| Objective:The study was to investigate the mechanism of oxidative stress in pathogenesis of acute-on-chronic hepatitis B liver failure (ACHBLF). By detecting the activity of xanthine oxidase (XOD) in the serum from patients with ACHBLF, and analyzing the correlation between the XOD activity and other parameters including serum total bilirubin (TBIL), prothrombin activity (PTA), HBVDNA levels, MELD points, data suggest the importance the oxidation in progession of ACHBLF, and the possibility of applying oxidative stress detection in prognosis of these liver diseases.Material and Methods:Patients were categorized into six groups:group A, healthy control,20 cases,10 males and 10 females; group B, CHB patients (PTA normal and TBIL<10×ULN),25 cases,19 males and 6 females; group C,20 patients with the tendency to severe hepatitis(40%<PTA<75% and TBIL≥10×ULN),13 males and 7 females; group D-F, ACHBLF, including:group D, patients in early stage (30%<PTA≤40%),20 cases 17 males and 3 females; group E, medium stage,10 cases (20%<PTA≤30%),10 males; group F, the end stage (PTA≤20%),9 cases (8 males and 1 female). All patients were diagnosed according to the diagnostic standards from "the Prevention and Treatment of Chronic Hepatitis B" and "Liver failure treatment guidelines" in 2006, and no of them was found to have any other system diseases. The venous blood specimen was collected, serum was separated and stored in the freezer (-80℃).The activity of XOD was measured by chemical chromometry by using the detetion kit (Nanjing Jiancheng Bioengineering Institute). The instructions and protocols were strictly followed. The statistic analysis were conducted by comparing between each two groups by using Student t test. Finally, the correlation between the level of XOD activity and TBIL, HBVDNA, PTA,MELD points in all the patients were respectively analyzed.Results:1,Both the males and females in the group A have a similar level of the XOD activity without significant difference (P>0.05).2,By comparing with group A, the activities of XOD all increased significantly in group B, C, ACHBLF (P<0.05); the highest was found in group ACHBLF, significantly higher than the activities in group B and C(P<0.05); moreover, group C has a higher level of XOD than B (P<0.05).3,Among the patients (TBIL≥10×ULN) ie. group C, D, E and F, the strongest activity of XOD in the serums was from group F, significantly higher than group C, D and E (P<0.05); the activities of XOD were significantly higher in group E and D than in group C (P<0.05); the activity of XOD in group E was higher than in group D, but the difference was not statistically significant (P>0.05).4,Among the patients (TBIL≥10×ULN) ie. group C, D, E and F, the activity of XOD had a positive correlation with level of serum TBIL and MELD (r=0.691, r=0.443, P<0.05) and a negative correlation with level of PTA (r=-0.860, respectively; P<0.05); no significant correlation with level of serum HBV-DNA (r=0.08, P>0.05).Conclusions:1,The activity of XOD in the serums of hepatitis patients was significantly higher compared with the healthy controls. The increase was also shown from the patients with CHB to patients with severe hepatitis and ACHBLF, indicating that oxidative damage s were accumulating along with the development and progression of hepatitis. The observations also suggests detecting the oxidative stress states could be served as the early prognosis of ACHBLF and anti-oxidation was important in the treatment. 2. The activity of XOD in the serums of patients (TBIL≥10×ULN) had a significant correlation with levels of TBIL, PTA and MELD, suggesting that the activity of XOD was increased with the degree of hepatic failure. Therefore, XOD activity could be helpful to be a biomarker for diagnose, monitor the critical ill patient and evaluate the prognosis.3,No correlation was found between activity of XOD in patients (TBIL≥10×ULN) and level of HBV-DNA, suggesting that no correlation was found between degree of oxidative stress in patients (TBIL≥10×ULN) and level of HBV-DNA. |
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