血清Th17、IL-17与HBV相关性慢加亚急性、慢性肝衰竭的相关性

Correlation of serum Th17、IL-17and HBV-related sub-acute、chronic liver failure

目的分析T辅助细胞17(Th17)和白细胞介素17(IL-17)在乙型肝炎病毒(HBV)相关性慢加亚急性肝衰竭(SACLF)、慢性肝衰竭(CLF)患者中的表达水平,探讨其对预后判断的意义。方法 HBV相关性肝衰竭43例、慢性乙型肝炎(CHB)29例、失代偿性肝硬化24例和健康对照者16例,采用流式细胞技术和ELASA法检测外周血Th17和IL-17水平。分析其结果,并与肝功能、凝血酶原时间(PT)和HBVM进行相关性分析。评估Th17和IL-17对预后判断的价值。结果Th17与AST、TBil、PT、IL-17呈正相关,与ALB、CHE呈负相关(P<0.05)。IL-17与TBil、PT呈正相关,与ALB呈负相关(P<0.05)。Th17、IL-17与HBsAg呈负相关(P<0.05)。肝衰竭患者Th17表达高于失代偿性肝硬化、CHB及健康人群(P<0.01),IL-17表达水平高于CHB和健康人群(P<0.01)。死亡患者Th17表达水平高于病情好转患者(P<0.05)。将Th17>8.5%联合iMELD>47.18作为对短期内死亡的判断标准,灵敏度为61.11%,特异性为91.49%。结论 Th17和IL-17与肝脏的损伤程度密切相关,Th17表达水平可作为疾病严重程度以及患者短期预后的判断指标之一。

Objective To analyze the expressions of T helper 17 （Thl7） and IL-17 in the patients with hepatitis B virus（HBV）-related subacute and chronic liver failure（SACLF） and chronic liver failure（CLF）, and to explore their significance in predicting prognosis. Methods The expressions of Thl7 and IL-17 in peripheral blood were detected by flow cytometry and ELISA in 43 patients with HBV-related liver failure,29 cases with chronic hepatitis B（CHB）,24 cases with decompensated liver cirrhosis and 16 healthy people. The results were compared to AST, total bilirubin （TBil） and prothrombin time （PT）. The significance in predicting prognosis was evaluated. Results The expression of Thl7 was positively correlated to AST, TBil, PT and ILqT, but negatively correlated to albumin （ALE） and cholinesterase （CHE） （ P〈0.05 ）. The expression of IL-17 was positively correlated to TBil and PT,but negatively correlated to ALB（P〈0. 05）. The expressions of Thl7 and IL17 were negatively correlated to HBsAg（P（0. 05）. Serum level of Thl7 was higher in the patients with liver failure than that in those with deeompensated liver cirrhosis, CHB and healthy people （P〈0. 01）. IL17 expression was higher in patients with liver failure than that in those with CHB and healthy people （P〈0. 0l）. The level of Th17 was higher in the died than that in the survivals （P〈0. 05）. Taking Th17〉8. 5% and a comprehensive model for end-stage liver disease（iMELD）〉 47.18 as the cut-off values for shorvterm death, the sensitivity was 61.11% and the specificity was 91.49%. Conclusion Serum levels of Th17 and IL-17 are closely related to the severity of hepatic injury. The level of Th17 expression could be taken as one of the markers for evaluating the severity and predicting the short-term prognosis in the patients with liver failure.