淋巴细胞亚群变化与糖皮质激素治疗早期乙肝肝衰竭患者的相关性研究

目的 探讨糖皮质激素治疗早期乙肝肝衰竭患者的病情转归及与淋巴细胞亚群的相关性。方法 纳入2011年12月—2014年12月收治的乙型病毒性肝炎慢加急(亚急性)早期肝衰竭患者60例，按知情同意分为2组，糖皮质激素治疗组32例，对照组28例。流式细胞仪检测治疗前后淋巴细胞亚群绝对计数的变化，观察2组的病情转归。结果 2组治疗前淋巴细胞亚群差异无统计学意义。治疗后，与对照组相比，治疗组CD4⁺/CD8⁺比例、CD3^-CD16⁺CD56⁺细胞增加，差异有统计学意义。与治疗前相比，治疗后治疗组CD3⁺CD4⁺T细胞绝对计数、对照组CD3⁺CD4⁺T细胞、CD3⁺CD8⁺T细胞绝对计数增多，差异有统计学意义。2组救治成功率比较，治疗组75.00%，对照组64.29%，差异无统计学意义(Z=0.816，P=0.366)。但10 d病情稳定率治疗组71.88%，高于对照组46.43%，差异有统计学意义(Z=4.029，P=0.044)。救治成功患者住院天数比较，治疗组35.00 d(29.00，51.00)，低于对照组50.50 d(38.25，58.00)，差异有统计学意义(Z=-2.241，P=0.025)。结论 在早期乙肝肝衰竭患者中应用糖皮质激素可较快稳定病情，减少住院时间；治疗后CD3⁺CD4⁺T淋巴细胞增高，CD3⁺CD8⁺水平稳定，CD4⁺/CD8⁺比例升高，CD3^-CD16⁺CD56⁺细胞增高可能预示患者预后良好。

Study on Changes of Lymphocyte Subsets in Patients with Early Stage of Hepatitis B Liver Failure after Treatment of Glucocorticoid

OBJECTIVE To investigate prognosis in patients with early stage of hepatitis B liver failure after treatment of glucocorticoid and its correlation with the lymphocyte subsets. METHODS Sixty patients with early stage of hepatitis B liver failure were divided into two groups(control and treatment) voluntarily. The treatment group included 32 patients received glucocorticoid treatment and the control group involved 28 patiens did not. Differences in counts of lymphocyte subsets were evaluated by flow cytometry between two groups, the prognosis was also observed. RESULTS There were no statistically significant differences in CD3⁺CD4⁺T cell, CD3⁺CD8⁺T cell, CD4⁺/CD8⁺ ratio between the two groups before treatment. The CD4⁺/CD8⁺ ratio and CD3^-CD16⁺CD56⁺ cell count were increased significantly compared with the control group after treatment. CD3⁺CD4⁺ cell count in each group significantly increased after treatment. Meanwhile, CD3⁺CD8⁺ cell count in control group had the same result. No statistical differences were observed in two groups of treatment success rate (the treatment group 75%, control group 64.29%, Z=0.816, P=0.366). But on the stable rate after 10 days treatment, treatment group was 71.88% higher than that of the control group 46.43%(Z=4.029, P=0.044). Comparison of hospitalization in patients with successful treatment, the treatment group 35.00 d(29.00, 51.00)] was significantly lower than that in the control group 50.50 d(38.25, 58.00)] (Z=-2.241, P=0.025). CONCLUSION Application of glucocorticoids can quickly stabilize the condition in patients with early stage of hepatitis B liver failure, decrease the duration of hospitalization. It may indicate that patients with a good prognosis if the number of CD3⁺CD4⁺T lymphocyte and CD3^-CD16⁺CD56⁺ cells is increased, the ratio of CD4⁺/CD8⁺ is higher after treatment.