| Liver cirrhosis can be developed from various chronic liver diseases,and with the appearance of necrosis of hepatocytes,excessive deposition of fibrous tissue,formation of regenerated nodules and pseudolobules in histology,complications such as hepatic encephalopathy,gastrointestinal hemorrhage,hypersplenism,ascites may occur in decompensation period.The etiology of liver cirrhosis is diverse,most of them are post-hepatitis B cirrhosis in China.According to the statistics,the number of people who have been infected with HBV in the world is as high as 2 billion,and about 10% or 20% of them died of cirrhosis caused by HBV infection and its complications,which is a serious threat to human health.Therefore,it is very critical that clinicians could timely and accurately make early detection,diagnosis and treatment in patients with hepatitis B liver cirrhosis,in order to alleviate the liver cell injury and delay the progression of the disease.Hepatitis B liver cirrhosis can be developed by hepatic fibrosis on the basis of hepatic stellate cell activation,differentiation and extra cellular matrix deposition.,and it is the result of the interaction among pathogenic antigen,hepatocyte function and immune system.In the progression and clinical outcome of liver fibrosis and cirrhosis,the role of immune response and immune microenvironments are being gradually recognized and studied,therefore,inhibition of liver immune inflammation is the key to the treatment of liver fibrosis and cirrhosis.In vivo,1,25(OH)2D3 is the active form of vitamin D after synthesis and hydroxylation,and related to the occurrence,development and treatment of immune-related diseases.In particular,it plays an important role in anti-fibrosis by inhibiting the activation and proliferation of HSC and promoting its apoptosis by binding to VDR.The cytokine is an immune-responsive molecule secreted by activated lymphocytes and monocytes.Macrophage migration inhibitory factor,interleukin 10 and interleukin 17 are involved in the immune response and inflammation through the regulation of cellular and humoral immunity,and closely related to the occurrence and development of chronic liver disease.Objective:In this study,through detecting the expressions of serum 1,25(OH)2D3,MIF,IL-10 and IL-17 in patients with hepatitis B liver cirrhosis,to analyze the correlation between them and the severity of the disease and the clinical parameters.To investigate the changes of these parameters in the progression of patients with hepatitis B liver cirrhosis,provide new ideas and directions for the assessment of the disease,the judgment of the prognosis and the formulation of the treatment scheme.And prevent the progression to the decompensated liver cirrhosis and the occurence of complications and malignant tumors of liver.Methods:Sixty patients with hepatitis B liver cirrhosis were selected as experimental group and divided into three groups according to the Child-Pugh classification.In the same period 20 healthy persons were selected as control group.ELISA was used to detect the levels of 1,25(OH)2D3,MIF,IL-10 and IL-17 in the experimental and control groups,and to analyze the correlation between them and ALT,AST,TBil,PT,ALB.Results:1.The average age of the experimental group was higher than that of the control group(P < 0.01),and there was no significant difference between the two groups in sex,BMI,residence status and blood pressure(P > 0.05).2.Compared with the control group,the concentrations of ALT,AST,TBIL,PT were higher in the experimental group,and the content of ALB was lower in the experimental group,and the differences were statistically significant(P < 0.05).3.Compared with the control group,the concentrations of 1,25(OH)2D3 and IL-10 were lower in the experimental group,and the content of MIF and IL-17 were higher in the experimental group,and the differences were statistically significant(P < 0.01).4.In the experimental group,the expression of 1,25(OH)2D3 and IL-10 were gradually decreased with the increase of Child-Pugh classification,and the expression of MIF and IL-17 were increased with the increase of Child-Pugh classification,and the differences between each group were statistically significant(P < 0.05).5.In the experimental group,a positive correlation between 1,25(OH)2D3 and IL-10 was found(r=0.289,P<0.05),and there was a negative correlation with MIF and IL-17(r =-0.607,-0.447,P < 0.01).6.In the experimental group,there was a negative correlation between 1,25(OH)2D3 and TBIL,PT(r=-0.307,-0.407,P<0.05),and a positive correlation with ALB(r=0.600,P<0.01).There was a negative correlation between MIF and AST,ALB(r=-0.319,-0.736,P<0.05),and a positive correlation with TBIL,PT(r=0.564,0.633,P<0.01).There was a negative correlation between IL-10 and TBIL,PT(r =-0.345,-0.448,P<0.01),and a positive correlation with ALB(r=0.381,P<0.01).There was a negative correlation between IL-17 and ALT,AST,ALB(r=-0.338,-0.424,-0.598,P<0.01),and a positive correlation with TBIL,PT(r=0.561,0.525,P<0.01).There was no correlation between 1,25(OH)2D3,MIF,IL-10 and ALT(P>0.05).Conclusion:1.The expression of 1,25(OH)2D3 in patients with hepatitis B liver cirrhosis was lower than that of the control group,and decreased gradually with the increase of Child-pugh classification,which was related to the immune state and the function of hepatocytes in vivo.The results suggest that the serum level of 1,25(OH)2D3 in patients with hepatitis B cirrhosis could be used to evaluate the degree of liver injury and judge the progression and prognosis of the disease.It may play a protective role in the pathogenesis of cirrhosis and provide new ideas for the treatment of cirrhosis.2.The expression of IL-10 in patients with hepatitis B liver cirrhosis was lower than that of control group,the expression of MIF and IL-17 were higher conversely.They all related to the severity of liver cirrhosis and liver function.And they could be used to judge the progression,prognosis and outcome of the hepatitis B liver cirrhosis.3.In this study,a positive correlation was found between 1,25(OH)2D3 and IL-10,and a negative correlation with MIF,IL-17,suggesting that vitamin D may delay the progression of liver fibrosis and cirrhosis by exerting the immunomodulatory effection,regulating the expression of cytokines and improving the immune microenvironment. |
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