HBV相关ACLF患者免疫功能及IL-10和IL-32与预后的相关性

The immune function of HBV-related ACLF patients and the correlation between IL-10,IL-32 and prognosis

目的探讨乙型肝炎病毒(HBV)相关慢加急性肝衰竭(ACLF)患者免疫球蛋白、T淋巴细胞及血清白细胞介素-10(IL-10)和白细胞介素-32(IL-32)水平变化与预后的相关性。方法选取2017年1月至2019年4月间本院住院治疗的HBV相关ACLF患者60例(HBV-ACLF组)和60例重度慢性乙型肝炎患者(CHB组),检测血免疫球蛋白(IgG、IgA、IgM)、T淋巴细胞亚群(CD3+、CD4+、CD8+)、IL-10和IL-32、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)和总胆红素(TBil),观察预后,分析结果。结果 HBV-ACLF组血ALT、AST和TBil水平明显高于CHB组,IgG、IgA水平明显高于CHB组,CD3+、CD4+水平明显低于CHB组,血清IL-10和IL-32水平明显高于CHB组,比较差异有统计学意义(P<0.05),IgM、CD8+、CD4+/CD8+两组比较差异无统计学意义(P>0.05);HBV-ACLF组28例患者病情好转,32例恶化,恶化组与好转组患者IgG、IgA、IgM水平、CD8+、CD4+/CD8+两组比较差异无统计学意义(P>0.05),恶化组CD3+、CD4+水平明显低于好转组,血清IL-10和IL-32的水平恶化组高于好转组,比较差异有统计学意义(P<0.05)。结论 HBV相关ACLF患者存在免疫球蛋白及T淋巴细胞免疫紊乱情况,同时血清IL-10和IL-32明显升高,T淋巴细胞紊乱及血清IL-10、IL-32与患者预后关系密切,可用于预后转归的判断。

Objective To explore the relationship between immunoglobulin,T lymphocytes,serum interleukin-10(IL-10),interleukin-32(IL-32)and prognosis of patients with hepatitis b virus(HBV)-related acute-on-chronic liver failure(HBV-ACLF). Methods 60 cases of HBV-ACLF patients(HBV-ACLF group)and 60 cases of severe chronic hepatitis B(CHB group)from January 2017 to April 2019 were recruited for the study. Serum immunoglobulins(IgG,IgA,IgM),T-lymphocyte subgroups(CD3+,CD4+,CD8+),IL-10 and IL-32,aspartate aminotransferase(AST),alanine aminotransferase(ALT)and total bilirubin(TBil)were detected. The results were analyzed and compared. Results Levels of ALT,AST and TBil in the HBV-ACLF group were higher than those in the CHB group(P<0.05). Levels of IgG and IgA of the HBVACLF group were higher than those of the CHB group(P<0.05),while levels of CD3+ and CD4+T-lymphocytes in the HBV-ACLF group were lower than those in the CHB group(P<0.05). There was no significant difference in IgM and CD8+,and CD4+/CD8+ between the two groups(P>0.05). Levels of IL-10 and IL-32 in the HBV-ACLF group were higher than those in the CHB group(P<0.05). Twenty eight cases got better and 32 cases got worse in the HBV-ACLF group. There was no significant difference in IgA,IgG,and IgM between the two groups(P>0.05). The levels of CD3+ and CD4+ in the deteriorated group were significantly lower than those in the improved group,and the levels of serum IL-10 and IL-32 in the deteriorated group were higher than those in the improved group,and the difference was statistically significant(P<0.05). Conclusion In patients with HBV-ACLF,immunoglobulin and T lymphocyte immune disorders occurr and serum Il-10 and Il-32 were significantly increased. T lymphocyte disorder and serum IL-10 and IL-32 are related to the patients prognosis and can be used to predict the prognosis.