乙型肝炎相关慢加急性肝衰竭患者的免疫状态及其与预后的相关性

发布时间：2018-06-05 23:18

本文选题：肝炎 + 乙型　；参考：《中国肝脏病杂志(电子版)》2016年03期

【摘要】：目的分析乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者的免疫状态及其与预后的相关性。方法选取2014年1月至2014年12月本院收治的72例HBV-ACFL患者为观察组(HBV-ACLF组),并按照预后分为好转组(38例)和恶化组(34例),同期选取72例重度慢性乙型肝炎(CHB)患者作为对照组(CHB组),分析两组患者免疫球蛋白、补体及T淋巴细胞亚群等免疫指标的差异及其与预后的关系。结果与对照组相比,观察组患者的AST、TBil和Fibroscan弹性值更高,抗病毒治疗者更少(χ~2=4.50,P=0.03)。观察组Ig G和Ig A分别为(19.96±6.13)g/L和(3.19±1.27)g/L,显著高于对照组(F=12.13、12.85,P均=0.001),而C3、C4、CD3~+和CD4~+T细胞计数分别为(0.38±0.26)g/L、(0.07±0.06)g/L、(908.72±376.33)细胞/μl和(428.97±1183.36)细胞/μl,显著低于对照组(F=46.33、24.62、16.27、3.60,P均0.05)。恶化组与好转组相比,男性患者更多(χ~2=8.05,P=0.005),均未进行抗病毒治疗,多伴有并发症(χ~2=3.99,P=0.046),ALT和AST水平更高(F=4.69、5.43,P=0.04、0.03),C3水平更低[(0.24±0.07)g/L vs(0.51±0.34)g/L](F=12.14,P=0.001),其余免疫指标无统计学差异(P均0.05)。Logistic分析发现C3水平下降与HBV-ACLF患者的病情恶化相关,其余免疫指标与预后无关。结论 HBV-ACLF患者存在免疫球蛋白升高、补体下降及T细胞损耗等免疫紊乱情况,C3水平下降与病情恶化有一定相关性。
[Abstract]:Objective to analyze the immune status and prognosis of patients with chronic hepatitis B associated with acute hepatic failure (HBV-ACLF). Methods from January 2014 to December 2014, 72 patients with HBV-ACFL in our hospital were selected as the observation group and divided into two groups according to the prognosis: 38 cases in the improvement group and 34 cases in the worsening group. 72 patients with severe chronic hepatitis B were selected as the control group. The immunoglobulin of the two groups was analyzed. The difference of complement and T lymphocyte subsets and its relationship with prognosis. Results compared with the control group, the elasticity of ASTTBil and Fibroscan in the observation group was higher than that in the control group, and the number of patients treated with antiviral therapy was lower (蠂 2 4.50). The levels of IGG and IgA were 19.96 卤6.13)g/L and 3.19 卤1.27g / L, respectively, which were significantly higher than those of the control group (F12.131312.85) P 0.001g / L, while the counts of C _ 3C _ 4C _ 4 ~ and CD _ 4T cells were 0.38 卤0.26g / L, 908.72 卤376.33) cells / 渭 l and 428.97 卤1183.36 cells / 渭 l, respectively, which were significantly lower than those of the control group. Compared with the improvement group, there were more male patients in the worsening group (蠂 2 + 8.05% P < 0.005), and none of the patients were treated with antiviral therapy. The levels of alt and AST were higher than those of FG 4.69 and 5.43. The level of C3 was lower [0.24 卤0.07)g/L vs(0.51 卤0.34)g/L] F _ (12.14 卤0.34)g/L) P _ (0.001). There was no significant difference in the other immunological markers (P all 0.05).Logistic analysis showed that the decrease of C _ 3 level was related to the deterioration of HBV-ACLF, and the other immunological indexes were not related to the prognosis. Conclusion the increase of immunoglobulin, the decrease of complement and T cell depletion, and the decrease of C3 level in patients with HBV-ACLF may be related to the deterioration of the disease.
【作者单位】：成都市公共卫生临床医疗中心肝炎科;
【基金】：四川省医学科研青年创新课题计划(Q14020) 四川省卫生和计划生育委员会科研课题(150035)
【分类号】：R512.62;R575.3

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