血清CD28、CTLA4及LAG3在慢性重型乙型肝炎患者的表达水平及其对短期预后的预测价值

目的探究慢性重型乙型肝炎患者血清白细胞分化抗原28(CD28)、细胞毒性T淋巴细胞相关抗原(CTLA4)及淋巴细胞活化基因3蛋白(LAG3)水平及其对患者短期预后的预测价值。方法选择2016年2月至2019年4月我院收治的107例慢性重型乙型肝炎、59例慢性乙型肝炎患者、50例健康体检者作为研究对象,分别纳入慢重肝组、慢乙肝组及健康组。收集各组受试者临床资料,测定血清CD28、CTLA4、LAG3水平,随访慢重肝组患者预后情况。结果①与健康组比较,慢重肝组、慢乙肝组患者天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、HBV-DNA载量及血清CTLA4、LAG3等指标水平升高(P<0.05),白蛋白(ALB)、CD28水平降低(P<0.05),慢重肝组各指标升高或降低幅度大于慢乙肝组(P<0.05)。②HBV-DNA载量与血清CD28水平呈负相关(P<0.05),与血清CTLA4、LAG3水平呈正相关(P<0.05)。③慢重肝组患者3个月内死亡率为48.60%,死亡组患者血清CD28低于存活组,CTLA4及LAG3水平显著高于存活组(P<0.05)。④血清CD28、CTLA4及LAG3预测慢重肝患者死亡的曲线下面积分别为0.777、0.792、0.774。⑤CD28高表达组患者生存率显著高于CD28低表达组(P<0.05);CTLA4高表达组、LAG3高表达组生存率显著低于CTLA4低表达组、LAG3低表达组(P<0.05)。结论血清CD28、CTLA4及LAG3与慢性重型乙型肝炎患者病情及预后有一定相关性,临床可考虑将其用于病情严重程度、预后评估的辅助指标。

Expression Levels of Serum CD28,CTLA4 and LAG3 in Patients with Severe Chronic Hepatitis B and Their Predictive Values for Short-term Prognosis

Objective To explore levels of serum cluster of differentiation 28(CD28),cytotoxic lymphocyte 4(CTLA4)and lymphocyte activation gene-3(LAG3)in patients with severe chronic hepatitis B(CHB)and their predictive values for short-term prognosis.Methods From February,2016 to April,2019,107 patients with severe CHB and 59 CHB patients who were admitted to the hospital,as well as 50 healthy people were enrolled for the study.All subjects were divided into the severe CHB group,CHB group and healthy group,respectively.The clinical data in each group were collected.The levels of serum CD28,CTLA4 and LAG3 of all patients were measured.The prognosis in severe CHB group was then followed up.Results①Compared with the healthy group,levels of aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin(TBIL),HBV-DNA load,serum CTLA4 and LAG3 were increased in the severe CHB group and CHB group(P<0.05),while albumin(ALB)and CD28 were decreased(P<0.05).The increase or decrease amplitude of all indexes in the severe CHB group were greater than that in the CHB group(P<0.05).②HBV-DNA load was negatively correlated with the level of serum CD28(P<0.05),while positively correlated with levels of serum CTLA4 and LAG3(P<0.05).③The mortality within 3 months in the severe CHB group was 48.60%.The serum CD28 in the death group was lower than that in the survival group,while levels of CTLA4 and LAG3 were significantly higher than those in the survival group(P<0.05).④The areas under the curve(AUC)of serum CD28,CTLA4 and LAG3 for predicting death in severe CHB patients were 0.777,0.792 and 0.774,respectively.⑤The survival rate of the CD28 high expression group was significantly higher than that of the CD28 low expression group(P<0.05).The survival rate of the CTLA4 high expression group and LAG3 high expression group was significantly lower than that of the CTLA4 low expression group and LAG3 low expression group(P<0.05).Conclusion Serum CD28,CTLA4 and LAG3 are associated with disease severity and prognosis of severe CHB patients.Clinically,they can be considered as auxiliary indexes for disease severity and prognosis evaluation.