HBV相关慢加亚急性肝衰竭患者中Th17细胞、Treg细胞的变化及其与肝功能和HBV-DNA载量间的研究

目的：通过检测乙型肝炎病毒(HBV)相关慢加亚急性肝衰竭(HBV-ACLF)患者外周血中的Th17细胞、Treg细胞的水平，探讨Th17、Treg细胞在HBV-ACLF发病机制中的作用。方法流式细胞术检测22例HBV-ACLF患者、24例慢性乙型肝炎患者（CHB）以及20例健康对照者(HC)外周血Th17、Treg细胞的频率，荧光定量PCR法检测患者外周血HBV-DNA水平，同时分析Th17细胞、Treg细胞、Th17/Treg与谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TB)及HBV-DNA载量间的相关性。结果 HBV-ACLF组患者的Thl7细胞、Treg细胞、Th17/Treg较CHB组和HC组明显增高，CHB组又较HC组Th17细胞、Treg细胞、Th17/Treg升高，差异均有统计学意义(P<0.05)；HBV-ACLF组外周血中Th17细胞与Treg细胞间存在正相关(r=0.873，P<0.05)，CHB组外周血中Th17细胞与Treg细胞间存在正相关(r=0.638，P<0.05)，HC组外周血中Th17细胞与Treg细胞间存在正相关(r=0.617，P<0.05)。HBV-ACLF组Thl7细胞与ALT呈正相关(r=0.612，P<0.05)，Th17/Treg与ALT呈正相关(r=0.592，P<0.05)；CHB组Thl7细胞与ALT呈正相关(r=0.636，P<0.05)，Th17/Treg与ALT呈正相关(r=0.712，P<0.05)。HBV-ACLF组、CHB组和HC组Th17、Treg、Th17/Treg与AST和TB间无相关性。HBV-ACLF组和CHB组Th17细胞、Treg细胞、Th17/Treg与HBV-DNA载量间无相关性。结论 Thl7细胞和Treg细胞在机体内可能处于一种平衡状态，在CHB和HBV-ACLF体内这种平衡可能已经打破。Thl7细胞、Treg细胞可能参与了慢性乙型肝炎和HBV相关慢加亚急性肝衰竭的发生发展，同时，Th17细胞有望成为评估HBV-ACLF患者肝脏损伤程度的一个免疫学指标。Th17细胞、Treg细胞与HBV-DNA载量无相关性。

Change of Th17 cell,Treg cell in patients with HBV-associated acute-on-chronic liver failure and its relationship with liver function and HBV-DNA load

Objective To detect the levels of Th7 and Treg cells in patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) and to analyze the effect of Th7 and Treg cells in the pathogenesis of HBV-ACLF. Methods The frequency of Th17 and Treg cells in peripheral blood of 22 patients with HBV-ACLF (HBV-ACLF group), 24 patients with chronic hepatitis B (CHB group) and 20 healthy controls (HC group) were deter-mined by flowcytometry. HBV-DNA loads were measured by fluorescent PCR. Finally, the correlations among Th17, Treg, Th17/Treg, alanine aminotransferase (ALT), aspertate aminotransferase (AST), total bilirubin (TB) and HBV-DNA loads were analyzed. Results The levels of Th17, Treg and Th17/Treg in HBV-ACLF group were significantly higher than those in CHB group and HC group, and the levels in CHB group were significantly higher than those in HC group (P<0.05). Th17 was positively correlated with Treg in HBV-ACLF group, CHB group, and HC group (P<0.05), with the correlation coefficients of 0.873, 0.638, 0.617, respectively. Th17 was positively correlated with ALT in HBV-ACLF group and CHB group (r=0.612, P<0.05; r=0.636, P<0.05), and Th17/Treg was positively correlated with ALT in HBV-ACLF group and CHB group (r=0.592, P<0.05;r=0.712, P<0.05). Th17, Treg, Th17/Treg showed no correlation with HBV DNA load in HBV-ACLF group and CHB group, and also with AST and TB in the three groups (P>0.05). Conclusion Th17 and Treg may be in a balanced state in healthy people, and such state might be broken in patients with CHB and HBV-ACLF, which indicates that Th17 and Treg are involved in the occurrence and development of CHB and HBV-AVLF. Th17 cell could be used as an immunological marker for determination of the liver damage degree in HBV-ACLF. Th17, Treg have no correlation with the load of HBV-DNA.