慢性丙型肝炎和丙型肝炎肝硬化患者外周血Treg和Th17水平变化临床意义探讨

Clinical significance of peripheral blood Treg and Th17 cells in patients with chronic hepatitis C and hepatitis C-induced liver cirrhosis

目的探讨外周血Treg和Th17细胞比率检测在评估HCV感染患者发生肝硬化的临床意义。方法2017年3月~2019年1月我院收治的丙型肝炎肝硬化患者35例、慢性丙型肝炎(CHC)患者31例和同期接受健康体检者66名,采用ELISA法检测血清白细胞介素-6(IL-6)、IL-17和转化生长因子-β(TGF-β)水平,使用流式细胞仪检测外周血Treg和Th17细胞比率。绘制ROC曲线观察各指标预测肝硬化的发生。结果丙型肝炎肝硬化患者血清IL-6、IL-17和TGF-β水平分别为(8.08±2.71)ng/L、(17.01±4.55)ng/L和(5.20±1.35)ng/L,显著高于健康人[分别为(6.64±2.33)ng/L、(12.76±3.46)ng/L和(4.19±1.07)ng/L,P<0.05]或CHC患者[分别为(7.20±2.49)ng/L、(14.12±3.87)ng/L和(4.41±1.20)ng/L,P<0.05],血清高水平的TGF-β能预测肝硬化的发生(AUC=0.963,P=0.000);肝硬化患者外周血Treg细胞比率为(6.27±1.02)%,显著高于CHC患者或健康人[分别为(5.75±0.84)%和(5.37±0.99)%,P<0.05],而Th17/Treg比值为(0.19±0.05),显著低于CHC患者或健康人[分别为(0.23±0.06)和(0.22±0.05),P<0.05];ROC曲线分析显示外周血Treg细胞比率或Th17/Treg细胞比值可有效预测肝硬化[AUC=0.820和AUC=0.607,P=0.000,P=0.041],而TH17细胞对肝硬化无预测价值。结论丙型肝炎肝硬化患者血清TGF-β水平和外周血Treg细胞比率有明显的变化,监测它们的变化可能有助于在慢性丙型肝炎病毒感染者中早期发现肝硬化,做到早诊断、早治疗,对改善预后有重要的临床意义。

Objective The aim of this study was to investigate the clinical significance of peripheral blood Treg and Th17 cells in patients with chronic hepatitis C(CHC)and hepatitis C-induced liver cirrhosis(LC).Methods 35 patients with CHC-induce LC,31 patients with CHC and 66 healthy subjects were enrolled in our hospital between March 2017 and January 2019.Serum interleukin-6(IL-6),IL-17 and transforming growth factor-β(TGF-β)were assayed by ELISA,and peripheral blood Treg and Th17 cells were detected by FCM.The area under ROC curve(AUC)was drawn to observe the predictive value of liver cirrhosis by each parameters.Results Serum IL-6,IL-17 and TGF-βlevels in patients with LC were(8.08±2.71)ng/L,(17.01±4.55)ng/L and(5.20±1.35)ng/L,significantly higher than[(6.64±2.33)ng/L,(12.76±3.46)ng/L and(4.19±1.07)ng/L,respectively,P<0.05]in healthy individuals or[(7.20±2.49)ng/L,(14.12±3.87)ng/L and(4.41±1.20)ng/L,respectively,P<0.05]in patients with CHC,and high serum TGF-βlevel could predict LC(AUC=0.963,P=0.000);peripheral blood Treg cell percentage in patients with LC was(6.27±1.02)%,significantly higher than(5.75±0.84)%and(5.37±0.99)%,respectively(P<0.05)in patients with CHC or in healthy persons,while the ratio of Th17/Treg cells was(0.19±0.05),much lower than(0.23±0.06)and(0.22±0.05),respectively,in patients with CHC or in healthy persons(P<0.05);ROC analysis showed that peripheral blood Treg cell percentage(AUC=0.820,P=0.000)or the ratio of Th17/Treg cells(AUC=0.607,P=0.041)could,while the TH17 cell percentage couldn’t predict the existence of LC.Conclusion Serum TGF-βlevel and peripheral blood Treg cells in patients with hepatitis C-induced LC changes obviously,which might make difference from in patients with chronic hepaitits C and help predict liver disease stage and diagnose LC early.