摘要
【目的】探讨Tc17细胞表达对乙肝相关慢加急性肝衰竭(HBV-ACLF)病情进展及乙肝病毒清除的影响。【方法】纳入43例HBV-ACLF患者,以20例慢性乙型肝炎患者(CHB)和12例健康体检者(NC)为对照,流式细胞术检测外周血中Tc17细胞的表达,荧光定量PCR法检测HBV-DNA载量,采用MELD、MELD-Na、CLIF-CACLF及AARC评分等指标评估患者病情,分析Tc17细胞表达对病情进展及乙肝病毒清除的影响。【结果】与NC组及CHB组比较,HBV-ACLF患者Tc17细胞表达明显升高(P<0.001及P=0.017)。相关分析发现Tc17细胞与AARC评分、MELD评分及MELD-Na评分均成正相关(r=0.504,P=0.001;r=0.417,P=0.005及r=0.382,P=0.012),而与CLIF-CACLF评分有相关趋势(r=0.294,P=0.055);且随着病情进展,Tc17细胞的表达逐渐升高。另外发现Tc17细胞与基线HBV-DNA载量成正相关(r=0.339,P=0.026),且Tc17细胞高表达的HBV-ACLF患者4周后HBVDNA下降较低表达组更明显(P<0.001);多因素线性回归分析发现只有基线Tc17细胞及谷草转氨酶水平与HBVDNA下降有关。【结论】Tc17细胞介导的炎症反应有助于清除HBV-DNA,但过激的炎症反应将导致患者病情进展。
【Objective】To investigate the effects of Tc17 cells on disease severity and elimination of HBV-DNA in patients with HBV related acute-on-chronic liver failure(HBV- ACLF).【Methods】Forty-three patients with HBV-ACLF were enrolled. Twenty patients with chronic hepatitis B(CHB) and 12 healthy subjects(NC)were enrolled as controls. Flow cytometry was used to detect the expression of peripheral Tc17 cells. HBV-DNA loads were measured,and the MELD,MELD-Na,CLIF-C ACLF and AARC scores were used to evaluate the disease severity. The effects of Tc17 cells on disease severity and decline of HBV-DNA were analyzed.【Results】Compared with NC group and CHB group, the expression of Tc17 cells in HBV-ACLF patients was significantly increased(P < 0.001 and P = 0.017). Correlation analysis showed that Tc17 cells were positively correlated with AARC score,MELD score and MELD-Na score(r = 0.504,P = 0.001;r = 0.417,P = 0.005 and r = 0.382,P = 0.012 ),and a correlated trend was found with CLIF-C ACLF score(r = 0.294,P = 0.055). And as the disease progressed,the expression of Tc17 cells gradually increased.In addition,Tc17 cells were positively correlated with HBV-DNA levels(r = 0.339,P = 0.026)at baseline,and the HBV-DNA levels were significantly decreased in patients with higher expression of Tc17 cells than in lower group after 4 weeks of treatment(P < 0.001). Furthermore,it was found that baseline Tc17 cells and AST levels were associated with the HBV-DNA decline by multivariate linear regression analysis.【Conclusion】Tc17 cells-mediated inflammatory response helps clear the HBV-DNA,but excessive inflammatory response may aggravate the disease severity.
作者
张耿林
徐士丞
张婷
林潮双
彭亮
高志良
ZHANG Geng-lin;XU Shi-cheng;ZHANG Ting;LIN Chao-shuang;PENG Liang;GAO Zhi-liang(Department of Infectious Diseases,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Ultrasound,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)
出处
《中山大学学报（医学版）》
CAS
CSCD
北大核心
2019年第5期739-746,共8页
Journal of Sun Yat-Sen University:Medical Sciences
基金
国家“十三五”科技重大专项(2018ZX10302204-002)
广东省医学科研基金(A2017048)
