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乙型肝炎相关慢加急性肝衰竭患者的免疫状态及其与预后的相关性

作者：唐玉珍陈竹王丽朱丽吴蓓李守娟

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出版年,卷(期):页码：2016,8(3):69-73

摘要：

摘要：目的分析乙型肝炎相关慢加急性肝衰竭（HBV-ACLF）患者的免疫状态及其与预后的相关性。
方法选取2014年1月至2014年12月本院收治的72例HBV-ACFL患者为观察组（HBV-ACLF组），并按照
预后分为好转组（38例）和恶化组（34例），同期选取72例重度慢性乙型肝炎（CHB）患者作为对照组
（CHB组），分析两组患者免疫球蛋白、补体及T淋巴细胞亚群等免疫指标的差异及其与预后的关系。
结果与对照组相比，观察组患者的AST、TBil和Fibroscan弹性值更高，抗病毒治疗者更少（χ 2 = 4.50，
P = 0.03）。观察组IgG和IgA分别为（19.96 ± 6.13）g/L和（3.19 ± 1.27）g/L，显著高于对照组（F =
12.13、12.85，P均= 0.001），而C3、C4、CD3 + 和CD4 + T细胞计数分别为（0.38 ± 0.26）g/L、（0.07 ±
0.06）g/L、（908.72 ± 376.33）细胞/μl和（428.97 ± 1183.36）细胞/μl，显著低于对照组（F = 46.33、
24.62、16.27、3.60，P均＜ 0.05）。恶化组与好转组相比，男性患者更多（χ 2 = 8.05，P = 0.005），均
未进行抗病毒治疗，多伴有并发症（χ 2 = 3.99，P = 0.046），ALT和AST水平更高（F = 4.69、5.43，P =
0.04、0.03），C3水平更低 [（0.24 ± 0.07）g/L vs （0.51 ± 0.34）g/L]（F = 12.14，P = 0.001），其余免疫
指标无统计学差异（P均＞ 0.05）。Logistic分析发现C3水平下降与HBV-ACLF患者的病情恶化相关，其
余免疫指标与预后无关。结论 HBV-ACLF患者存在免疫球蛋白升高、补体下降及T细胞损耗等免疫紊乱
情况，C3水平下降与病情恶化有一定相关性。

Abstract: Objective To explore the immune state of patients with hepatitis B virus related acute-on-chronic
liver failure (HBV-ACLF) and the relationship with prognosis. Methods Total of 72 patients with HBV-
ACLF from January 2014 to December 2014 in our hospital were enrolled as the observation group (HBV-
ACLF group) and divided into recover group (38 cases) and deterioration group (34 cases) according to the
prognosis. While 72 patients with chronic hepatitis B (CHB) were enrolled as the control group (CHB group).
The immune indexes such as immunoglobulin (Ig), complement (C) and T-lymphocyte subsets were tested
and analyzed, respectively. Results Compared with control group, HBV-ACLF group had higher levels of
aspartate transaminase (AST), total bilirubin (TBil) and Fibroscan value, and fewer cases accepted antiviral
treatment. The levels of IgG and IgA in observation group were (19.96 ± 6.13) g/L and (3.19 ± 1.27) g/L,
respectively, which were much higher than those in control group (F = 12.13, 12.85; P = 0.001). The levels
of C3, C4, CD3 + T cell and CD4 + T cell were (0.38 ± 0.26) g/L, (0.07 ± 0.06) g/L, (908.72 ± 376.33) cell/μl and
(428.97 ± 1183.36) cell/μl, respectively, which were much lower than those in control group (F = 46.33, 24.62,
16.27 and 3.60; P ＜ 0.05). Male patients and complications in deterioration group were more than those
in recover group (χ 2 = 8.05, 3.99; P = 0.005, 0.046). No cases accepted antiviral treatment in deterioration
group, the levels of ALT and AST were significantly higher (F = 4.69, 5.43; P = 0.04, 0.03) and the levels of
C3 was significantly lower than those in recover group [(0.24 ± 0.07) g/L vs (0.51 ± 0.34) g/L, F = 12.14, P =
0.001]. The immune index C3 had some relationship with disease deterioration according to Logistic analysis.

Conclusions Patients with HBV-ALCF have autoimmune disorders including high-level immunoglobulin,
low-level complement and T cell loss, and the declined level of C3 may have a certain relationship with
disease deterioration.

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