HBV相关慢加急性肝衰竭患者T淋巴细胞亚群和体液免疫指标检测的临床意义

Clinical Significance of Detection of T-Lymphocyte Subsets and Humoral Immune Indices in Patients with HBV-Associated Acute-on-chronic Liver Failure

目的探讨乙型肝炎病毒感染相关慢加急性肝衰竭(HBV-ACLF)患者外周血T淋巴细胞亚群和体液免疫指标水平的变化及其临床意义。方法选择HBV-ACLF患者87例,并以健康体检者25例作为正常对照组,分别使用流式细胞仪及其配套试剂检测外周血T淋巴细胞亚群(CD4^+、CD8^+值和CD4^+/CD8^+比值)的水平,使用全自动生化分析仪、采用免疫比浊法检测体液免疫指标(血清IgG、IgM、IgA和补体C3)的水平。比较T淋巴细胞亚群和体液免疫各指标水平的差异。结果与正常对照组比较,早期、中期、晚期3组CD4^+值、CD4^+/CD8^+比值、血清补体C3水平及早期组血清IgG水平均明显降低,早期组CD8^+值、晚期组血清IgG水平均明显升高(均P<0.05);与早期组比较,中期、晚期2组CD4^+、CD8^+值均明显降低和血清IgG水平均明显升高,晚期组CD4^+/CD8^+比值明显升高(均P<0.05);与中期组比较,晚期组血清补体C3水平明显降低(均P<0.05);与无继发感染组比较,继发感染组CD4^+值、CD4^+/CD8^+比值和血清补体C3水平均明显降低(均P<0.05)。结论HBVACLF患者早期、中期、晚期均存在明显的细胞免疫和体液免疫功能紊乱,机体免疫失衡时更易出现感染。

Objective To investigate the dynamic changes in peripheral blood T-lymphocyte subsets and humoral immune indices and their clinical significance in patients with HBV-associated acute-on-chronic liver failure(HBV-ACLF).Methods Eighty-seven HBV-ACLF patients and 25 healthy control subjects were selected in this study.Peripheral blood T-lymphocyte subsets(CD4+,CD8+value,CD4+/CD8+ratio)were determined by flow cytometry.Hhumoral immune indices(IgG,IgM,IgA,complement C3)were measured by immunoturbidimetry using automatic biochemical analyzer.Results Compared with control group,CD4+value,CD4+/CD8+ratio and serum complement C3 concentration decreased in all early-,middle-and late-stage HBV-ACLF groups,serum IgG concentration reduced in early-stage HBV-ACLF group,CD8+value increased in early-stage HBV-ACLF group,and serum IgG concentration elevated in late-stage HBV-ACLF group(P<0.05).Compared with early-stage HBV-ACLF group,CD4+and CD8+value decreased and serum IgG concentration increased in both middle-and late-stage HBV-ACLF groups,and CD4+/CD8+ratio elevated in late-stage HBV-ACLF group(P<0.05).Compared with middle-stage HBV-ACLF group,serum C3 level reduced in late-stage HBV-ACLF group(P<0.05).Compared with patients without secondary infection,CD4+value,CD4+/CD8+ratio and serum C3 concentration decreased in patients with secondary infection(P<0.05).Conclusion Patients with HBV-ACLF had obvious cellular and humoral immune disorder in early,middle and late stages,suggesting that infection is more likely to occur in patients with immune imbalance.