外周血T细胞对HBV-SACLF预测作用的研究

Study of peripheral blood T cells to predicting the prognosis of chronic hepatitis B virus liver failure

目的探讨辅助性T细胞(Th)22、Th1及Th17细胞在乙型肝炎病毒-慢加亚急性肝衰竭(HBV-SACLF)中的表达及其对肝衰竭发生的预测作用。方法收集2015年3月至2016年2月在高邮市人民医院住院的30例普通乙型肝炎患者(乙型肝炎组)、39例HBV-SACLF患者(HBV-SACLF组)和30例健康对照者(健康对照组)外周血标本,釆用流式细胞术检测各组外周血Th22、Th1、Th17水平并进行比较,观察早期、中期及晚期HBV-SACLF患者外周血Th22、Th1、Th17水平,分析其对HBV-SACLF的预测价值。结果 HBV-SACLF组患者外周血Th22、Th1、Th17水平均明显高于乙型肝炎组和健康对照组,差异均有统计学意义(P<0.05)。HBV-SACLF晚期Th22、Th1、Th17水平均明显高于中期和早期,中期Th22、Th1、Th17水平均明显高于早期,差异均有统计学意义(P<0.05)。HBV-SACLF组患者外周血中Th1与Th17、Th22均呈正相关(r=0.715、0.579,P<0.05),Th17与Th22呈明显正相关(r=0.693,P<0.05)。Th1、Th17及Th22分别与总胆红素、终末期肝模型评分呈正相关(P<0.05),与清蛋白呈负相关(P<0.05),与谷草转氨酶、谷丙转氨酶及HBV-DNA无相关性(P>0.05)。Th22、Th1、Th17联合检测曲线下面积与三者单项检测比较,差异均无统计学意义(P>0.05)。结论 HBV-SACLF外周血Th22、Th1、Th17水平能够反映病情的严重程度,且在预测HBV-SACLF发生方面有一定价值。

Objective To investigate the expression of Th22,Th1 and Th17 cells in hepatitis B virus-slow subacute liver failure（HBV-SACLF）and predict the occurrence of liver failure. Methods The peripheral blood samples from 30 patients with hepatitis B（hepatitis B group）,39 patients with HBV-SACLF（HBV-SACLF group）and 30 healthy controls（control group）were collected. The levels of Th22,Th1,and Th17 in peripheral blood of each group were measured by flow cytometry and compared.The levels of Th22,Th1,and Th17 in peripheral blood of patients with HBV-SACLF during the early,mid-dle,and late stages were observed,and the predictive value of HBV-SACLF were analyzed. Results The levels of Th1,Th17,and Th22 in peripheral blood of HBV-SACLF patients were significantly higher than those in hepatitis B group and controlgroup,with statistically significant differences（P〈0.05）. The proportions of Th22,Th1,and Th17 in the late stage of HBV-SACLF were significantly higher than those in the middle and early stages（P〈0.05）;the proportions of Th22,Th1,and Th17 in the middle stage of HBV-SACLF were significantly higher than those in the early stage,and the differences were statistically significant（P〈0.05）. In the HBV-SACLF group,there were positive correlation between Th22,Th1,and Th17 in the peripheral blood（r=0.715、0.579,P〈0.05）,and there were positive correlation between Th17 and Th22（r=0.693,P〈0.05）. Th22,Th1,and Th17 were positively correlated with total bilirubin and end-stage liver model scores（P〈0.05）,and negatively correlated with albumin（P〈0.05）.Th22,Th1,and Th17 had no correlation with aspartate amino transferase,alanine amino transferase,andHBV-DNA（P〉0.05）. There was no significant difference in the combined detection compared with single detection（P〉0.05）.Conclusions HBV-SACLF peripheral blood Th22,Th1,and Th17 levels can reflect the severity of the disease,and have some value in predicting the occurrence of SACLF.