外周血T淋巴细胞对乙肝病毒相关慢加急性肝衰竭患者预后的影响  

Effects of peripheral blood T lymphocytes on the prognosis of patients with hepatitis B virus-associated acute-on-chronic liver failure

作　　者：汪增秀[1] 谭善忠[1,2] 孙薇薇[1] 沈建军[1] 肖倩[1] 梁重锋[1] 蒋淑莲[1] WANG Zengxiu;TAN Shanzhong;SUN Weiwei;SHEN Jianjun;XIAO Qian;LIANG Chongfeng;JIANG Shulian(Department of Integrated Chinese and Western Medicine,The Second Hospital of Nanjing,Nanjing,Jiangsu210003,China;The First Clinical Medical School of Nanjing University of Traditional Chinese Medicine,Nanjing,Jiangsu210006,China)

机构地区：[1]南京市第二医院中西医结合科,江苏南京210003 [2]南京中医药大学第一临床医学院,江苏南京210006

出　　处：《安徽医药》2017年第12期2173-2176,共4页Anhui Medical and Pharmaceutical Journal

基　　金：江苏省中医药领军人才项目(LJ200922);南京市医学科技重点项目(ZKX13018);南京市科技计划项目(201503030)

摘　　要：目的探讨乙肝病毒相关慢加急性肝衰竭(HBV-ACLF)患者外周血T淋巴细胞亚群比例对其预后的影响。方法选择HBV-ACLF患者43例,随访观察3个月后患者的存活率,应用流式细胞仪测定外周血CD3^+、CD4^+和CD8^+T淋巴细胞及CD4^+CD25^+Treg细胞的百分比,并计算CD4^+和CD8^+T淋巴细胞比值,分析T淋巴细胞亚群对乙肝病毒相关慢加急性肝衰竭患者预后的影响,选择门诊同期健康体检者20例为健康对照组。结果 3个月后,43例HBV-ACLF患者存活26例,死亡17例。与肝衰竭存活组相比,肝衰竭死亡组CD3^+细胞百分率(22.96±20.59)%、CD8^+细胞百分率(31.63±12.69)%均低于存活组(37.89±17.36)%和(36.52±9.75)%,而CD4^+细胞百分率(55.15±14.23)%、CD4^+/CD8^+(1.77±1.38)高于存活组(48.51±13.35)%、(1.32±0.68),均差异有统计学意义(P<0.05),但两组之间CD4^+CD25^+Treg细胞比例差异无统计学意义。与健康对照组相比,肝衰竭死亡组患者外周血CD3^+、CD8^+T淋巴细胞及CD4^+CD25^+Treg细胞比例下降,CD4^+T淋巴细胞、CD4^+/CD8^+升高,肝衰竭存活组患者CD3^+T淋巴细胞及CD4^+CD25^+Treg细胞百分比下降,均差异有统计学意义(P<0.05)。结论 T淋巴细胞亚群比例的变化在一定程度上可以预测HBV-ACLF患者的预后,外周血T淋巴细胞CD3^+、CD8^+、CD4^+CD25^+Treg比例下降的程度越重,预后可能越差。Objective To investigate the effects of T lymphocyte subsets in peripheral blood of patients with hepatitis B virus associated acute on chronic liver failure.MethodsForty three cases of hepatitis B virus associated acute on chronic liver failure(HBV ACLF)patients and20healthy subjects were recruited in this study.Three months later,the survival rates of patients with liver failure were followed up.Flow cytometric analysis was used to detect the quantification of peripheral CD3+,CD4+CD8+T lymphocyte subgroup and CD4+CD25+Treg and calculate the ratio of CD4+and CD8+T lymphocytes,analyze the effect of T lymphocyte subsets on the prognosis of patients with chronic hepatitis B virus associated acute liver failure.ResultsThree months later,26patients survived and17cases died.Compared with HBV ACLF survival group,the proportions of the peripheral blood CD3+(22.96±20.59)%,CD8+cells(31.63±12.69)%were lower than the survival group(37.89±17.36)%and(36.52±9.75)%;the percentages of CD4+cells(55.15±14.23)%and CD4+/CD8+(1.77±1.38)were higher than those in the survival group(48.51±13.35)%,(1.32±068)%,and there were significant differences between them(P<0.05),but there was no statistically significant difference between the two groups in CD4+CD25+Treg cells.Compared with healthy control group,the proportions of the peripheral blood CD3+,CD8+T lymphocytes and CD4+CD25+regulatory T cells of HBV ACLF death group were significantly lower while CD4+T lymphocytes and CD4+/CD8+were significantly higher,the proportions of the peripheral blood CD3+T lymphocytes and CD4+CD25+regulatory T cells of HBV ACLF survival group were significantly lower;the differences were statistically significant(P<0.05).ConclusionsThe changes of the proportion of T lymphocyte subsets can predict the prognosis of patients with HBV ACLF to a certain extent.The more serious the ratio of CD3+,CD8+T lymphocytes and CD4+CD25+Treg in peripheral blood T lymphocytes,the worse the prognosis.

关 键 词：乙型肝炎病毒相关慢加急性肝衰竭 外周血T淋巴细胞亚群 

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