肝硬化门静脉高压患者免疫功能及血清细胞因子水平变化分析

An Analysis on Changes in Immune Function and Serum Cytokines Levels in Patients with Cirrhotic Portal Hypertension

目的探究肝硬化门静脉高压患者免疫功能及血清C反应蛋白(CRP)、降钙素原(PCT)、前列腺素E(PGE)等因子变化情况。方法选择2014年2月至2019年3月我院收治的81例肝硬化门静脉高压患者及50例健康志愿者作为研究对象,分别纳入门静脉高压组及对照组。测定天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、白蛋白(ALB)、总胆红素(TBIL)、门静脉内径(Pvd)指标;测定CD3^+、CD4^+、CD8^+T淋巴细胞比例、CD4^+/CD8^+水平及血清CRP、PCT、PGE等细胞因子水平。结果①门静脉高压组ALT、AST、TBIL、Dpv等指标显著高于对照组(P<0.05),ALB显著低于对照组(P<0.05)。②门静脉高压组患者CD3^+、CD4^+T淋巴细胞亚群计数及CD4^+/CD8^+显著低于对照组(P<0.05),CRP、PCT、PGE等细胞因子指标高于对照组(P<0.05)。③随肝功能分级的升高,患者CD3^+、CD4^+T淋巴细胞亚群比例及CD4^+/CD8^+降低,血清CRP、PCT、PGE水平升高,差异具有统计学意义(P<0.05)。④Spearman相关性分析示,肝功能分级与CD4^+、CD4^+/CD8^+等免疫指标呈负相关(P<0.05),与CRP、PCT、PGE水平呈正相关(P<0.05);Pearson相关性分析示,Dpv与CD4^+/CD8^+呈负相关,与PCT、PGE水平呈正相关(P<0.05)。结论肝硬化门静脉高压患者可出现免疫功能失调及细胞因子紊乱,这一变化与肝功能及门静脉压力相关,临床可将其作为评估患者病情的参考指标。

Objective To explore changes in immune function,levels of serum C-reactive protein(CRP),procalcitonin(PCT)and prostaglandin E(PGE)in patients with cirrhotic portal hypertension(CPH).Methods 81 CPH patients who were admitted to the hospital and 50 healthy volunteers during the period from February,2014 to March,2019 were enrolled for the study.They were divided into the portal hypertension group and control group,respectively.The liver function indexes[aspartate aminotransferase(AST),alanine aminotransferase(ALT),albumin(ALB),total bilirubin(TBIL)]were measured for all the patients.The proportion of CD3^+,CD4^+and CD8^+T lymphocytes,CD4^+/CD8^+,levels of serum CRP,PCT and PGE were measured as well.Results①ALT,AST,TBIL and Dpv in the portal hypertension group were significantly higher than those in the control group(P<0.05),while ALB was significantly lower than that in the control group(P<0.05).②The counts of CD3^+and CD4^+T lymphocyte subsets,and CD4^+/CD8^+in the portal hypertension group were significantly lower than those in the control group(P<0.05),while cytokines such as CRP,PCT and PGE were higher than those in the control group(P<0.05).③With the increase of liver function grading,proportion of CD3^+and CD4^+T lymphocyte subsets,and CD4^+/CD8^+were decreased,while levels of serum CRP,PCT and PGE were increased(P<0.05).④Spearman correlation analysis showed that liver function grading was negatively correlated with immune indexes such as CD4^+and CD4^+/CD8^+(P<0.05),while positively correlated with levels of CRP,PCT and PGE(P<0.05).Pearson correlation analysis showed that Dpv was negatively correlated with CD4^+/CD8^+,while positively correlated with levels of PCT and PGE(P<0.05).Conclusion There are risks of immune dysfunction and cytokine disorders in CPH patients,which could be related to liver function and portal pressure.Clinically,these factors can be applied as reference indexes for assessing patients′condition.