标题：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

      作者：沈敏1，林明强1，冯奇桃1，吕友凯1，李永武2
    (海南省农垦总医院感染性疾病科1、分子生物学实验室2，海南海口570311)

      卷次： 2016年27卷5期

      【摘要】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。
      【关键词】Th17；Treg；HBV；慢加亚急性肝衰竭；谷丙转氨酶；谷草转氨酶
      【中图分类号】R512.6+2 【文献标识码】A 【文章编号】1003—6350（2016）05—0692—05C

hange of Th17 cell, Treg cell in patients with HBV-associated acute-on-chronic liver failure and itsrelationship with liver function and HBV-DNA load.
Shen Min 1, LIN Ming-qiang 1, FENG Qi-tao 1, LV You-kai 1, LIYong-wu 2. Department of Infectious Diseases 1, Laboratory of Molecular Biology 2, Hainan Provincial Nongken GeneralHospital, Haikou 570311, Hainan, CHINA【Abstract】Objective To detect the levels of Th7 and Treg cells in patients with hepatitis B virus-associatedacute-on-chronic liver failure (HBV-ACLF) and to analyze the effect of Th7 and Treg cells in the pathogenesis ofHBV-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 determinedby 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-DNAloads were analyzed. Results The levels of Th17, Treg and Th17/Treg in HBV-ACLF group were significantly higherthan 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 thecorrelation coefficients of 0.873, 0.638, 0.617, respectively. Th17 was positively correlated with ALT in HBV-ACLFgroup and CHB group (r=0.612, P<0.05; r=0.636, P<0.05), and Th17/Treg was positively correlated with ALT inHBV-ACLF group and CHB group (r=0.592, P<0.05; r=0.712, P<0.05). Th17, Treg, Th17/Treg showed no correlationwith 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 patientswith CHB and HBV-ACLF, which indicates that Th17 and Treg are involved in the occurrence and development of CHBand HBV-AVLF. Th17 cell could be used as an immunological marker for determination of the liver damage degree inHBV-ACLF. Th17, Treg have no correlation with the load of HBV-DNA.【Key words】Th17; Treg; Hepatitis B virus (HBV); Acute-on-chronic liver failure (ACLF); Alanine aminotransferase(ALT); Aspartate aminotransferase (AST)