自身免疫性肝炎患者血清瘦素、外周血调节性T细胞和Th17细胞水平变化  

Changes of serum leptin level and percentages of peripheral blood regulatory T cells and Th17 cells in patients with autoimmune hepatitis

作　　者：蒋叶舟 花霞 陈国飞 朱青蓝 蔡明月 Jiang Yezhou;Hua Xia;Chen Guofei(Clinical Laboratory,Integrated Traditional Chinese and Western Medicine Hospital,Suzhou 215101,Jiangsu Province,China)

机构地区：[1]江苏省苏州市中西医结合医院检验科,215101 [2]江南大学附属无锡市第五医院影像科

出　　处：《实用肝脏病杂志》2024年第5期713-716,共4页Journal of Practical Hepatology

基　　金：江苏省中医药科技发展计划项目(编号:YB2020015)。

摘　　要：目的探讨自身免疫性肝炎(AIH)患者血清瘦素水平及外周血调节性T细胞(Tregs)和辅助性T细胞17(Th17)比例变化及其临床意义。方法2018年3月~2023年3月我院诊治的AIH患者69例,均接受肝穿刺活检和泼尼松和硫唑嘌呤联合治疗。采用ELISA法检测血清细胞因子水平,使用流式细胞仪检测外周血Tregs和Th17淋巴细胞百分比,并计算Th17/Tregs细胞比值。结果22例重症AIH血清血清瘦素、IL-17、IL-22和TNF-α水平、外周血Th17/CD4^(+)细胞百分比和Th17/Tregs比值分别为(335.6±84.2)ng/mL、(18.5±4.1)pg/mL、(48.7±11.4)pg/mL、(5.6±0.9)ng/mL、(3.3±1.2)%和(20.1±3.0),显著高于47例轻中症组【分别为(66.9±13.8)ng/mL、(6.9±2.5)pg/mL、(13.8±3.3)pg/mL、(1.1±0.4)ng/mL、(2.5±0.3)%和(12.4±1.5),P<0.05】,而外周血血小板计数、血清IL-10水平和外周血Tregs/CD4^(+)细胞百分比分别为(129.8±29.4)×10^(9)/L、(2.3±0.7)pg/mL和(1.6±0.4)%,显著低于轻中症患者【分别为(174.2±35.6)×10^(9)/L、(4.8±0.9)pg/mL和(2.0±0.8)%,P<0.05】;经肝组织学检查,发现肝组织炎症G1~2级42例和G3~4级27例;G3~4级AIH组血清瘦素、IL-17、IL-22和TNF-α水平和外周血Th17/CD4^(+)百分比和Th17/Tregs细胞比值显著高于G1~2级,而血小板计数、Tregs/CD4^(+)细胞百分比和血清IL-10水平显著低于G1~2级组(P<0.05);所有患者经治疗均获得完全应答,其中<3个月、3~6个月和>6个月应答的AIH患者分别为35例、23例和11例;血清瘦素及外周血Tregs/CD4^(+)和Th17/CD4^(+)细胞百分比或Th17/Tregs细胞比值高的患者应答时间显著减慢(P<0.05)。结论监测AIH患者血清瘦素及外周血调节性T细胞和Th17细胞百分比可能有助于预测免疫抑制治疗的疗效,值得临床进一步深入研究。Objective This study was conducted to explore the clinical implications of serum leptin level,and peripheral blood regulatory T cells(Tregs)and helper T 17(Th17)cells in patients with autoimmune hepatitis(AIH).Methods 69 patients with AIH were enrolled in our hospital between March 2018 and March 2023,and all underwent liver biopsies and received standardized prednisone and azathioprine combination therapy.Serum cytokine levels were assayed by ELISA,and the percentages of peripheral blood Tregs and Th17 cells were detected by FCM.Results Serum leptin,IL-17,IL-22 and TNF-α,and percentage of blood Th17/CD4^(+)cells and the Th17/Tregs cell ratio in 22 patients with severe AIH were(335.6±84.2)ng/mL,(18.5±4.1)pg/mL,(48.7±11.4)pg/mL,(5.6±0.9)ng/mL,(3.3±1.2)%and(20.1±3.0),all significantly higher than[(66.9±13.8)ng/mL,(6.9±2.5)pg/mL,(13.8±3.3)pg/mL,(1.1±0.4)ng/mL,(2.5±0.3)%and(12.4±1.5),respectively,P<0.05],while blood platelet count,serum IL-10 level and percentage of blood Tregs/CD4^(+)cells were(129.8±29.4)×10^(9)/L,(2.3±0.7)pg/mL and(1.6±0.4)%,all much lower than[(174.2±35.6)×10^(9)/L,(4.8±0.9)pg/mL and(2.0±0.8)%,P<0.05]in 47 patients with mild/moderate AIH;the histo-pathological examination showed G1-2 histological activity in 42 cases and G3-4 in 27 cases;serum leptin,IL-17,IL-22 and TNF-αlevels,percentage of blood Th17/CD4^(+)cell and the Th17/Tregs cell ratio in patients with G3-4 were significantly higher than,while the platelet count,percentage of Tregs/CD4^(+)cells and serum IL-10 level were much lower than in those with G1-2(P<0.05);all patients in our series obtained complete response(CR)after immunosuppression therapy,and the CR occurred less than three months in 35 cases,three to six months in 23 cases and longer than six months in 11 cases;the patients with increased serum leptin levels,percentages of blood Tregs/CD4^(+)and Th17/CD4^(+)cells,and the Th17/Tregs cell ration cost longer period for CR(P<0.05).Conclusion The surveillance of serum leptin levels and peripheral blood Tregs

关 键 词：自身免疫性肝炎 泼尼松 瘦素 调节性T细胞 辅助性T细胞 治疗 

分 类 号：R575.1[医药卫生—消化系统]