糖皮质激素对HBV相关肝衰竭前期患者CD4+CD25+调节性T淋巴细胞的影响及其临床意义

摘要

Objective To investigate the effect and clinical significance of glucocorticoid on CD4+CD25+ regulatory T cells (Tregs) in patients with hepatitis B virus (HBV)-related pre-liver failure.Methods The subjects of this study included 78 patients with pre-liver failure induced by HBV (cases) and 24 healthy individuals (controls).Among the 78 cases,42 received glucocorticoid treatment and 36 did not.Between-group differences in Tregs (in peripheral blood) were evaluated by flow cytometry and statistical analysis.Results Two weeks of glucocorticoid treatment led to an increase in Treg level compared to baseline (before therapy:2.76 ± 0.73 vs.3.88 ± 1.60).In addition,after the two weeks of glucocorticoid treatment,the Treg level of improved patients was significantly higher than that measured at baseline (before therapy:2.70 ± 0.77 vs.3.97±1.59,P ＜ 0.05).Conclusion Glucocorticoids up-regulate the expression of Treg cells,which may contribute to the immunological mechanism that protects pre-liver failure patients from deterioration of their condition.Careful inspection and monitoring of Treg levels may help improve prognosis of these patients.%目的 探讨糖皮质激素对HBV相关肝衰竭前期患者CD4+CD25+调节性T淋巴细胞(Treg 细胞)的影响及其临床意义. 方法 纳入2011年8月至2013年4月住院治疗的HBV相关肝衰竭前期患者78例,随机分为两组,其中糖皮质激素治疗组42例,非激素治疗组36例,以同期24名健康志愿者作为正常对照组.流式细胞仪检测甲强龙治疗前后外周血CD4+CD25+CD 127low/-Treg细胞比例的变化.三组均数的比较采用Kruskal-Wallis检验,两两比较采用Man whitney检验.结果 激素组治疗后Treg细胞比例(3.88％±1.60％)较治疗前(2.76％±0.73％)明显升高;激素治疗有效患者治疗后Treg细胞比例(3.97％±1.59％)较治疗前(2.70％±0.77％)上调,P值均＜0.05.结论 糖皮质激素能上调Treg细胞比例,可能是阻断肝衰竭前期患者发生重症化的免疫学机制之一,重视Treg细胞比例检查和监测有助于判断预后.