慢性乙型肝炎急性肝衰竭患者外周血免疫活性细胞特点及其与预后的关系

目的慢性乙型肝炎(乙肝)急性肝衰竭(慢加急性肝衰竭,ACLF)的发病机制尚不清楚,本文主要研究ACLF患者的免疫特点及其与预后的关系。方法选取ACLF患者75例,慢性乙型肝炎(CHB)患者31例,乙型肝炎肝硬化(LC)患者36例,健康志愿者30例,采用流式细胞仪检测外周血CD3 、CD4 、CD8 T细胞、NK细胞、NKT细胞等细胞亚群计数,用SPSS10.0软件对其进行统计学分析。结果ACLF组外周血淋巴细胞总数、CD4 、CD8 T细胞、NKT细胞与健康对照组及慢性乙肝组相比,均具有显著性差异(P<0.001或P<0.01或P<0.05)。ACLF组外周血NK细胞与健康对照组相比,具有显著性差异(P<0.01)。ACLF患者死亡组中淋巴细胞总数、CD4 、CD8 T细胞、NK细胞计数均低于存活组各细胞计数,二者具有显著性差异(P<0.05)。结论ACLF患者外周血免疫活性细胞的减少可能是ACLF病情急剧进展的驱动因素。

Characterization of circulating immunologically-competent cells (ICCs) in patients with acute-on-chronic liver failure associated with hepatitis B virus infection and its relationship with the prognosis

Objective Since the immunological alterations in acute-on-chronic liver failure(ACLF) in chronical hepatitis B virus(HBV)-infected patients remain poorly understood, this study attempts to investigate the characterization of immunologically competent cells(ICCs)in ACLF and its relationship with the prognosis in those patients. Methods Circulating ICCs, such as CD3 , CD4 , CD8 T-cells, NKT and NK cells were examined in ACLF patients(n = 75), as well as in patients with chronic hepatitis B(CHB, n = 31), hepatitis B-related liver cirrhosis(LC, n = 36), and normal controls(NC, n = 30)with a FACS Calibur Flow Cytometer. SPSS10.0 software was used to make analysis. Results The peripheral blood(PB)lymphocytes, CD4 , CD8 T-cells and NKT cells markedly decreased in ACLF patients compared with NC and CHB patients(P < 0.001 or <0.01 or <0.05). ACLF patients displayed a significant increase in NK cells compared with NC(P < 0.01). Furthermore, there was a significant increase in the peripheral blood(PB) lymphocytes, CD4 , CD8 T cells and NK cells of the non-survivors compared with the survivors in ACLF group(P < 0.05). Conclusions The decrease of circulating ICCs probably serves as a factor for the progressive development of ACLF.