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摘要：
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摘要：目的 探讨原发性胆汁性肝硬化（primary biliary cirrhosis，PBC）患者外周血Th9细胞表达水
平及其与肝功能指标和Mayo评分的相关性。方法 纳入2017年1月至2019年1月深圳市宝安区石岩人
民医院收治的50例PBC患者为PBC组。另选取同期于本院接受诊治的50例免疫系统异常患者作为
对照组。采用流式细胞术检测外周血Th9细胞表达水平。采用日立全自动生化检测仪检测两组患者
生物化学指标，包括碱性磷酸酶（alkaline phosphatase，ALP）、天门冬氨酸氨基转移酶（aspartate
aminotransferase，AST）、丙氨酸氨基转移酶（alanine aminotransferase，ALT）、γ-谷氨酰转肽酶
（γ-glutamine transpeptidase，γ-GT）、总胆红素（total bilirubin，TBil）、白蛋白（albumin，ALB）
和凝血酶原时间（prothrombin time，PT）并计算Mayo评分。采用间接免疫荧光法检测抗线粒体抗体
的表达。水肿积分由2～3名有经验的医师通过患者症状进行双盲评价。采用实时荧光定量聚合酶链
式反应检测外周血单个核细胞中嘌呤盒-1（purine-rich box 1，PU-1）和转化生长因子-β（transforming
growth factor-β，TGF-β）mRNA相对表达量。采用Pearson相关性分析PBC患者外周血Th9细胞表达水
平与肝功能指标和Mayo评分的相关性。结果 PBC组患者PT [（13.42 ± 1.34）s vs（7.05 ± 1.01）s]、
ALP [（391.42 ± 182.39）U/L vs（63.29 ± 20.71）U/L]、AST [（147.20 ± 60.28）U/L vs（19.04 ± 7.23）U/L]、
ALT [（166.19 ± 80.34）U/L vs（24.12 ± 10.38）U/L]、γ-GT [（442.08 ± 124.47）U/L vs（28.10 ± 13.82）U/L]、
TBil [（140.58 ± 20.75）μmol/L vs（12.84 ± 3.99）μmol/L]、抗线粒体抗体阳性占比 [25/50（50.00%）
vs 14/50（28.00%）]、水肿积分 [（0.54 ± 0.04）分 vs（0.15 ± 0.01）分]、肝脏形态缩小人数占比
[6/50（12.00%）vs 0/50（0.00%）]、肝实质回声中结节增生表现人数占比 [5/50（10.00%）vs 0/50
（0.00%）]、肝内胆管壁增强人数占比 [26/50（52.00%）vs 1/50（2.00%）]及肝实质回声中颗粒表现人数占
比 [34/50（68.00%）vs 2/50（4.00%）]均显著高于对照组，ALB水平 [（31.29 ± 7.45）g/L vs（45.12 ± 1.88）g/L]
显著低于对照组（P均＜ 0.05）。PBC组患者外周血Th9细胞亚群占比为（1.68 ± 0.32）%，显著高于对照组的
（0.19 ± 0.04）%，PBC组患者Mayo评分为（6.45 ± 1.17）分，显著高于对照组的（2.10 ± 0.48）分，差异均有统计
学意义（t = 32.670、24.323，P ＜ 0.001）。Pearson相关性分析表明，PBC患者外周血Th9细胞表达水平与
AST、ALT、γ-GT、TBil及Mayo评分均呈正相关（r均＞ 0，P均＜ 0.05）。PBC组PU-1和TGF-β mRNA
表达量均显著高于对照组（5.87 ± 1.03 vs 1.34 ± 0.47；4.33 ± 0.78 vs 1.38 ± 0.51），差异有统计学意义（t
值分别为28.293、22.383，P均＜ 0.001）。结论 PBC患者外周血Th9细胞表达水平显著升高，且与肝功
能指标和Mayo评分呈正相关。Th9细胞表达水平可能反映了患者病情的严重程度。
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Abstract: Objective To investigate the expression level of Th9 cells in peripheral blood of patients with
primary biliary cirrhosis (PBC) and its relationship with liver function indexes and Mayo score. Methods
Total of 50 patients with PBC admitted to Shiyan People’s Hospital of Baoan District from January 2017
to January 2019 were included as PBC group and 50 patients with abnormal immune system who received
treatment in our hospital at the same time were selected as control group. Flow cytometry were used to detect
the expression level of Th9 cells in peripheral blood. Automatic biochemical tester were used to detect the
biochemical indicators of the patients, including alkaline phosphatase (ALP), aspartate aminotransferase
(AST), alanine aminotransferase (ALT), γ-glutamine transpeptidase (γ-GT), total bilirubin (TBil), albumin
(ALB) and prothrombin time (PT). Mayo score was also calculated. Indirect immunofluorescence was used
to detect the expression of anti-mitochondrial antibodies. Edema score was double-blind evaluated by 2～3
experienced physicians according to the symptoms of the patients. Real-time fluorescence quantitative
polymerase chain reaction was used to detect the relative expression of purine-rich box 1 (PU-1) and
transforming growth factor-β (TGF-β) mRNA in peripheral blood mononuclear cells. Pearson correlation
analysis was used to analyze the relationship among blood Th9 cell expression level, liver function indexes
and Mayo score of patients with PBC. Results PT [(13.42 ± 1.34) s vs (7.05 ± 1.01) s], ALP [(391.42 ±
182.39) U/L vs (63.29 ± 20.71) U/L], AST [(147.20 ± 60.28) U/L vs (19.04 ± 7.23) U/L], ALT [(166.19 ±
80.34) U/L vs (24.12 ± 10.38) U/L], γ-GT [(442.08 ± 124.47) U/L vs (28.10 ± 13.82) U/L], TBil [(140.58 ±
20.75) μmol/L vs (12.84 ± 3.99) μmol/L], ratio of positive anti-mtDNA antibody [25/50 (50.00%) vs 14/50
(28.00%)], edema score (0.54 ± 0.04 vs 0.15 ± 0.01), ratio of liver morphology reduction [6/50 (12.00%) vs
0/50 (0.00%)], ratio of proliferation of nodules in echo of liver parenchyma [5/50 (10.00%) vs 0/50 (0.00%)], ratio
of intrahepatic bile duct wall enhancement [26/50 (52.00%) vs 1/50 (2.00%)] and ratio of proportion of granule in
the echo of liver parenchyma [34/50 (68.00%) vs 2/50 (4.00%)] of patients in PBC group were significantly higher
than those in control group, while ALB level [(31.29 ± 7.45) g/L vs (45.12 ± 1.88) g/L] was significantly lower than
that in control group (all P ＜ 0.05). The percentage of Th9 subgroup [(1.68 ± 0.32)% vs (0.19 ± 0.04)%] and Mayo
score (6.45 ± 1.17 vs 2.10 ± 0.48) in peripheral blood of patients in PBC group were significantly higher than those
in control group, the differences were statistically significant (t = 32.670, 24.323; P ＜ 0.001). Pearson correlation
analysis showed that the expression levels of Th9 cells in peripheral blood of patients with PBC were positively
correlated with the levels of AST, ALT, γ-GT, TBil and Mayo score (r ＞ 0, P ＜ 0.05). The relative expression of
PU-1 and TGF-β mRNA of patients in PBC group were significantly higher than those in control group (5.87 ± 1.03
vs 1.34 ± 0.47; 4.33 ± 0.78 vs 1.38 ± 0.51), the differences were statistically significant (t = 28.293, 22.383; P ＜ 0.001).
Conclusions The expression level of Th9 cells in peripheral blood of patients with PBC increased significantly, and
was closely related to liver function indexes and Mayo score. The expression level of Th9 cells may be detected to
effectively reflect the severity of the patient’s disease.
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