原发性胆汁性肝硬化患者肝硬化期外周血淋巴细胞计数及T细胞亚群检测与分析

目的探讨原发性胆汁性肝硬化(PBC)患者肝硬化期外周血淋巴细胞总数及T细胞亚群的特点并分析影响因素及临床意义。方法对86例肝硬化期PBC患者的临床资料、实验诊断数据进行回顾性分析,比较40例代偿期和46例失代偿期PBC患者肝功、免疫学指标和外周血淋巴细胞亚群特点,对可能的影响因素进行相关性分析。结果失代偿期PBC患者年龄、血清总胆红素(TBil)水平、血清总IgA水平、Mayo评分高于代偿期患者(P0.05),而ALT、ALB、外周血淋巴细胞绝对数(LYMPH)、淋巴细胞百分率(LYMPH%)、T淋巴细胞绝对数(CD3+)、T辅助细胞绝对数(CD3+CD4+)和T抑制细胞绝对数(CD3+CD8+)均低于代偿期患者(P0.05);LYMPH、LYMPH%、CD3+、CD3+CD4+和CD3+CD8+结果中,失代偿期减低者频率均高于代偿期(45.7%vs.10%,34.8%vs.7.5%,58.7%vs.17.5%,45.7%vs.5%,60.9%vs.27.5%,P0.05),失代偿期增高者频率均低于代偿期(54.3%vs.90%,6.5%vs.27.5%,0 vs.20%,2.2%vs.22.5%,2.2%vs.10%,P0.05)。在可能的影响因素中,年龄、Mayo评分、上消化道出血、脾大或脾切除、腹水等肝硬化失代偿表现对结果影响呈负相关;而ALT、ALB对结果影响呈正相关。结论随着肝硬化程度的加深,PBC患者外周血淋巴细胞总数及T细胞亚群数量降低;从淋巴细胞定量角度分析,随着疾病的进展,PBC患者免疫水平下降。

Detection and analysis of peripheral lymphocytes and T cell subsets in patients with primary biliary cirrhosis presenting with advanced disease

Objective To quantitative detect and analyse peripheral lymphocytes and T cell subsets in patients with primary biliary cirrhosis presenting with advanced disease.Methods We reviewed the clinical data of 86 PBC patients with liver cirrhosis who had a conventional analysis of blood and T cell subsets at Beijing You＇an Hospital from June 2003 to December 2008.Peripheral lymphocytes and T cell subsets were compared between patients with hepatic decompensation and those without hepatic decompensation.Results PBC patients with hepatic decompensation had significantly older age,higher levels of serum total bilirubin,serum IgA,and greater Mayo Risk Score than those without hepatic decompensation.However,ALT,ALB,lymphocytes,lymphocytes percentage,CD3＋T cells,CD3＋CD4＋T cells and CD3＋CD8＋T cells of patients with hepatic decompensation were significantly lower than those without hepatic decompensation.The frequency of patients with low levels of lymphocytes,lymphocytes percentage,CD3＋T cells,CD3＋CD4＋T cells and CD3＋CD8＋T cells were more in hepatic decompensation group than in the counterpart（45.7% vs.10%,34.8% vs.7.5%,58.7% vs.17.5%,45.7% vs.5%,60.9% vs.27.5%,P0.05）.The frequency of patients with higher levels of lymphocytes,lymphocytes percentage,CD3＋T cells,CD3＋CD4＋T cells and CD3＋CD8＋T cells were less in hepatic decompensation group than in the counterpart（54.3% vs.90%,6.5% vs.27.5%,0 vs.20%,2.2% vs.22.5%,2.2% vs.10%,P0.05）.Among possible influence factors,age,Mayo Risk Score,variceal bleeding,splenomegaly or splenectomy,ascites had significant negative association with the results;however,ALT,and ALB levels had significant positive association with the results.Conclusion From the point of quantitative detect and analyse peripheral lymphocytes and T cell subsets,patients with PBC had decreased peripheral lymphocytes and T cell subsets and their immunity are impaired as the disease progresses.