恩替卡韦治疗慢性乙型肝炎和乙型肝炎肝硬化患者血清和肝组织可溶性纤维蛋白原样蛋白2水平的变化

目的探讨应用恩替卡韦治疗的慢性乙型肝炎病毒感染者外周血和肝组织可溶性纤维蛋白原样蛋白2(s FGL2)水平的变化及其临床意义。方法 2016年6月～2017年6月我院收治的CHB患者112例和乙型肝炎肝硬化患者112例,其中CHB患者轻度38例,中度45例,重度29例。给予所有患者恩替卡韦治疗72周。常规行肝活检。采用ELISA法检测血清s FGL2水平,采用免疫组化法检测肝组织s FGL2表达。结果 CHB患者肝组织s FGL2阳性率为63.4%(71/112),显著低于肝硬化患者的82.1%(92/112),差异有统计学意义(P<0.05);CHB患者肝组织s FGL2表达随病情程度加重而增强;治疗后,CHB患者血清ALT、AST和s FGL2水平分别(49.8±6.3) U/L、(52.3±7.6) U/L和(84.7±10.3)μg/L,而肝硬化患者则分别为(41.8±4.2) U/L、(42.3±5.4) U/L和(104.9±19.4)μg/L,差异显著(P<0.05);在治疗24 w、48 w和72 w,CHB患者血清s FGL2水平分别为(98.2±10.8)μg/L、(81.6±9.5)μg/L和(69.4±8.7)μg/L,呈依次降低趋势;在治疗72 w末,完全应答65例,部分应答31例,无应答16例,其血清s FGL2水平分别为(74.6±9.1)μg/L、(97.2±11.4)μg/L和(123.6±15.2)μg/L,组间差异显著(P<0.05)。结论 CHB患者在抗病毒治疗后外周血和肝组织s FGL2水平降低显著,其与病情合应答反应关系密切,对病情评估和疗效预测可能具有重要的应用价值。

Changes of serum and hepatic fibrinogen-like protein 2 levels in patients with chronic hepatitis B and hepatitis B cirrhosis after receiving entecavir therapy

Objectiv To investigate the changes of serum and hepatic fibrinogen-like protein 2 （sFGL2） levels in patients with chronic hepatitis B（CHB） and hepatitis B cirrhosis after receiving entecavir therapy. Methods 112 patients with CHB and 112 patients with hepatitis B cirrhosis were admitted to our hospital between June 2016 and June 2017,and among patients with CHB were mild in 38 cases,moderate in 45 cases,and severe in 29 cases. All patients received liver biopsies and were given entecavir treatment for 72 weeks. Serum sFGL2 levels were assayed by ELISA,and hepatic sFGL2 expression was detected by immunohistochemistry. Results The positive rate of hepatic sFGL2 expression in patients with CHB was 63.4% （71/112）,much lower than 82.1% （92/112） in cirrhotic patients （P<0.05）;hepatic sFGL2 expression intensified as liver injuries increased in patients with CHB;at the end of 72 week observation,serum ALT,AST and sFGL2 levels in patients with CHB were （49.8±6.3） U/L,（52.3±7.6）U/L and （84.7±10.3） μg/L,while in patients with liver cirrhosis were （41.8±4.2）U/L,（42.3±5.4） U/L and（104.9±19.4） μg/L,respectively,and the difference was significant between the two groups （P<0.05）;at the end of 24 w,48 w and 72 w,serum sFGL2 level in patients with CHB were（98.2±10.8） μg/L,（81.6±9.5） μg/L and （69.4±8.7） μg/L,in a gradually decreased manner;at the end of 72 w,65 patients with CHB got complete response,31 got partial response and 16 were non-responders,and their serum sFGL2 levels were （74.6±9.1） μg/L,（97.2±11.4） μg/L and（123.6±15.2） μg/L,respectively,with the differences among the three groups significant（P<0.05）. Conclusion Serum and hepatic sFGL2 levels in patients with CHB significantly decrease after antiviral therapy,which might be closely related to the state of disease activity and the response to treatment.