慢加急性肝衰竭患者外周血细胞毒性T细胞上共刺激分子的表达及其临床意义

目的探讨PD-1/PD-L1、细胞毒T淋巴细胞相关抗原（CTLA）-4、CD28在乙型肝炎（下简称乙肝）致慢加急性肝衰竭（HBV-ACLF）不同时期细胞毒性T细胞（CTL）上的阳性表达、动态变化及其临床意义。方法对43例HBV-ACLF患者、15例慢性乙肝（CHB）患者及15名正常人采用流式细胞术检测外周全血中CTL上PD-1、PD-L1、CTLA-4、CD28的阳性表达,并观察ACLF患者早期、中期、晚期共刺激分子的动态变化。结果 HBV-ACLF与CHB、CHB与正常对照组间外周血CTL上PD-1、CTLA-4、CD28及CTL的阳性表达率比较,除CHB与正常对照组CTL的差异无统计学意义（P〉0.05）外,其余各分子的差异均有统计学意义（P〈0.05或〈0.01）;对各分子进行早期与中期、中期与晚期比较,差异均有统计学意义（均P〈0.05）。结论 HBV-ACLF患者外周血共刺激分子的动态变化可以反映其免疫状态,对指导临床治疗可能具有一定的价值。

Expression of Costimulate Molecules on Peripheral Cytotoxic T Cell in Patients with Acute-on-chronic Liver Failure and Clinic Significance

Objective To investigate the espression,dynamic change and clinical significance of PD-1/PD-L1,CTLA-4 and CD28B on CTL of HBV-ACLF patients during different periods.Methods The expression of PD-1/PD-L1,CTLA-4 and CD28 on periph CTL cells was detected in 43 patients with HBV-ACLF,15 patients with CHB and 15 health adults by the fluorescence-activated cell sorter;dynamic changes of costimulatory molecules were observed during the nonage,metaphase and advanced stage of ACLF.Results The expression of PD-1,CTLA-4,CD28,CTL cells in 43 patients with HBV-ACLF was compared with 15 patients with CHB and 15 health adults.In addition to CTL of CHB and health,the difference was not statistically significant,the rest were significantly different in the molecules.The expression of costimulating molecules on peripheral CTL cells in the nonage,metaphase and advanced stage of 43 patients with ACLF was significantly different（P0.05）.Conclusion Costimulatory molecules may have a certain value for evaluating immune state,guiding the regulation of immunity.