Effects Of Cytomegalovirus And(or) EB Reactivation On Prognosis Of Patients With Liver Failure

BackgroundLiver failure is a serious obstacle to the liver function caused by many factors,its clinical manifestations usually include abnormal liver function,liver biochemical abnormalities,blood coagulation dysfunction,some can progress to hepatic encephalopathy and multiple organ failure and even death.Liver failure can be complicated by a variety of serious complications and the prognosis is poor.The phenomenon of immunologic derangement like the inflammatory factor storm of septicopyemia and immunologic paralysis will appear during the disease,easy to continue a variety of infections(include bacteria,fungi and viruses).Both cytomegalovirus(CMV)and Epstein-Barr virus(EBV)are DNA viruses in herpes diseases with the virological characteristic of latent-activation.When patient is initial infected with two viruses,they can not be cleared up because of their special virological characteristic,viruses can not be monitored by the host immune surveillance so that they can latent for a long time with the potential risk of reactivation.The above viruses will reactivate when the immunity is low,for example,patients who acquired immunodeficiency disease,patients who use immunosuppressive agents in long-term and some cancer patients.In our early work,it has been proved that the reactivation rate of CMV and EBV in the group of gay is higher than normal person.There has been a lot of reactivation study about the CMV in sepsis and the mortality rate of people with sepsis will be increased because of the infection of CMV activation.Many researchers proved the reactivation rate of CMV in patients with chronic hepatitis B and liver failure is higher than normal person obviously.Are CMV and EBV reactivation associated with worsening liver failure? There are no reports.Therefore,in this study,in the course of treatment CMV,EBV infection status were monitored in patients with liver failure,observed in patients with liver failure in CMV and(or)EBV reactivation is aggravating illness,affect the prognosis of patients.At the same time,some inflammatory factors in patients with liver failure were detected to understand the immune status in patients with liver failure and the relationship between these two kinds of virus reactivation.ObjectiveIf the reactivation of Cytomegalovirus(CMV)and/or Epstein-Barr virus(EBV)in patients with liver failure will aggravate the condition and affect the prognosis.Methods1.Collect 35 liver failure patients who were diagnosed in our hospital from November 2015 to November 2016,the standard of diagnosis reference to “Guidelines for diagnosis and treatment of liver failure”.Count the liver function and blood coagulation in patients when they were treated for 2 weeks in hospital,and count peripheral venous blood centrifugated when they were hospitalized and treated for 2 weeks,the upper serum was gathered to be prepared.At the same time,the serums from 25 healthy people were gathered to be the control group.Test the virus quantification and virus-related antibodies in the serum from all groups where can detect CMV and(or)EBV quantitative amplification positive or Ig M antibody positive were considered for viral activation infection.According to the situation of virus activation(with virus activation or without virus activation),divided 35 liver failure patients into virus activation group and non-virus activation group.People who died during they lived in hospital and people who gave up the treatment automatically because of the critical condition were considered as dead.2.Use ELISA to test CMV-Ig G,CMV-Ig M antibody and EBV-VCA-Ig M,EBV-VCA-Ig G antibody of serum sample from all groups;use the real-time fluorescent quantitation method to test the copy number of CMV and virus EBV in serum.;use ELISA to test the concentration in the serum of 4 cytokine in liver failure patients which were treated for 2 weeks and healthy control group,the 4 cytokine is IL-4,IL-10,IL-17 and IFN-r respectively.3.Statistical analysis software SPSS 23.0 was adapted to analyze the data,Median(M)and quartile spacing(Q)show the data which does not conform to the normal distribution.The comparison among groups takes rank sum test,the difference P<0.05 is with the statistical significance.R*C chi-square test is adapted to the comparison of the intermittent rate among groups,Fisher exact probability test will be adapted when n?40 or the minimum theoretical frequency T<1;when n>40 or the minimum theoretical frequency 1?T<5,continuity correction chi-square test will be adapted,P<0.05 is considered statistically significant.Results1.There are 35 patients in liver failure group total,7 liver failure patients are with virus activation,28 patients are non-virus activation,the virus activation rate is 20% in liver failure group,the virus activation rate is 0% in healthy control group,The rate of CMV and / or EBV reactivation in patients with liver failure was significantly higher than that in healthy controls(P<0.05).2.In the liver failure group,the mortality rate is 71.4% who with the virus activation,the mortality rate is 17.85% who without the virus activation,the mortality rate was significantly higher in the liver failure group with the virus activation.The difference is with statistically significant(P <0.05).3.Compare to the liver failure group with non-virus activation,ALT,TB,INR of patients with virus activation is raised obviously(P<0.05),PTA,albumin of them is reduced obviously(P<0.05),AST difference between the liver failure group with virus activation and non-virus activation is no statistically significant.4.Compare to the healthy control group,the concentration of IL-4,IL-10,IL-17 in the serum of liver failure patients with virus activation is raised obviously(P<0.05),IL-10,IL-17 in the serum of liver failure patients with non-virus activation is raised obviously;the concentration of IL-4,IL-10 in the serum of liver failure patients with virus activation is higher than liver failure patients with non-virus activation(P<0.05);the comparison of the concentration of IL-17 between liver failure patients with virus activation and liver failure patients with non-virus activation does not have difference and the statistically significant(P>0.05);the concentration of IFN-r among liver failure patients with non-virus activation,liver failure patients with virus activation and healthy control group does not have the obviously difference(P>0.05).Conclusion1.CMV-Ig G and EBV-VCA-Ig G in 35 liver failure patients were positive which means the latent CMV and EBV are in their bodies,and patients with liver failure are prone to CMV and / or EBV reactivation.2.Reactivation of CMV and / or EBV may aggravate the condition of patients with liver failure,and is closely related to the mortality of patients.3.Revealed in the body of the liver failure patients,the interaction`s presence between proinflammatory and antiinflammatory,and then elevated IL-4 and IL-10 may be associated with viral activation infection.