慢性重型乙型肝炎患者外周血单核细胞TOLL样受体4的变化及与TNF-α的关系

目的通过研究慢性重型乙型肝炎患者外周血单核细胞TOLL样受体4（TLR4）的变化情况及其与TNF-α的关系，探讨其意义。方法随机选取慢性乙型肝炎患者31例，设定为慢性乙型肝炎组，慢性重型乙型肝炎患者30例设定为慢性乙型肝炎组，健康志愿者30例为正常对照组，用流式细胞仪检测各组外周血单核细胞表面TLR4的表达，ELISA法检测血清肿瘤坏死因子α（TNF-α）的水平，荧光定量PCR法检测血清HBV DNA并取对数作为复制水平的指标，总胆红素（TB）和凝血酶原时间（PT）的检测按照本院常规检测。结果正常对照组、慢性乙型肝炎组和慢性重型乙型肝炎组外周血单核细胞TLR4的平均免疫荧光强度分别为2．3±1．1、3．7±2．3和（6．9±4．1）MFI，慢性重型乙型肝炎组较正常对照组和慢性乙型肝炎组显著为高（P〈0．05），但慢性乙型肝炎组与正常对照组比较差异无统计学意义（P〉0．05）；3组外周血清TNF-α水平分别为（53．8±38．1）、（164．3±89．9）和（359．8±140．0）ng／L，血清TNF-α水平均依次升高，且各组间比较差异均有统计学意义（P〈0．05）；慢性重型乙型肝炎组外周血单核细胞TLR4表达水平与血清TNF-α表达水平呈正相关（r=0．666，P〈0．01）。结论TLR4可能与慢性重型乙型肝炎的发病有关。

Relationship between Toll-like receptor 4(TLR4) on the peripheral blood monocytes and serum TNF-α in patients with chronic severe hepatitis B

Objective To study the change of TLR4 on peripheral blood monoeytes (PBMCs) and its role in the pathogenesis of chronic severe hepatitis B. Methods The expression of TLR4 on 10000 CDI4 + PBMCs was determined by flow eytometer in 30 healthy control,31 patients with chronic hepatitis B and 30 patients with chronic severe hepatitis B. The level of serum tumor necrosis factor α(TNF- α) was determined by ELISA. Results The values of TLR4 on PBMCs and serum TNF-αof the groups of healthy control, patients with chronic hepatitis B and patients with chronic severe hepatitis B were 2.3±1.1,3.7±2.3, (6.9±4.1 ) mean fluorescence intensity (MFI) and (53.8±38.1 ), ( 164.3±89.9) and (359.8±140.0) ng/L. The TLR4 value in patients with chronic severe hepatitis B was signifi- cant higher than those in healthy control and the patients with chronic hepatitis B ( P <0.05). However, there was no significant difference between the patients with chronic hepatitis B and healthy control ( P > O. 05 ). TNF-α increased gradually and significantly from the healthy control to the patients with chronic hepatitis B and patients with chronic severe hepatitis B. There was a significant positive correlation be- tween the value of TLR4 and the value of serum TNF-αin the patients with chronic severe hepatitis B( r=0.666, P <0.01). Conclusion There may be a role of TLR4 in the pathogenesis of chronic severe hepatitis B.