不同病因肝衰竭患者外周血单个核细胞HLA-DR基因水平及血Th17和CD4+CD25+Treg细胞百分比的变化

目的探讨不同病因所致肝衰竭患者外周血单个核细胞（PBMCs）HLA-DR mRNA及Th17和CD4⁺CD25⁺Treg细胞水平的变化及其意义。方法本研究纳入肝衰竭患者50例,其中乙型肝炎肝衰竭15例,药物性肝损伤12例,酒精性肝病13例,自身免疫性肝炎10例;慢性乙型肝炎患者17例和正常人10例。采用PCR法检测PBMCs中HLA-DR mRNA水平,使用流式细胞仪检测CD4⁺CD25⁺Treg和Th17细胞百分比。结果乙型肝炎肝衰竭患者HLA-DR mRNA水平为（134.5±15.2）,显著高于药物性肝损伤组的（17.9±1.2）、酒精性肝病组的（19.6±2.0）和自身免疫性肝炎组的（11.2±1.2）,P<0.05];不同病因肝衰竭患者Th17和CD4⁺CD25⁺Treg细胞百分比分别为（4.4±0.6）%和（3.9±0.6）%左右]的差异无统计学意义（P>0.05）,但与慢性乙型肝炎分别为（3.7±0.2）%和（6.1±0.4）%和正常人（2.1±0.7）%和（7.0±0.9）%比,均有显著性差异（P<0.05）;对不同病因肝衰竭患者进行动态观察发现,19例死亡患者CD4⁺CD25⁺Treg细胞百分比呈持续下降,直至死亡,而31例生存患者则逐渐恢复至接近正常水平。结论外周血单个核细胞HLA-DR mRNA水平及Th17和CD4⁺CD25⁺Treg细胞百分比的变化与肝衰竭患者的病情密切相关,可作为判断肝衰竭严重程度及预后的指标。

HLA-DR mRNA levels,Th17 and CD4+CD25+Treg cell percentages in peripheral blood mononuclear cells in patients with liver failure

ObjectiveTo investigate the changes of HLA-DR mRNA,and Th17 and CD4⁺CD25⁺Treg cells in peripheral blood mononuclear cells（PBMCs） in patients with liver failure. Methods HLA-DR mRNA was detected by PCR,and Th17 and CD4⁺CD25⁺Treg cells were measured by flow cytometry in 50 patients with liver failure,including 15 arisen from hepatitis B,12 from drug-induced liver injury（DILI）,13 from alcoholic liver diseases,and 10 from autoimmune liver diseases,and in 17 patients with chronic hepatitis B and 10 healthy persons. Results The HLA-DR mRNA levels in PBMCs in patients with hepatitis B-induced liver failure was（134.5±15.2）,much higher than （17.9±1.2）in DILI-,（19.6±2.0）in alcoholic and（11.2±1.2）,P<0.05] in autoimmune liver disease-induced liver failure;the percentages of Th17 cells and CD4⁺CD25⁺Treg cells （4.4±0.6）% and（3.9±0.6）% or less,respectively] in patients with different etiologic liver failures were not significantly different（P>0.05）,while there were a significant difference as compared to（3.7±0.2）% and（6.1±0.4）% in patients with chronic hepatitis B or（2.1±0.7）% and（7.0±0.9）% in normal control （P<0.05）;the percentages of CD4⁺CD25⁺Treg cells in 19 died patients decreased gradually,while it increased gradually in 31 survived patients. Conclusion The HLA-DR mRNA levels and CD4⁺CD25⁺Treg cells are closely related to the illness severity of patients with liver failure,and they may be used as parameters to estimate the clinical prognosis.