AIH-PBC重叠综合征患者的免疫学、炎症因子特征及其与肝功能的相关性

Characteristics of immunology,inflammatory factors and their correlation with liver function in patients with autoimmune hepatitis-primary biliary cholangitis overlap syndrome

目的探讨自身免疫性肝炎(AIH)-原发性胆汁性胆管炎(PBC)重叠综合征(OS)患者的免疫学、炎症因子特征及其与肝功能损伤的相关性。方法纳入2019年1月至2021年12月西安市第一医院收治的186例AIH-PBC OS患者作为OS组,同期在我院体检的90例健康者作为对照组。比较两组受检者的天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)、CD4+T细胞、调节性T细胞(Treg)、辅助性T细胞17(Th17)、自然杀伤细胞(NK细胞)、Th17/Treg、肿瘤坏死因子α(TNF-α)、干扰素-γ(IFN-γ)、白介素(IL)-17、转化生长因子-β(TGF-β)、IL-6、IL-4、IL-17/TGF-β以及IFN-γ/IL-4水平。采用Pearson相关性分析法分析患者的免疫学指标、炎症因子与肝功能的相关性。结果OS组患者的ALT、AST、ALP水平分别为(175.39±49.24)U/L、(189.58±34.09)U/L、(246.73±30.28)U/L,明显高于对照组的(26.46±8.23)U/L、(20.35±5.76)U/L、(75.40±9.12)U/L,差异均具有统计学意义(P<0.05);两组受检者的CD4+T细胞、Treg、Th17、NK细胞、Th17/Treg水平比较差异均具有统计学意义(P<0.05);两组受检者的TNF-α、IFN-γ、IL-17、TGF-β、IL-6、IL-4、IL-17/TGF-β比较,差异均具有统计学意义(P<0.05);经Pearson相关性分析结果显示,AIH-PBC OS患者的肝功能指标与Treg、TGF-β呈负相关(P<0.05),与Th17、Th17/Treg、TNF-α、IL-17、IL-6、IL-17/TGF-β呈正相关(P<0.05)。结论AIH-PBC OS患者伴有明显的免疫功能和炎症因子水平紊乱,Th17/Treg失衡可能参与了AIH-PBC OS患者的病情进展。

Objective To investigate the characteristics of immunology,inflammatory factors and their correlation with liver function damage in patients with autoimmune hepatitis(AIH)-primary biliary cholangitis(PBC)overlap syndrome(OS).Methods A total of 186 patients with AIH-PBC OS admitted to Xi'an First Hospital from January 2019 to December 2021 were included as the OS group,and 90 healthy subjects who admitted to the hospital during the same period were included as the control group.The aspartate aminotransferase(AST),alanine aminotransferase(ALT),alkaline phosphatase(ALP),CD4+T cells,regulatory T cells(Treg),T helper cell 17(Th17),natural killer cells(NK cells),Th17/Treg,tumor necrosis factor-alpha(TNF-α),Interferon-γ(IFN-γ),interleukin(IL)-17,transforming growth factor-β(TGF-β),IL-6,IL-4,IL-17/TGF-βand IFN-γ/IL-4 levels were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between immunological indexes,inflammatory factors and liver function.Results The levels of ALT,AST,and ALP in the OS group were(175.39±49.24)U/L,(189.58±34.09)U/L,and(246.73±30.28)U/L,respectively,which were significantly higher than(26.46±8.23)U/L,(20.35±5.76)U/L,(75.40±9.12)U/L in the control group(P<0.05).There were significant differences in the levels of CD4+T cells,Treg,Th17,NK cells,and Th17/Treg between the two groups(P<0.05).There were significant differences in the levels of TNF-α,IFN-γ,IL-17,TGF-β,IL-6,IL-4,IL-17/TGF-βbetween the two groups(P<0.05).Pearson correlation analysis showed that the liver function indexes of AIH-PBC OS patients were negatively correlated with Treg and TGF-β,and positively correlated with Th17,Th17/Treg,TNF-α,IL-17,IL-6 and IL-17/TGF-β(P<0.05).Conclusion AIH-PBC OS patients are accompanied by obvious disturbances in immune function and inflammatory factor levels,and the imbalance of Th17/Treg may involved in the progression of AIH-PBC OS patients.