上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

戊型病毒性肝炎患者外周血Th17、Treg、Th17/Treg变化及其临床意义

孙蔚1，朱海超2，甘建和1，吴云辉1，徐英1，陈丽1   

  1. 1.苏州大学附属第一医院感染病科， 苏州 215006； 2．南阳医学高等专科学校第一附属医院消化内科， 南阳 473000
  • 出版日期:2015-11-28 发布日期:2016-01-13
  • 通讯作者: 甘建和, 电子信箱: ganjianhe@aliyun.com。
  • 作者简介:孙蔚（1981—）， 女， 主治医师， 硕士; 电子信箱: 20084232111026@suda.edu.cn。
  • 基金资助:

    国家科技部“十二五”重大专项（2012X10002004-008）

Changes and clinic significance of Th17, Treg, and Th17/Treg in peripheral blood of patients with viral hepatitis E

SUN Wei1, ZHU Hai-chao2, GAN Jian-he1, WU Yun-hui1, XU Ying1, CHEN Li1   

  1. 1．Department of Infectious Diseases, the First Hospital Affiliated to Soochow University， Suzhou 215006， China; 2．Department of Digestion, the First Hospital Affiliated to Nanyang Mdeical College, Nanyang 473000， China
  • Online:2015-11-28 Published:2016-01-13
  • Supported by:

    Major Scinece and Technology Program in the “12th 5-year Plan” of China， 2012X10002004-008

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摘要：

目的  观察急性戊型肝炎患者（AHE）和戊型肝炎病毒相关肝衰竭患者（HEV-LF）外周血中T辅助细胞17（Th17）、调节性T细胞（Treg）及其比值（Th17/Treg）的变化，并探讨临床意义。方法  应用流式细胞术分别检测20名健康对照（对照组）、25例AHE患者（AHE组）和14例HEV-LF患者（HEV-LF组）外周血中Th17、Treg细胞百分率，计算Th17/Treg，同时检测总胆红素（TBiL）、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、凝血酶原活动度(PTA)等指标。结果  外周血Th17、Treg细胞百分率和Th17/Treg由高到低依次为HEV-LF组、AHE组和对照组，部分差异有统计学意义（P<0.05）。在HEV-LF组，Th17细胞百分率与ALT、TBiL呈正相关（r=0.591、0.539；P<0.05），与PTA呈负相关性(r=-0.565，P<0.05)；Th17/Treg与ALT呈正相关（r=0.777，P<0.05），与PTA呈负相关（r=-0.653，P<0.05)，其余均无相关性（P>0.05）。HEV-LF组外周血Th17细胞百分率升高是患者预后的危险因素（OR=4.301, P<0.05）。结论  戊型肝炎病毒急性感染导致不同临床经过的患者均存在不同程度的免疫功能紊乱。外周血Th17细胞百分率、Th17/Treg均与肝脏炎症坏死相关；外周血Th17细胞百分率升高可能与戊型肝炎重症化有关，可作为HEV-LF患者预后评估的指标之一。

关键词: 戊型肝炎, 肝衰竭, T辅助细胞17, 调节性T细胞

Abstract:

Objective  To observe changes of T helper 17 (Th17), regulatory T cells (Treg), and  the ratio of Thl7/Treg in peripheral blood of patients with acute hepatitis E (AHE) and hepatitis E virus related liver failure (HEV-LF) patients and explore the clinic significance. Methods  The flow cytometry was used to detect the percentages of Treg and Thl7 cells in peripheral blood of 20 healthy controls (control group), 25 patients with AHE (AHE group), and 14 patients with HEV-LF (HEV-LF group). The percentage of Th17/Treg was calculated and indexes such as TBiL, ALT, AST, and PTA were determined. Results  The percentages of Th17 and Treg cell and Th17/Treg of the HEV-LF group were the highest, followed by those of the AHE group and those of the control group were the lowest. Part of differences were statistically significant (P<0.05). For the HEV-LF group, percentage of Th17 positively correlated with ALT and TBiL (r=0.591, 0.539; P<0.05) and negatively correlated with PTA (r=-0.565; P<0.05), while ratio of Th17/Treg positively correlated with ALT (r=0.777; P<0.05) and negative correlated with PTA (r=-0.653; P<0.05) and no other correlations were found (P>0.05). The increase of the percentage of Th17 cells in peripheral blood of patients of HEV-LF group was the risk factor of prognosis （OR=4.301, P<0.05）. Conclusion  Acute infection of HEV results in different degrees of immune dysfunction of patients with different clinical courses. Th17/Treg and Th17 in peripheral blood correlate with the hepatic inflammation and necrosis. The increase of the percentage of Th17 cells in peripheral blood may be a pathogenesis of severe hepatitis E and can be used as an indicator to assess the prognosis of patients with HEV-LF.

Key words: viral hepatitis E, liver failure, T helper 17, regulatory T cells