Dynamic Changes And Its Clinical Significance Of IL-18 In Serums Of Chronic Hepatitis B Patients

Objective: Hepatitis B virus(HBV)on human health have serious harm in the human body after dyeing.HBV infection,which is prevalent in the worldwide,is a global public health problem.The pathogenesis of chronic hepatitis B(CHB)is very complicated and not clear so far.A number of studies have shown that HBV does not directly damage liver cells in the body after infection and influence of disease evolution and prognosis through the mechanism of the immune response of CD4+T cells and CD8+T cells mediated.The clinical characteristics and severity of the disease depend on the degree of immune response induced by the patient.Interleukin-18(IL-18)is produced by activated macrophages,T cells and NK cells,it is a very important pre inflammatory cytokines in the body,it can enhance the cytotoxicity of NK cells,and T cell proliferation,differentiation,maturation,promote and regulate the immune response.Current studies suggest that IL-18 levels are closely related to HBV infection.In order to discuss the relationship between IL-18 levels and the outcome of the disease pathogenesis,CHB,in this study,the changes of serum IL-18 levels in patients with CHB were detected by ELISA and compared in different clinical types of patients,mainly discusses the different serum IL-18 levels and between IFN gamma,liver function biochemical indexes,HBV serum marker material and the relationship between,in-depth understanding of the relationship with chronic viral hepatitis lesions,inflammation of the liver,hepatic fibrosis,and virus replication,for clinical diagnosis and prognosis estimation and provide a theoretical basis for treatment.Methods:1 Study Subjects : A total of 176 cases were studied,including 166 patients and 10 healthy subjects.89 cases of patients with CHB,which havelight chronic hepatitis B with 31 cases,moderate chronic hepatitis B with 51 cases and Severe chronic hepatitis B with 36 cases with 7 cases.There are 41 cases of liver cirrhosis with hepatitis B(including 29 cases of liver cirrhosis decompensated and 12 cases of liver cirrhosis compensatory).36 patients infected with HBV related acute-on-chronic liver failure.There were 84 cases of HBeAg positive and 72 cases of HBeAg negative in 166 cases.Liver puncture biopsy was performed in 57 patients.During the same period,10 healthy subjects were selected as control group.2 All patients were routine vein blood samples,which collected to detect liver function.The changes of serum IL-18 levels in patients were detected by ELISA and compared in patients with different clinical types.At the same time,statistical analysis serum levels of IL-18 and IFN-? levels,liver function biochemical indexes,HBV-DNA load and serum HBV marks and liver tissue pathological changes.Results:1 The analysis of the serum levels of IL-18 and IFN-? among the patients with different clinical classificationGroup CHB-l,group CHB-m,group CHB-s,group LC-d,group LC-c,group ACLF and group Control were compared,the levels of serum IL-18 and IFN-? were significantly increased,and the difference was statistically significant(P<0.05).ACLF group was significantly higher than other groups,the difference between the groups was statistically significant(P<0.05).There was no significant difference between the other groups(P > 0.05).Linear correlation analysis showed that there was a certain correlation between the IL-18 level and IFN-? in the serum of the patients,correlation coefficient(r=0.545,P<0.05).The results suggested that IL-18 may be involved in the progression of chronic hepatitis B.2The relationship between serum IL-18 and liver cell injury and inflammatory response2.1 Analysis of the relationship between serum IL-18 and ALTAccording to the ALT value,the patients were divided into threegroups,including ULN?ALT?2ULN(54cases),2ULN<ALT?5ULN(58cases)and ALT>5ULN(cases),the results show that the level of serum IL-18 increased with the increase of ALT value.The difference was statistically significant(P<0.05),the results suggested that IL-18 may be related to the inflammation and necrosis of liver cells.2.2 The relationship between serum IL-18 and liver inflammation gradingIn 176 cases,there were 57 cases of patients with biopsy of liver biopsy.The serum IL-18 value was not increased with the increase of liver inflammation,the difference was not statistically significant between the groups(P>0.05).3 The relationship between serum IL-18 and hepatic fibrosisThere are 54 cases of hepatic fibrosis in 57 patients with liver disease.With the degree of liver fibrosis increased,the level of IL-18 did not increase,the difference between groups was not statistically significant(P >0.05).4 The relationship between serum IL-18 and chronic hepatitis B in the patients with severe4.1 The relationship between serum IL-18 and serum ALT,TBIL,PTA,ALBThe correlation coefficients of ALT,TBIL,PTA,ALB and IL-18 in serum were(r=0.201,P=0.001),(r=0.247,P=0.001),(r=-0.362,P=0.000),(r=-0.445,P=0.000).The results showed that the serum IL-18 was correlated with ALT,TBIL,PTA and ALB(P < 0.05).4.2 The relationship between serum IL-18 and MELD scoreAccording to MELD scores,the patients with LC-c,LC-d and ACLF were divided into MELD>40 groups and MELD?40 groups,and analysis the relationship between serum IL-18 and MELD score.The results showed that serum IL-18 levels of MELD>40 groups were increased significantly than the MELD?40 groups,and the difference was statistically significant(P <0.05).4.3 The relationship between serum IL-18 and the prognosis of patients with ACLFIn this study,36 patients with ACLF were followed which 11 patientssurvived and 25 patients died.The mean value of serum IL-18 in the survival group was lower than that in the death group,but there was no statistically significant difference(P>0.05).5 The relationship between the levels of IL-18 in serum and the duplication of HBV-DNAAccording to the results of HBV load,the cases were divided into three groups.Analysis of variance display that the serum level of IL-18 had no significant difference between the three groups in the comparison between each other(P>0.05).6 The relationship between serum IL-18 and HBV replicationHBeAg positive group(84 cases)and HBeAg negative group(82 cases)patients with serum IL-18 level of statistical analysis,the results showed that there was not statistically significant(P > 0.05).Conclusions:1 Compared with control group,the level of serum IL-18 of patients with chronic hepatitis B and HBV related cirrhosis and acute liver failure is significantly increased,acute liver failure group increases the most significantly.It suggests that IL-18 may reflect the severity of liver damage,associate with severe chronic hepatitis B.IL-18 may be one of the important mechanisms of liver cell damage after HBV infection.2 The level of HBV-DNA,whether the HBeAg is positive,they are all with no obvious correlation between serum levels of IL-18 patients,it indicates that serum IL-18 itself may be no obvious effect on HBV replication.