摘要目的：探讨HBV相关慢加急性肝衰竭（ HBV-ACLF）患者外周血单个核细胞（ PBMC）干扰素诱导蛋白10（IP-10） mRNA的表达与血清HBsAg和HBV DNA水平的相关性及其在预后评估中的价值。方法选取2013年10月至2015年2月湖北文理学院附属医院收治的80例HBV-ACLF患者、60例慢性乙型肝炎（ CHB ）患者和25名健康体检者，采用荧光定量PCR法检测HBV-ACLF、CHB患者和健康体检组PBMC中IP-10 mRNA的表达，组间差异的比较用方差分析。检测HBV-ACLF患者血清HBsAg和HBV DNA水平，采用Pearson检验分析IP-10 mRNA表达与血清HBsAg和HBV DNA水平的相关性。恩替卡韦抗病毒治疗3个月，采用t检验比较HBV-ACLF患者生存组与死亡组IP-10 mRNA、HBsAg和HBV DNA的差异，采用受试者工作特征曲线（ ROC）评价IP-10 mRNA、HBsAg和HBV DNA在HBV-ACLF预后评估方面的价值。结果 HBV-ACLF患者、CHB患者和健康体检者PBMC中IP-10 mRNA水平分别为0.998±0.186、0.641±0.083和0.412±0.062，且HBV-ACLF患者IP-10 mRNA水平明显高于CHB组和健康对照组（ t＝3.841和16.661，P＜0.01）。 Pearson相关性分析显示，外周血IP-10 mRNA水平与血清HBsAg水平呈负相关（r＝－0.576， P＜0.01），与血清HBV DNA水平呈正相关（r＝0.547， P＜0.01）。 HBV-ACLF生存组外周血IP-10 mRNA水平平均为0.894±0.164，低于死亡组的1.103±0.177（t＝－4.328，P＜0.01）；生存组血清HBsAg水平平均为3.303±0.565，高于死亡组的2.605±0.844（t＝3.251，P＜0.01）。 ROC分析显示，IP-10 mRNA预测疾病预后的曲线下面积（AUC）为0.820，高于HBsAg（0.663）和HBV DNA（0.570）。结论 HBV-ACLF患者PBMC中IP-10 mRNA表达增高，与患者血清HBsAg和HBV DNA水平密切相关，且IP-10 mRNA水平能更好地预测HBV-ACLF患者的预后。

abstractsObjective To investigate the correlations of expression of interferon inducible protein 10 ( IP-10) mRNA in peripheral blood mononuclear cells ( PBMCs) with serum levels of HBsAg and HBV DNA&nbsp;in patients with HBV-related acute on chronic liver failure ( HBV-ACLF ) , and to assess its value in predicting disease prognosis .Methods Eighty patients with HBV-ACLF, 60 patients with chronic hepatitis B (CHB), and 25 healthy subjects were enrolled during October 2013 and February 2015.IP-10 mRNA in PBMCs was measured by real time quantitative polymerase chain reaction ( RT-qPCR) , and the difference in IP-10 mRNA expression among three groups was compared by ANOVA .Serum levels of HBsAg and HBV DNA were also measured in patients with HBV-ACLF, and Pearson correlation test was performed to analyze the correlations of IP-10 mRNA with HBsAg and HBV DNA levels .t test was used to analyze the differences in IP-10 mRNA, HBsAg and HBV DNA levels between fatal and surviving cases after 3-month entecavir therapy in HBV-ACLF group.Receiver operating characteristic curves ( ROC) was used to evaluate the prognostic value of IP-10 mRNA, HBsAg and HBV DNA in HBV-ACLF patients .Results IP-10 mRNA level in HBV-ACLF group was 0.998 ±0.186, which was higher than those in CHB patients and healthy controls (0.641 ±0.083 and 0.412 ±0.062, t=3.841 and 16.661, P<0.01).Pearson correlation analysis showed that IP-10 mRNA level was negatively correlated with HBsAg level in HBV-ACLF patients (r=-0.576, P<0.01), but positively correlated with HBV DNA level (r=0.547, P<0.01).After 3-month entecavir therapy , IP-10 mRNA level in surviving cases of HBV-ACLF group was 0.894 ±0.164, which was lower than that in fatal cases ( 1.103 ±0.177, t =-4.328, P <0.01 ); HBsAg level in surviving cases was higher than that in fatal cases (3.303 ±0.565 vs.2.605 ±0.844, t =3.251, P<0.01).The area under ROC of IP-10 mRNA in evaluating prognosis of HBV-ACLF was 0.820, which was higher than those of HBsAg (0.663) and HBV DNA (0.570).Conclusions IP-10 mRNA in patients with HBV-ACLF is over-expressed and is correlated with HBsAg and HBV DNA levels .It may be used for predicting the prognosis of patients with HBV-ACLF.