乙型肝炎病毒相关慢加亚急性肝功能衰竭患者外周血Th17、Treg、Th17/Treg比值的变化及与MELD评分的相关性

Th17,Treg and Th17/Treg in peripheral blood of patients with hepatitis B virus-related subacute-on-chronic liver failure and their relevance with model for end-stage liver disease score

目的探讨乙型肝炎病毒相关慢加亚急性肝功能衰竭(SACLF)患者外周血Th17、Treg、Th17/Treg比值变化及评估预后的意义。方法采用流式细胞仪分别检测42例SACLF患者(SACLF组)、20例慢性乙型肝炎(CHB)患者(CHB组)以及20例健康人(健康对照组)外周血Th17、Treg、Th17/Treg的比值。研究SACLF组Th17/Treg与终末期肝病评分(MELD)的相关性。结果 SACLF组及CHB组Th17频数分别为(2.51±0.57)%、(0.96±0.35)%,均较健康对照组(0.34±0.22)%明显升高(P<0.05);SACLF组与CHB组比较差异有统计学意义(P<0.05)。SACLF组Treg频数较健康对照组升高(P<0.05);CHB组Treg频数与健康对照组比较差异无统计学意义(P>0.05);SACLF组与CHB组间比较差异有统计学意义(P<0.05)。SACLF组及CHB组患者Th17/Treg比值分别为(0.43±0.16)、(0.23±0.18),均较健康对照组(0.07±0.15)明显升高(P<0.05),且SACLF组与CHB组间比较差异有统计学意义(P<0.05)。SACLF患者MELD评分与Th17、Th17/Treg与呈正相关(r=0.647、0.566,P<0.05),与Treg无明显相关性(P>0.05)。结论 Th17/Treg失衡可能是乙型肝炎重症化的机制之一,SACLF组免疫失衡程度尤其是Th17的升高均与预后呈正相关。

Objective To investigate the changes of T helper 17（Th17）,regulatory T cells（Treg）and Th17/Treg in peripheral blood of patients with HBV-related subacute-on-chronic liver failure（SACLF）and their prognostic significance.Methods Th17,Treg and Th17/Treg were detected in 42 patients with SACLF,20 patients with chronic hepatitis B（CHB）and 20 cases of normal control group by flow cytometry.The relationship between Th17/Treg and MELD were evaluated in patients with SACLF.Results Th17 of SACLF group（2.51±0.57）%,was significantly higher than CHB patients and health control,（5.84±1.50）%,（4.82±1.43）%（P〈0.05）;Treg of SACLF group was also significantly higher than CHB group and healthy control（P〈0.05）;but there was no statistically significant difference in Th17 and Treg between CHB group and healthy control（P〉0.05）;The Th17/Treg in SACLF group and the CHB group 0.43±0.16 and 0.23±0.18,respectively,both increased significantly compared with healthy control,0.07±0.15（P〈0.05）,and the difference between SACLF group and CHB group was also statistically significant（P〈0.05）.The MELD score of SACLF group,was positively correlated with Th17 and Th17/Treg（r=0.65,0.57,P〈0.05）,but no obvious correlation with Treg was found（P〉0.05）.Conclusion The imbalance of Th17/Treg may participate in the pathogenesis of severe hepatitis B,and its imbalance extents,especially the rise of Th17,which was positively correlated with prognosis.