人工肝血浆置换治疗对肝功能衰竭患者移植相关免疫功能的影响

Influence of plasma exchange on transplantation-related immune function in the liver failure patients

目的 探讨人工肝血浆置换（PE）治疗前后肝功能衰竭患者外周血T淋巴细胞亚群及白细胞介素（IL）-17等移植相关免疫指标变化的临床意义。方法 将28例肝移植术后肝功能衰竭患者和20例肝功能衰竭患者分别纳入研究组和对照组,采集PE术前、术后即刻、术后1 d和术后2 d的外周抗凝血和血清,应用流式细胞技术分别检测不同时间段T淋巴细胞亚群百分计数,应用酶联免疫吸附试验（ELISA）法检测血清IL-17浓度变化。结果 肝移植组患者治疗前的CD3-＋T细胞[（58.12±4.98）%]、CD4-＋T细胞[（28.85±4.18）%]和CD4-＋/CD8-＋比值（1.18）显著低于对照组,而CD4-＋CD25-＋Foxp3-＋T细胞[（10.58±5.01）%]则高于对照组。PE治疗后移植组患者的CD3-＋T细胞迅速增高到（66.07±4.75）%,CD4-＋T细胞增高到（37.16±3.89）%,CD4-＋/CD8-＋比值由1.18升高到1.35。CD4-＋CD25-＋Foxp3-＋T细胞百分计数在后当天即明显降低至（6.89±4.98）%,而后逐渐上升至术前水平。PE治疗对对照组患者T细胞亚群有类似作用,但作用强度低于对移植后患者。移植组患者PE治疗前的IL-17浓度[（85.175±50.151）ng/L]显著低于对照组[（198.042±80.985）ng/L],PE术后2组患者IL-17均即刻显著升高,而且移植组患者IL-17升高幅度比对照组更为明显。结论 肝移植后肝功能衰竭患者处于免疫抑制状态,PE治疗后细胞免疫功能显著增强,在稳定内环境和同时可能导致排异反应的加剧。

Objective To evaluate the influence of plasma exchange （PE） on the transplantationrelated immune function of patients with liver failure. Methods Twenty-eight patients pastransplantation and 20 patients with liver failure were included in the study prospectively. The peripheral blood samples were collected at the set time points. The percentages of T lymphocytes were detected by flow cytometer with dif ferent fluorescence labels including CD3-fluoreseeine isothiocyanate （FITC）, CD4-peridinin chlorophyll protein （ PerCP）, CD8-phycoerylhrin （PE）, CD25-FITC and Foxp3-PE. The changes of interleukin （ IL）-17 concentration were identified by enzyme linked immunosorbent assay （ELISA）. Results The percent countings of CD3＋ T cells [（58. 12 ±4.98）%], CD4＋ T cells [（28.85 ±4. 18）%] and CIM＋/CDf＋＋ ratio （1.18） in patients post-transplantation were significantly lower than those in regular patients. After PE treatment, in patients post-transplantation, the percent counting of CD3 ＋ T ceils, CD4 ＋ T cells and CD4 ＋/CD8 ＋ ratio were increased to （66.07 ± 4.75 ）%, （37. 16 ±3.89）% and 1.35, respectively, after the procedure and then reduced back gradually. The ratio of CD4 ＋ CD25 ＋ Foxp3 ＋ T cells （Treg） was decreased to （ 6. 89 ± 4. 98 ） % immediately after treatment. The similar changes were observed as well in control group, however, the effects were less apparent than those in transplantation group. The concentration of IL-17 was lower in transplantation group [ （85. 175 ± 50. 151 ） ng/L] and increased significantly in both groups following PE at very early stage. The change was more remarkable in transplantation group. Conclusion PE treatment is meaningful in accommodation of the cellular immune function of patients post-transplantation and the transplant rejection could be aggravated.