自身免疫性肝炎患者血清白细胞分化抗原38和白细胞介素21水平变化及其临床意义探讨*

目的 探讨应用血清白细胞分化抗原38(CD38)和白细胞介素21(IL-21)水平判断自身免疫性肝炎(AIH)患者肝组织炎症活动度的效能。方法 2018年10月～2021年10月我院收治的53例AIH患者,进行临床病情分度,均接受肝活检。采用ELISA法检测血清CD38和IL-21水平。采用单因素分析影响AIH患者病情的因素,对影响AIH患者病情的因素进行Logistic回归分析,应用受试者工作特征曲线(ROC)分析应用血清CD38和IL-21水平判断AIH患者肝组织炎症活动度的效能。结果 19例重度患者血清总胆红素、ALT、AST、CD38、IL-21、存在肝硬化比率和肝组织汇管区淋巴细胞浸润占比分别为(89.4±15.2)μmol/L、(179.3±36.5)U/L、(216.1±37.6)U/L、(19.0±4.5)pg/mL、(367.8±62.0)pg/mL、36.8%和84.2%,显著高于34例轻中度患者【分别为(36.5±6.8)μmol/L、(61.2±25.9)U/L、(78.7±33.8)U/L、(11.1±2.3)pg/mL、(209.5±46.2)pg/mL、8.8%和5.9%,P<0.05】;23例肝组织G3～G4患者血清CD38和IL-21水平分别为(21.8±4.4)pg/mL和(387.1±59.7)pg/mL,显著高于30例肝组织G1～G2患者【分别为(12.4±2.3)pg/mL和(194.6±45.5)pg/mL,P<0.05】;多因素Logistic回归分析显示血清总胆红素、CD38和IL-21水平及肝组织汇管区淋巴细胞浸润均是影响AIH患者肝组织炎症活动严重的独立危险因素(P<0.05);经ROC分析显示,分别以血清CD38和IL-21水平为20.4 pg/mL和379.3 pg/mL为截断点,联合判断AIH患者肝组织炎症活动严重的AUC为0.939,其灵敏度和特异度分别为82.6%和96.7%,显著优于任一指标的单独判断。结论 AIH患者血清CD38和IL-21水平随病情严重而升高,可以利用这一特征初步判断肝组织炎症活动度程度,值得进一步研究。

Serum peripheral blood leukocyte differentiation antigen 38 and interleukin 21 levels in patients with autoimmune hepatitis

Objective The purpose of this study was to investigate serum peripheral blood leukocyte differentiation antigen 38 (CD38) and interleukin 21 (IL-21) level changes and their implications in patients with autoimmune hepatitis (AIH). Methods 53 patients with AIH were admitted to our hospital between October 2018 and October 2021, and all underwent liver biopsies. The patients were clinically defined to mild or moderate and severe degree of the disease. Serum CD38 and IL-21 levels were determined by enzyme-linked immunosorbent assay. The univariate and multivariate Logistic regression analysis were applied to analyze the factors affecting the intrahepatic tissue inflammatory activity, and the area under the receiver operating characteristic curve (AUROC) was applied to judge the diagnostic efficacy. Results Serum bilirubin, ALT, AST, CD38, IL-21 levels, the incidence of liver cirrhosis and the percentage of intrahepatic lymphocyte infiltration in portal area in 19 patients with severe degree of AIH were(89.4±15.2)μmol/L,(179.3±36.5)U/L,(216.1±37.6)U/L, (19.0±4.5)pg/mL, (367.8±62.0)pg/mL, 36.8% and 84.2%, all significantly higher than (36.5±6.8)μmol/L, (61.2±25.9)U/L, (78.7±33.8)U/L, (11.1±2.3)pg/mL, (209.5±46.2)pg/mL, 8.8% and 5.9%, respectively, P<0.05] in 34 patients with mild/moderate AIH; serum CD38 and IL-21 levels in 23 patients with G3-G4 AIH were (21.8±4.4)pg/mL and (387.1±59.7)pg/mL, both significantly higher than (12.4±2.3)pg/mL and (194.6±45.5)pg/mL, respectively, P<0.05] in 30 patients with G1-G2; the multivariate Logistic regression analysis showed that serum bilirubin, CD38 and IL-21 levels and intrahepatic lymphocyte infiltration in portal area were all the independent risk factors for severe liver tissue injury (P<0.05); the ROC analysis showed that the AUC was 0.939, with the sensitivity of 82.6% and specificity of 96.7% when the combination of serum CD38 (20.4 pg/mL as the cut-off-value ) and IL-21 (379.3 pg/mL as the cut-off-value) was applied to predict the intrahepatic inflammatory activity, superior to any one of the two parameter. Conclusion Serum CD38 and IL-21 levels increase in patients with autoimmune hepatitis, as the disease deteriorate, and the clinicians might predict the disease severity based on this phenomenon.