基于外周血T淋巴细胞比例特点的慢加急性肝衰竭正虚机制  

Relationship between percentages of T lymphocytes in peripheral blood and deficiency of vital qi in patients with HBV- ACLF

作　　者：曹慧[1] 张旸[2] 谭善忠[1,2] 赵磊[1] 沈建军[1] 肖倩[1] 梁重峰[1] 蒋淑莲[1] 

机构地区：[1]南京市第二医院中西医结合科,南京210003 [2]南京中医药大学临床医学院,南京210046

出　　处：《临床肝胆病杂志》2014年第4期320-323,共4页Journal of Clinical Hepatology

基　　金：南京市医学科技发展项目(DYY056;ZKX13018);南京市科技计划项目(201104004);江苏省"六大人才高峰"项目(苏人社发〔2010〕555号);江苏省中医药领军人才项目(LJ200922);江苏省"333高层次人才培养工程"项目(苏人才〔2011〕15号)

摘　　要：目的探讨外周血T淋巴细胞比例特点与HBV相关慢加急性肝衰竭正虚机制的关系。方法选取2010年1月-2012年12月在本院就诊的HBV相关慢加急性肝衰竭早期患者(肝衰竭组)40例与慢性乙型肝炎(CHB)患者(CHB组)50例,以门诊同期健康体检者20例为健康对照组,应用流式细胞仪测定外周血CD3+T淋巴细胞、CD4+和CD8+T淋巴细胞比值、CD4+CD25+调节性T细胞所占比例,比较组间差异。3组间比较采用方差分析。结果肝衰竭组外周血CD3+T淋巴细胞(34.12%±22.33%)、CD4+/CD8+比值(1.78±1.25)和CD4+CD25+调节性T细胞(0.83%±1.00%)所占比例与健康对照组(分别为50.31%±12.09%、1.32%±0.31%、2.93%±1.31%)和CHB组(分别为49.72%±20.11%、1.31%±0.52%、3.17%±2.29%)相比较均下降,差异有统计学意义(P<0.05)。结论 HBV相关慢加急性肝衰竭一旦形成,外周血T淋巴细胞及相关效应T淋巴细胞便处于"耗损"状态,体现其"正虚"的病机特点。Objective To investigate the relationship between percentages of T lymphocytes in peripheral blood and deficiency of vital qi in patients with hepatitis B virus - related acute - on -chronie liver failure （ HBV - ACLF）. Methods Forty patients with early - stage HBV - ACLF were enrolled as liver failure group, and 50 patients with chronic hepatitis B （CHB） as CHB group; 20 healthy subjects who underwent physical examination in the clinic during the same period were selected as control group. Flow eytometry was used to determine the percentages of CD3 ＋ T lymphocytes, CD4 ＋ and CD8 ＋ T lymphocytes, and CD4 ＋ CD25 ＋ regulatory T cells （Tregs） in peripheral blood, as well as CD4 ＋/CD8 ＋ ratio, and the three groups were compared in this regard by analysis of variance. Results Compared with the control group and CHB group, the liver failure group had a significantly decreased pereentage of CD3 ＋ T lymphocytes in peripheral blood （34.12% ±22.33% vs 50.31% ±12.09% and 49.72% ±20.11%, P 〈0.05）, a significantly increased CD4 ＋/CD8 ＋ ratio （ 1.78 ± 1.25 vs 1.32±0.31 and 1.31 ±0.52, P 〈 0.05 ）, and a significantly decreased percentage of CD4 ＋ CD25 ＋ Tregs in peripheral blood （0.83% ±1.00% vs 2.93% ± 1.31% and 3.17% ±2.29%, P 〈 0. 05 ）. Conclusion Once HBV - ACLF develops, T lymphocyte cells in peripheral blood and related effector T lymphocytes are ＂exhausted＂, which reveals that the characteristics of its patbogenesis is ＂deficiency of vital qi＂.

关 键 词：肝功能衰竭 肝炎 乙型 慢性 T淋巴细胞 中西医结合疗法 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]