目的探究血清白细胞介素-17(IL-17)及IL-17-197A/G位点单核苷酸多态性与乙型病毒性肝炎易感性。方法选择2017年1月-2019年3月于华中科技大学同济医学院附属武汉中心医院就诊的乙型肝炎病毒(Hepatitis B virus,HBV)感染患者200例为研究对...目的探究血清白细胞介素-17(IL-17)及IL-17-197A/G位点单核苷酸多态性与乙型病毒性肝炎易感性。方法选择2017年1月-2019年3月于华中科技大学同济医学院附属武汉中心医院就诊的乙型肝炎病毒(Hepatitis B virus,HBV)感染患者200例为研究对象,其中自限性HBV感染组48例、无症状慢性HBV携带组31例、慢性乙型肝炎组75例、慢性乙型肝炎肝硬化组46例。采用PCR技术检测IL-17-197G/A位点的单核苷酸多态性;采用荧光定量PCR检测HBV-DNA载量;检测肝功能指标[丙氨酸氨基转移酶(Alanine aminotransferase,ALT)、天冬氨酸氨基转移酶(Aspartate aminotransferase,AST)、总胆红素(Total bilirubin,TBIL)]和血清IL-17水平。结果慢性乙型肝炎肝硬化组患者的AA、AG、GG基因型频率分别为73.91%(34/46)、15.22%(7/46)、10.87%(5/46)与其他三组比较,差异有统计学意义(P<0.05);慢性乙型肝炎肝硬化组的A等位基因频率为81.52%高于自限性HBV感染组15.63%和慢性乙型肝炎组36.67%(P<0.05);慢性乙型肝炎肝硬化组高病毒载量者的IL-17为(6.68±0.72)pg/ml高于低病毒载量者(P<0.05);慢性乙型肝炎肝硬化组ALT>40 U/L、AST>40 U/L、TBIL>20μmol/L患者的IL-17分别为(6.92±0.74)U/L、(8.97±0.69)U/L、(6.96±0.67)μmol/L高于ALT、AST、TBIL低水平者(P<0.05)。结论IL-17高水平与乙型肝炎病毒感染慢性化进程有关,IL-17-197G/A位点基因型单核苷酸多态性可能与HBV感染有关,A等位基因可能为易感基因,AA基因型可能增加了HBV感染的不良转归。展开更多
Endoscopic therapy（ET） is most common method for preventing variceal bleeding in cirrhosis, but the outcomes are not perfect. Recently, transjugular intrahepatic portosystemic shunt（TIPS） is introduced into clinic...Endoscopic therapy（ET） is most common method for preventing variceal bleeding in cirrhosis, but the outcomes are not perfect. Recently, transjugular intrahepatic portosystemic shunt（TIPS） is introduced into clinical practice. However, the beneficial effects of TIPS compared to ET on cirrhotic patients is unknown. The aim of this study was to evaluate and compare the effects of TIPS with those of the most frequently used ET for prevention of variceal rebleeding（VRB） in liver cirrhosis. The PubMed, EMBASE, and Cochrane Library databases were searched from inception to February 2017. The primary study outcomes included the incidence of VRB, all-cause mortality, bleeding-related death, and the incidence of post-treatment hepatic encephalopathy（PTE）. The odds ratios（ORs） with 95% confidence intervals（CI） were pooled for dichotomous variables. Subgroup analyses were performed. Twenty-four studies were eligible and they included 1120 subjects treated with TIPS and 1065 subjects treated with ET. Although there was no significant difference in survival and PTE, TIPS was superior to ET in decreasing the incidence of VRB（OR=0.27; 95% CI, 0.19–0.39, P〈0.00001）, and decreasing the incidence of bleeding-related death（OR=0.21; 95% CI, 0.13–0.32, P〈0.00001）. Subgroup analysis found a lower mortality（OR=0.48; 95% CI, 0.23–0.97; P=0.04） without any increased incidence of PTE（OR=1.37; 95% CI, 0.75–2.50; P=0.31） in the studies of a greater proportion（≥40%） of patients with Child-Pugh class C cirrhosis receiving TIPS, and TIPS with covered stent did not increase the risk of PTE compared to ET（OR=1.52, 95% CI =0.82–2.80, P=0.18）. It was concluded that TIPS with covered stent might be considered the preferred choice of therapy in patients with severe liver disease for secondary prophylaxis.展开更多
基金supported by the Natural Science Foundation of Central Hospital of Wuhan(No.YQ16B01)
文摘Endoscopic therapy（ET） is most common method for preventing variceal bleeding in cirrhosis, but the outcomes are not perfect. Recently, transjugular intrahepatic portosystemic shunt（TIPS） is introduced into clinical practice. However, the beneficial effects of TIPS compared to ET on cirrhotic patients is unknown. The aim of this study was to evaluate and compare the effects of TIPS with those of the most frequently used ET for prevention of variceal rebleeding（VRB） in liver cirrhosis. The PubMed, EMBASE, and Cochrane Library databases were searched from inception to February 2017. The primary study outcomes included the incidence of VRB, all-cause mortality, bleeding-related death, and the incidence of post-treatment hepatic encephalopathy（PTE）. The odds ratios（ORs） with 95% confidence intervals（CI） were pooled for dichotomous variables. Subgroup analyses were performed. Twenty-four studies were eligible and they included 1120 subjects treated with TIPS and 1065 subjects treated with ET. Although there was no significant difference in survival and PTE, TIPS was superior to ET in decreasing the incidence of VRB（OR=0.27; 95% CI, 0.19–0.39, P〈0.00001）, and decreasing the incidence of bleeding-related death（OR=0.21; 95% CI, 0.13–0.32, P〈0.00001）. Subgroup analysis found a lower mortality（OR=0.48; 95% CI, 0.23–0.97; P=0.04） without any increased incidence of PTE（OR=1.37; 95% CI, 0.75–2.50; P=0.31） in the studies of a greater proportion（≥40%） of patients with Child-Pugh class C cirrhosis receiving TIPS, and TIPS with covered stent did not increase the risk of PTE compared to ET（OR=1.52, 95% CI =0.82–2.80, P=0.18）. It was concluded that TIPS with covered stent might be considered the preferred choice of therapy in patients with severe liver disease for secondary prophylaxis.
