红细胞天然免疫粘附功能在肝病不同病期的变化及意义

目的　研究肝病患者红细胞天然免疫粘附功能 (RNIAF)的变化 ,探讨其在评估肝病病情严重程度中的应用价值。方法　红细胞天然免疫粘附功能测定 :采用红细胞在自身血浆中天然免疫粘附肿瘤细胞的方法 :5 0 μl 1.2 5 %的红细胞悬液在 10 0 μl自身血浆中与 10 0 μl的 1× 10 6/ml肿瘤细胞悬液反应 ,1个肿瘤细胞粘附有 5个或以上的红细胞为一个粘附单位 ,计算粘附率。血清sCR1水平测定 :采用鼠抗人CR1单克隆抗体包被聚苯乙烯微孔板 ,及碱性磷酸酶结合的第二抗体建立的夹心ELISA法定量测定肝病血清sCR1浓度变化。红细胞膜CR1分子定量测定 :采用细胞酶免疫分析法。结果　肝病患者红细胞天然免疫粘附功能不同程度地低于正常人群 (P <0 .0 1) ,自急性肝炎、慢性肝炎、肝硬化Child′A、肝硬化Child′B、肝硬化Child′C、重型肝炎依次加重 ,与患者CHE、PT、PTA等指标显著正相关 ,重型肝炎病情恢复期时其RNIAF显著回升 ,但患者CHE、PT、PTA等指标持续处于低水平。肝病红细胞CR1数量亦不同程度地下降 ,但其变化较RNIAF的变化迟缓。血清sCR1水平在肝硬化病人明显升高 ,但在慢性肝炎及急性肝炎变化不如RNIAF的变化明显。结论　红细胞天然免疫粘附功能可灵敏地反应肝病病情的严重程度 ,在慢性肝病 ,RNIAF的变化先于CHE

The changes and significance of red cell nature-immune-adhesion function in liver diseases at different stages

OBJECTIVE: To study the changes of red cells nature immune adhesion function (RNIAF) in liver diseases at different stages, and the feasibility of RNIAF in evaluating the severity of liver diseases. METHODS: Venous blood was extracted from 682 patients with liver disease, including cirrhosis, chronic hepatitis, acute hepatitis, hepatitis gravis, and 50 healthy blood donors as controls. Suspension of red cells in self-plasma was mixed with solution of mouse ascites carcinoma cells. A tumor cell attached with 5 red cells or 2 lymphocytes/granulocytes was counted as one rosette. The adhesion rate was calculated. Serum soluble complement receptor 1 (sCR1) was measured with a newly established sandwich enzyme-linked immunosorbent assay (ELISA). The CR1 expressed on erythrocytes has assayed by cell-ELISA. RESULTS: The expression of CR1 on erythrocytes was lower among the patients with liver diseases. Compared with that in healthy controls, RNIAF decreased among the patients with various liver diseases (all P < 0.01) in the order of acute hepatitis, chronic hepatitis, cirrhosis Child's A, cirrhosis Child's B, cirrhosis Child's C, and hepatitis gravis. CHE and PTA decreased and PT increased among the patients with cirrhosis and hepatitis gravis (all P < 0.05 or P < 0.01). RNIAF was positively correlated with CHE, PT, and PTA in patents with cirrhosis. CHE, PT and PTA remained at low levels while RNIAF almost returned to its normal level in the convalescents of hepatitis gravis. CR1 expressed on erythrocytes and sCR1 in serum in various liver diseases were decreased at different degrees, however, they changed significantly later than RNIAF. Serum sCR1 significantly increased in the patients with cirrhosis, particularly in those in grades Child's A to C. CONCLUSION: Low-cost, easy to operate and with early change and stable results, RNIAF may be used as an important indicator to evaluate the severity of liver diseases. of CHE, PT/PTA. It is an important to evaluate the severity of liver function in clinic.