)果1乙型肝炎組患者血清中ALT和TBil含量明顯高于健康對照組（P0.05）；慢性重型乙型肝炎組患者血清中ALT和TBil含量高于慢性乙型肝炎組（P0.05）；2乙型肝炎組患者血清中LPS，TNF-α及IL-6的含量較健康對照組明顯增高（P0.05），慢性重型乙型肝炎組患者血清中LPS，TNF-α及IL-6的含量明顯高于慢性乙型肝炎組患者（P0.05）；3慢性重型乙型肝炎患者血清中ALT與LPS，TNF-α和IL-6相比無明顯相關(guān)性；4慢性重型乙型肝炎患者血清中TNF-α含量隨著LPS升高而升高，兩者間有相關(guān)性（rLPS-TNF-α=0.358P0.005），慢性重型乙型肝炎患者血清中IL-6含量隨著LPS升高而升高，兩者呈正相關(guān)（rLPS-IL-6=0.344P0.005）；5LPS，TNF-α和IL-6的水平與慢性重型乙型肝炎患者預(yù)后存在顯著的相關(guān)性。 結(jié)論慢性重型乙型肝炎患者肝功能明顯受損；在慢性乙型肝炎重型化過程中，內(nèi)毒素水平增高可能是其重要誘因之一，內(nèi)毒素介導(dǎo)TNF-α及IL-6升高可能是肝細(xì)胞損傷機(jī)制之一；內(nèi)毒素和TNF-α及IL-6可以作為慢性重型乙型肝炎預(yù)后判斷的間接指標(biāo)。
[Abstract]:Objective to detect the serum endotoxin in patients with severe hepatitis B (LPS), tumor necrosis factor alpha (TNF- alpha) and interleukin -6 (IL-6) level, compared with the normal control group and chronic hepatitis B patients, and explore their relationship with hepatitis B, and provide theoretical and clinical basis for judging the clinical treatment of chronic hepatitis and the prognosis of the patients.
Methods patients from June 2012 to October 2013 in Tangshan City infectious hospital patients and healthy subjects were 120 cases, including 40 cases of chronic severe hepatitis B patients (male: 34 cases, female: 6 cases), age: 22~44 years old (average age: 33.4 + 12 years), 40 cases of chronic hepatitis B patients (male: 33 cases, female: 7 cases), age: 26~48 years old (average age: 36.1 + 8.3 years) and 40 cases of non hepatitis B patients (healthy subjects) as normal control group (male: 35 cases, female: 5 cases), age: 25~46 years old (average age: 35.3 + 10.2 years). After the hospital had no treatment before the morning fasting venous blood, serum total bilirubin (TBil) and alanine aminotransferase (ALT); and three respectively by Limulus peptide chromogenic substrate method and ELISA method to detect the content of LPS, TNF- alpha and IL-6. The application of SPSS13.0 statistical software data processing of measurement data. Mean standard deviation (x S) indicated the use of variance analysis. The relationship between endotoxin and cytokine and the prognosis of patients was analyzed by Pearson moment correlation analysis.
The results of ALT and TBil in 1 hepatitis B patients were significantly higher than those in healthy control group (P0.05); ALT and TBil in the sera of patients with chronic severe hepatitis B is higher than that of chronic hepatitis B (P0.05); the 2 group of hepatitis B in the serum of patients with LPS, the content of TNF- alpha and IL-6 higher than those in healthy control group (P0.05), sera of patients of chronic severe hepatitis B in LPS, the content of TNF- alpha and IL-6 was significantly higher than that in chronic hepatitis B patients (P0.05 group); 3 patients with chronic severe hepatitis B in ALT and LPS, TNF- and IL-6 showed no significant correlation between alpha TNF- alpha 4; the content of serum in patients with chronic severe hepatitis B. With the increase of LPS, and there is a correlation between (rLPS-TNF- alpha =0.358P0.005), the content of IL-6 in serum of patients with severe chronic hepatitis B and increased with the increase of LPS, there is a positive correlation between them (rLPS-IL-6=0.344P0.005); 5LPS, TNF- and IL-6 There is a significant correlation between the level and the prognosis of chronic severe hepatitis B patients.
Conclusion the liver function of patients with chronic severe hepatitis B was significantly impaired; in chronic hepatitis B during endotoxin levels may be one of the important cause of endotoxin mediated TNF- alpha and IL-6 increase may be one of the mechanisms of injury of liver cells; indirect index of endotoxin and TNF- alpha and IL-6 can be used to judge the prognosis of chronic severe hepatitis B.

【學(xué)位授予單位】：河北聯(lián)合大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R512.62

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