乙肝病毒相关慢加急性肝衰竭患者中PMN-MDSC的表达及意义  

Expression and significance of polymorphonuclear myeloid-derived suppressor cells in patients with HBV-related acute-on-chronic liver failure

作　　者：孙健 戚健君 杨剑 全斌[1] 黄建军[2] 余雪平[3] 侯为顺[1] SUN Jian;QI Jianjun;YANG Jian;QUAN Bin;HUANG Jianjun;YU Xueping;HOU Weishun(Department of Infectious Diseases,Yijishan Hospital of Wannan Medical College,Wuhu 241001;Department of Clinical Laboratory,Yijishan Hospital of Wannan Medical College,Wuhu 241001;Department of Infectious Diseases,the First Hospital of Quanzhou,Fujian Medical University,Quanzhou 362000,China)

机构地区：[1]皖南医学院弋矶山医院感染性疾病科,安徽芜湖241001 [2]皖南医学院弋矶山医院检验科,安徽芜湖241001 [3]福建医科大学泉州第一医院感染性疾病科,福建泉州362000

出　　处：《南京医科大学学报（自然科学版）》2024年第6期838-844,共7页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金(82370604);安徽省高校自然科学类科学研究重点项目(2022AH051213);安徽省卫生健康科研项目(AHWJ2022b054);皖南医学院重点项目科研基金(WK2022ZF10)。

摘　　要：目的:探讨乙肝病毒相关慢加急性肝衰竭(hepatitis B virus-related acute-on-chronic liver failure,HBV-ACLF)患者中多核型髓源性抑制细胞(polymorphonuclear myeloid-derived suppressor cell,PMN-MDSC)的表达及意义。方法:选取2022年9月—2023年8月皖南医学院弋矶山医院收治的HBV-ACLF患者40例为研究组,同期在该院诊治或体检的慢性乙肝(chronic hepa-titis B,CHB)患者20例、健康对照(healthy control,HC)10例为对照组,收集临床资料,留取血标本。流式细胞术检测入院当日外周血PMN-MDSC频率,比较研究组和两个对照组外周血PMN-MDSC频率的差异。采用Spearman检验分析HBV-ACLF外周血PMN-MDSC频率与炎症指标、疾病严重度的相关性。分别根据是否合并或继发感染及访视期第28天预后情况对HBV-ACLF患者分组,比较各组外周血PMN-MDSC频率的差异。结果:HBV-ACLF组外周血PMN-MDSC频率显著高于CHB组和HC组(P均<0.001),CHB组和HC组之间PMN-MDSC频率差异无统计学意义。HBV-ACLF外周血PMN-MDSC频率与白细胞计数、中性粒细胞淋巴细胞比值、降钙素原水平、国际标准化比值、总胆红素水平、Child-Turcotte-Pugh评分、终末期肝病模型评分均呈正相关(r=0.347、0.799、0.506、0.450、0.462、0.470、0.481,P均<0.05),与淋巴细胞计数呈负相关(r=-0.428,P<0.01)。40例HBV-ACLF患者中,合并感染18例,继发感染17例,28 d预后差21例,其外周血PMN-MDSC频率均高于对照组患者,差异有统计学意义(P均<0.001)。结论:HBV-ACLF患者外周血富集PMN-MDSC,其频率与感染风险、疾病严重度及患者短期预后密切相关。Objective:To investigate the expression and significance of polymorphonuclear myeloid-derived suppressor cells(PMN-MDSC)in patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods:A total of 40 HBV-ACLF patients admitted to Yijishan Hospital of Wannan Medical College from September 2022 to August 2023 were selected as the study group,while 20 patients with chronic hepatitis B(CHB)and 10 healthy controls(HC)diagnosed or undergoing examinations at the same hospital during the same period were collected as the two control groups.Clinical data were collected and blood samples were obtained.Flow cytometry was used to detect the frequency of peripheral blood PMN-MDSC on the day of admission,and to compare the differences in the frequency of PMN-MDSC between the study group and the two control groups.Spearman’s correlation analysis was used to investigate the correlation between the frequency of PMN-MDSC and inflammation markers or disease severity.HBV-ACLF patients were further grouped based on whether they had concurrent or secondary infections and the prognosis on day 28 of follow-up,and the differences in PMN-MDSC frequency among groups were compared.Results:The frequency of PMN-MDSC in HBV-ACLF group was significantly higher than that in the CHB group and the HC group(P<0.001 for both),whereas there was no significant difference in the PMN-MDSC frequency between the CHB and HC groups(P>0.05).The frequency of PMN-MDSC in HBV-ACLF patients was positively correlated with the white blood cell count,neutrophil-to-lymphocyte ratio,procalcitonin,international normalized ratio,total bilirubin,Child-Turcotte-Pugh score,and the model of end-stage liver disease score(r=0.347,0.799,0.506,0.450,0.462,0.470,0.481,respectively,all P<0.05),and negatively correlated with the lymphocyte count(r=-0.428,P<0.01).Among the 40 HBV-ACLF patients,18 had concurrent infections,17 had secondary infections,and 21 had poor prognosis on day 28,with their peripheral blood PMN-MDSC frequencies significantly higher

关 键 词：髓源性抑制细胞 乙型肝炎病毒 慢加急性肝衰竭 感染 预后 

分 类 号：R557.1[医药卫生—血液循环系统疾病]