不同类型肝硬化患者肝功能和免疫功能的对比分析

Comparative analysis of liver function and immune function in patients with different types of cirrhosis

目的:对比乙型肝炎肝硬化、酒精性肝硬化和混合型(乙型肝炎+酒精性肝炎)肝硬化患者的肝功能和免疫功能指标,并分析其与Child-Pugh分级的相关性,为临床评估患者免疫状态及采取相关治疗提供参考。方法:选取2019年3月—2020年7月贵州医科大学附属医院收治的肝硬化患者128例,其中乙型肝炎肝硬化44例,酒精性肝硬化48例,混合型肝硬化36例。采用全自动生化分析仪检测肝功能指标,免疫比浊法检测免疫球蛋白,流式细胞术(FCM)检测外周血淋巴细胞亚群百分比。结果:乙型肝炎肝硬化患者谷草转氨酶/谷丙转氨酶(AST/ALT)、免疫球蛋白A(IgA)、γ-谷氨酰转肽酶(γ-GT)、CD3+CD4+细胞百分比显著低于酒精性肝硬化患者和混合型肝硬化患者(P均<0.05),而酒精性肝硬化患者和混合型肝硬化患者相应指标间的差异无统计学意义(P>0.05)。乙型肝炎肝硬化患者及混合型肝硬化患者Child-Pugh分级与AST、AST/ALT、总胆红素(TBIL)、免疫球蛋白G(IgG)、IgA均呈正相关(r=0.464、0.469、0.705、0.540、0.540和0.555、0.563、0.782、0.424、0.515,P<0.05),与白蛋白(ALB)、白蛋白/球蛋白(A/G)均呈负相关(r=-0.772、-0.642和-0.623、-0.470,P<0.01);酒精性肝硬化患者Child-Pugh分级与AST、TBIL呈正相关(r=0.375、0.573,P<0.05),与ALB呈负相关(r=-0.451,P<0.01)。结论:酒精性肝硬化和混合型肝硬化患者相比乙型肝炎肝硬化患者,肝功能和免疫功能受损更为严重,且不同类型肝硬化患者的Child-Pugh分级与肝功能生化指标和免疫球蛋白存在显著相关性。

Objective:To provide reference for clinical diagnosis and treatment by comparing liver function and immune function of patients with hepatitis B cirrhosis,alcoholic cirrhosis and the mixed cirrhosis(Hepatitis B virus with alcoholic cirrhosis)and analyzing their correlation with Child-Pugh classification.Methods:A total of 128 patients with cirrhosis were selected in The Affiliated Hospital of Guizhou Medical University from March 2019 to July 2020,including 44 cases of hepatitis B cirrhosis,48 cases of alcoholic cirrhosis,36 cases of the mixed cirrhosis.Liver function indicators were detected via automatic biochemical analyzer,immunoglobulins were detected via immunoturbidimetric assay,and the percentages of peripheral blood lymphocyte subsets were detected via flow cytometry(FCM).Results:The percentages of AST/ALT,IgA,GGT,CD3+CD4+cells in patients with hepatitis B cirrhosis were significantly lower than those with alcoholic cirrhosis and the mixed cirrhosis(P<0.05),while there was no statistically significant difference between alcoholic cirrhosis and mixed cirrhosis(P>0.05).Child-Pugh classification of patients with hepatitis B liver cirrhosis and mixed cirrhosis were both positively correlated with AST,AST/ALT,TBIL,IgG,IgA(r=0.464,0.469,0.705,0.540,0.540 and 0.555,0.563,0.782,0.424,0.515,P<0.05),and both negatively correlated with ALB,A/G(r=-0.772,-0.642 and 0.623,-0.470,P<0.01);Child-Pugh classification of patients with alcoholic cirrhosis was positively correlated with AST,TBIL(r=0.375,0.573,P<0.05),and negatively correlated with ALB(r=-0.451,P<0.01).Conclusion:Patients with alcoholic cirrhosis and mixed liver cirrhosis have more severe impairment of liver function and immune function compared with patients with hepatitis B cirrhosis.There was a significant correlation between Child-Pugh classification and liver function biochemical indicators and immunoglobulins of patients with different types of cirrhosis.