外周血髓源性抑制细胞在HBV相关慢加急性肝衰竭患者中表达的研究

目的：探讨外周血髓源性抑制细胞（myeloid-derived suppressor cells , MDSCs）在HBV相关慢加急性肝衰竭（HBV-related acute-on-chronic liver failure, HBV-ACLF）患者疾病进程中的临床意义。方法入组45例HBV-ACLF患者、34例慢性乙型肝炎（chronic hepatitis B, CHB）患者和25例健康对照者（healthy controls, HC），采用流式细胞仪检测外周血MDSCs频率。对HBV-ACLF患者进行为期3周的随访，根据临床疗效分为好转组和无效组，动态观察2组患者外周血MDSCs的频率变化。结果 HBV-ACLF组外周血MDSCs频率（1.53%±1.15%）高于CHB组（0.92%±0.46%）和HC组（0.91%±0.47%）（P均〈0.01）。 HBV-ACLF组外周血MDSCs频率分别与TBIL、CRE、国际标准化比值（international normalized ratio, INR）、终末期肝病模型（model for end-stage liver disease, MELD）分值和MELD-Na分值呈正相关（r=0.434，P=0.003；r=0.343，P=0.021；r=0.505， P=0.000；r=0.528，P=0.000；r=0.451，P=0.002），其中与INR和TBIL成多元线性关系，回归模型为y=-0.781＋0.623×INR＋0.003× TBIL。3周内死亡的HBV-ACLF组患者基线外周血MDSCs频率（2.09%±1.51%）高于好转组（1.15%±0.56%）和无效组（1.17%±0.70%）（P〈0.05）。外周血MDSCs频率与患者整体预后存在较弱的等级相关（r=0.309，P=0.039）。随访显示好转组和无效组患者外周血MDSCs频率均无明显变化。结论 HBV-ACLF患者外周血MDSCs频率显著升高；其与预后存在相关性，外周血MDSCs频率过高的患者预后差。

Expression of myeloid-derived suppressor cells in peripheral blood in patients with HBV-related acute-on-chronic liver failure

Objective To investigate clinical significance of myeloid-derived suppressor cells （MDSCs） in peripheral blood in the progression of HBV-related acute-on-chronic liver failure （HBV-ACLF）. Methods Totally 45 HBV-ACLF patients, 34 pa-tients with chronic hepatitis B （CHB） and 25 healthy controls （HC） were enrolled in the study. Flow cytometry was applied to detect the frequencies of MDSCs in peripheral blood. HBV-ACLF patients were given a three-week follow-up, and were divided into an improved group and an ineffective group according to the clinical efficacy. The changes of the frequencies of MDSCs in peripheral blood in the improved group and the ineffective group were observed dynamically. Results The frequencies of MDSCs in peripheral blood in HBV-ACLF group （1.53%±1.15%） were significantly higher than those in CHB group （0.92%±0.46%） and those in HC group （0.91%±0.47%） （P〈0.01）. The frequency of MDSCs in peripheral blood in HBV-ACLF group was positively correlated with TBIL （r=0.434, P=0.003）, CRE （r=0.343, P=0.021）, international normalized ratio （INR） （r=0.505, P=0.000）, model for end-stage liver disease （MELD） score （r=0.528, P=0.000） and MELD-Na score （r=0.451, P=0.002）, and had a multiple linear relationship with INR and TBIL （the regression model：y =-0.781＋0.623 ×INR＋0.003 ×TBIL）. The HBV-ACLF patients who died within 3 weeks had higher frequencies of MDSCs in peripheral blood （2.09%±1.51%） than the improved group （1.15%±0.56%） and the ineffective group （1.17%±0.70%） （P〈0.05）. The frequencies of MDSCs in peripheral blood had a weak rank correlation with the prognosis of the pa-tients （r=0.309, P=0.039）. The follow-up showed the frequencies of MDSCs in peripheral blood were not significantly different in the improved group and the ineffective group. Conclusions The frequency of MDSCs in peripheral blood in HBV-ACLF patients in-creases significantly. It is correlated with the prognosis of HBV-ACLF patients. The higher the frequency of MDSCs in peripheral blood is, the poorer prognosis the HBV-ACLF patients have.