外周血T细胞受体多样性指数联合CD4/CD8+T细胞比值对乙肝相关性肝细胞癌预后转归的预测价值分析

Analysis of the predictive value of T cell receptor diversity index combined with CD4/CD8+T cell ratio in peripheral blood for patients with HBV related liver cancer

目的 探讨外周血T细胞受体(T cell receptor, TCR)多样性指数、CD4/CD8+T细胞比值对乙型肝炎病毒(HBV)相关性肝细胞癌预后转归的预测价值。方法 收集2020年7月至2021年8月我院收治的HBV相关性肝细胞癌患者51例,同期选取在我院进行体检的健康成人35例为对照组。检测所有受试者外周血T淋巴细胞分群、TCR多样性,比较不同预后转归患者与健康人群的获得性免疫功能及相关生化指标。分析外周血TCR多样性指数、CD4/CD8+比值、二者联合对HBV相关性肝癌疾病转归的预测价值。结果 TCR多样性指数、CD4/CD8+比值水平等在健康人群与HBV相关性肝癌人群中差异有统计学学意义(P<0.05),预后不良组TCR D50值、CD4+T细胞比例、CD4/CD8+均下降,而CD8+T细胞比例显著上升(P<0.05);TCR多样性指数、CD4/CD8+比值、二者联合预测疾病预后的曲线下面积(AUC)分别为0.872、0.832、0.945。二者联合敏感度86.40%,特异度93.10%。结论 预后不良的HBV相关性肝癌患者获得性免疫功能相关指标均显著降低,TCR多样性指数、CD4/CD8+比值二者联合检测对于HBV相关性肝癌患者的预后具有较高的预测价值,可作为临床上评估肝癌患者肝切除术后不良预后的指标。

Objective To explore the predictive value of T cell receptor(TCR)diversity index and CD4/CD8+T cell ratio in peripheral blood in patients with HBV related liver cancer.A total of 51 patients with HBV related liver cancer in our hospitals from July 2020 to August 2021 was selected as a liver cancer group.At the same time,35 healthy adults who underwent physical examination in our hospital were selected as a control group.T lymphocyte groups and TCR diversity in peripheral blood of all subjects were detected.Acquire immune function and related biochemical indexes were compared between patients with different prognosis and healthy population.The predictive value of TCR diversity index,CD4/CD8 ratio and their combination on the outcome of HBV related liver cancer was analyzed.There were significant differences in TCR diversity index and CD4/CD8 ratio between healthy people and HBV related liver cancer patients.In a poor prognosis group,TCR D50 value,CD4+T cell ratio and CD4/CD8 ratio were decreased while CD8+T cell ratio was significantly increased(P<0.05).The areas under ROC curves of TCR diversity index was 0.872,CD4/CD8 ratio was 0.832 and their combination was 0.945 for prediction of disease prognosis of these patients.The sensitivity and specificity of the combination detection were 86.40%and 93.10%,respectively.The indicators related to acquire immune function are significantly decreased in the poor prognosis group of patients with HBV related liver cancer.The combined detection of TCR diversity index and CD4/CD8 ratio has a high predictive value for the prognosis of the patients.It can be used as a clinical indicator to evaluate the poor prognosis of the patients after hepatectomy.