乙肝相关慢加急性肝衰竭患者Th17细胞水平及其临床意义

目的探讨乙肝相关慢加急性肝衰竭（HBV-ACLF）外周血Th17细胞的表达及其与临床转归的关系。方法采用流式细胞术分析外周血中Th17细胞比例,flowcytomix技术检测血清中IL-17的水平,荧光PCR检测HBV-DNA载量,ELISA检测HBeAg的状态,分析Th17细胞及IL-17的表达与HBV病毒及预后的关系。结果与健康对照组及慢乙肝组相比,HBV-ACLF患者Th17细胞及IL-17水平明显升高（P〈0.01）,且Th17细胞与IL-17水平成正相关;进一步分析发现不同病毒复制水平及HBeAg状态的HBV-ACLF患者Th17细胞及IL-17的差异无统计学意义;与预后好转患者相比,预后不佳HBV-ACLF患者Th17细胞及IL-17水平明显增高（P〈0.05）,且IL-17的水平与终末期肝病评分成正相关。结论 Th17细胞可能参与了HBV-ACLF的发病机制,且IL-17的表达越高可能提示患者的预后不佳。

Th17 cells in patients with HBV-related acute-on-chronic liver failure

Objective To investigate Th17 cells and its relationship with prognosis of patients with HBV-related acute-on-chronic liver failure.Methods Peripheral blood samples were collected from 37 HBV-ACLF patients,26 chronic hepatitis B patients and 17 normal controls.Th17 cells in circulating blood were determined by flowcytometry.IL-17 level was measured by flowcytomix.HBeAg and HBV-DNA loads were measured by ELISA and fluorescent PCR,respectively.The frequency of Th17 cells and the level of IL-17 in HBV-ACLF patients and their correlations with HBeAg,HBV-DNA loads and prognosis were analyzed.Results Higher frequency of Th17 cells and level of IL-17 were detected in patients with HBV-ACLF than those of the NC subjects and CHB patients（P0.01）.There was positive correlation between Th17 cells and the level of IL-17,but no significant differences in the level of IL-17 and frequency of Th17 cells were observed in HBV-ACLF patients with different HBV-DNA levels and different states of HBeAg.However,Th17 cells and IL-17 were markedly higher in patients with poor outcome than those with good outcome.Furthermore the level of IL-17 was positively correlated with MELD score of HBV-ACLF patients.Conclusion Th17 cells may contributed to the mechanism of the HBV-ACLF and the elevated level of IL-17 may be a good marker to indicate unfavorable poor prognosis in HBV-ACLF patients.