摘要
目的 探究肝性脑病(HE)患者外周血Th17/Treg平衡变化及其与预后的关系。方法 选择2019年2月至2020年2月中国人民武装警察部队海警总队医院收治的50例HE患者作为研究对象,参照West-Haven分级标准将患者分为HE0~Ⅱ级组(n=25)和HEⅢ~Ⅳ级组(n=25);另选择同期在该院就诊的25例慢性肝病患者(设为慢性肝病组),以及在该院体检的25名健康者(设为健康对照组)纳入研究。比较4组患者外周血Th17/Treg比值及炎性因子[IL-17、IL-10和转化生长因子-β(TGF-β)]的表达水平,并分析其与患者预后的关系。采用多因素logistic回归法分析预后的影响因素,采用ROC曲线评估外周血Th17/Treg比值判断HE患者预后的效能。结果 HEⅢ~Ⅳ级组、HE0~Ⅱ级组和慢性肝病组的Th17/Treg比值、IL-17表达水平均高于健康对照组,HEⅢ~Ⅳ级组和HE0~Ⅱ级组的Th17/Treg比值、IL-17表达水平均高于慢性肝病组,HEⅢ~Ⅳ级组的Th17/Treg比值、IL-17表达水平均高于HE 0~Ⅱ级组,差异均有统计学意义(P均<0.05)。HEⅢ~Ⅳ级组、HE 0~Ⅱ级组和慢性肝病组的IL-10、TGF-β表达水平均低于健康对照组,HEⅢ~Ⅳ级组和HE0~Ⅱ级组的IL-10、TGF-β表达水平均低于慢性肝病组,HEⅢ~Ⅳ级组的IL-10、TGF-β表达水平均低于HE 0~Ⅱ级组,差异均有统计学意义(P均<0.05)。50例HE患者治疗1周后有14例预后不良,36例预后良好。预后不良组与预后良好组患者的性别、年龄、BMI、药物使用情况的差异均无统计学意义(P均>0.05)。与预后良好组比较,预后不良组中肝功能Child-Pugh C级占比、HEⅢ~Ⅳ级占比、Th17/Treg比值,以及ALT、AST、血氨、IL-17的表达水平均较高,而IL-10、TGF-β的表达水平均较低,差异均有统计学意义(P均<0.05)。多因素logistic回归分析结果显示,肝功能分级、HE分级、AST、血氨、Th17/Treg比值、IL-17均是影响HE患者预后的危险因素,而TGF-β是影响预后的保护因素(P均<0.05)。ROC曲线�
Objective An attempt is made in this paper to explore the changes of Th17/Treg balance in peripheral blood of patients with hepatic encephalopathy(HE) and its relationship with prognosis.Methods Fifty HE patients admitted to the Hospital of Chinese People’s Armed Police Marine Police Corps from February 2019 to February 2020 were selected as the study subjects.According to the West-Haven classification standard,the patients were assigned to the HE 0–Ⅱ group(n=25) and the HE Ⅲ–Ⅳ group(n=25).In addition,twenty-five patients with chronic liver disease(assigned as the chronic liver disease group) and twenty-five healthy people(assigned as the healthy control group) were selected to be included in the study.The peripheral blood Th17/Treg ratio and the expression of inflammatory factors(IL-17,IL-10,and transforming growth factor(TGF-β)) were compared in the 4 groups,and the relationship between them and the prognosis was analyzed.The multivariate logistic regression model was used to analyze the risk factors affecting prognosis,and ROC curve was used to evaluate the efficacy of peripheral blood Th17/Treg ratio in judging prognosis of HE patients.Results The expression of Th17/Treg ratio and IL-17 in the HE Ⅲ–Ⅳ group,the HE 0–Ⅱ group,and the chronic liver disease group are higher than those in the healthy control group and the chronic liver disease group.The expression of Th17/Treg ratio and IL-17 in the HE Ⅲ–Ⅳ group are higher than those in the HE 0–Ⅱ group,with a statistically significant difference(P0.05).Compared with the good prognosis group,in the poor prognosis group,the proportion of liver function Child-Pugh grade C,the proportion of the HE Ⅲ–Ⅳ,the ratio of Th17/Treg,and the expression of ALT,AST,blood ammonia,and IL-17 are all higher,while the expression of IL-10 and TGF-β are all lower(P<0.05).The multivariate logistic regression analysis shows that liver function grade,HE grade,AST,blood ammonia,Th17/Treg ratio,and IL-17 are all risk factors for poor prognosis of HE pa
作者
杨君寅
计钰亮
朱婷婷
YANG Junyin;JI Yuliang;ZHU Tingting(Department of Gastroenterology,Hospital of Chinese People’s Armed Police Marine Police Corps,Jiaxing 314000,China)
出处
《国际消化病杂志》
CAS
2022年第4期255-260,共6页
International Journal of Digestive Diseases
基金
嘉兴市科技计划项目(2018AD32187)。
关键词
肝性脑病
外周血
Th17
TREG
预后
Hepatic encephalopathy
Peripheral blood
Th17
Treg
Prognosis
