目的 探讨丙型肝炎肝硬化(CHC-LC)患者外周血Th17/Treg失衡及其相关细胞因子变化的临床意义.方法 收集2014年5月-2016年5月于天门市第一人民医院就诊的CHC患者96例,其中CHC患者54例(CHC组)、CHC-LC患者42例(LC组)、健康体检者40例(HC组).采用流式细胞术检测3组的外周血Th17/Treg细胞表达情况,采用ELISA法检测血清IL-6、IL-10、IL-17及TGFβ,同时检测HCV RNA、AST、ALT、TBil.多组比较采用方差分析,进一步两组间比较采用SNK-q检验;计数资料组间比较采用,检验;相关性分析采用Pearson相关性分析法.结果 LC组的外周血Th17细胞比率[(5.97±0.84)％]、Treg细胞比率[(3.14±0.72)％]、Th17/Treg(1.90±0.52)均显著高于HC组[(2.39±0.46)％、(1.72±0.53)％、(1.39±0.12)]和CHC组[(4.75±0.67)％、(2.81±0.87)％、(1.69±0.45)],差异均有统计学意义(F值分别为312.95、47.21、17.34,P值均＜0.001). LC组的各细胞因子IL-6、IL-17、IL-10及TGFβ均显著高于HC组和CHC组,差异均有统计学意义(F值分别为160.38、574.11、23.90、36.97,P值均＜0.001).Th17细胞比率、Treg细胞比率、Th17/Treg及各细胞因子(IL-17、IL-6、IL-10、TGFβ)与ALT、AST呈显著正相关性(ALT:r值分别为0.633、0.525、0.631、0.931、0.841、0.372、0.343,P值均＜0.05;AST:r值分别为0.597、0.502、0.564、0.873、0.813、0.365、0.337,P值均＜0.05),Th17细胞比率、Treg细胞比率、IL-6、IL-17、TGFβ与TBil均呈显著正相关性(r值分别为0.344、0.231、0.401、0.339、0.307,P值均＜0.05).结论 Th17/Treg细胞及相关因子可能与CHC及LC的发生发展密切相关,Th17/Treg及其相关细胞因子检测可能对CHC-LC的防治具有重要意义.%Objective To investigate the clinical significance of Th17/Treg imbalance and changes in associated cytokines in chronic hepatitis C (CHC) patients with liver cirrhosis.Methods A total of 96 CHC patients who visited The First People's Hospital of Tianmen from May 2014 to May 2016 were enrolled and divided into CHC group with 54 CHC patients,LC group with 42 CHC patients with LC,and HC group with 40 healthy persons who underwent physical examination.Flow cytometry was used to measure the percentages of Th17 and Treg cells in peripheral blood,ELISA was used to measure the serum levels of intedeukin-6 (IL-6),interleukin-10 (IL-10),interleukin-17 (IL-17),and transforming growth factor-β (TGFβ),and the levels of HCV RNA,aspartate transaminase (AST),alanine aminotransferase (ALT),and total bilirubin (TBil) were also measured.An analysis of variance was used for comparison between multiple groups,and the SNK-q test was used for comparison between any two groups;the chi-square test was used for comparison of categorical data between groups;Pearson correlation analysis was also performed.Results Compared with the HC group and the CHC group,the LC group had significantly higher percentages of Th17 cells (5.97 ％ ± 0.84 ％ vs 2.39％-± 0.46％/4.75 ％ ± 0.67 ％,F =312.95,P ＜ 0.001) and Treg cells (3.14％ ± 0.72％ vs 1.72％ ± 0.53 ％/2.81％ ± 0.87 ％,F =47.21,P ＜ 0.001) in peripheral blood,as well as a significantly higher Th17/Treg ratio (1.90 ±0.52 vs 1.39 ±0.12/1.69-±0.45,F =17.34,P ＜0.001).The LC group also had significantly higher serum levels of IL-6,IL-17,IL-10,and TGF-β than the HC group and the CHC group (F =160.38,574.11,23.90,and 36.97,all P ＜ 0.001).The percentages of Th17 and Treg cells,Th17/Treg ratio,and levels of IL-17,IL-6,IL-10,and TGF-β were significantly positively correlated with ALT and AST levels (ALT:r =0.633,0.525,0.631,0.931,0.841,0.372,and 0.343,all P ＜0.05;AST:r =0.597,0.502,0.564,0.873,0.813,0.365,and 0.337,all P ＜ 0.05),and the percentages of Th17 and Treg cells and levels of IL-6,IL-17,and TGFβ were also significantly positively correlated with TBil level (r =0.344,0.231,0.401,0.339,and 0.307,all P ＜ 0.05).Conclusion Th17 and Treg cells and associated cytokines may be closely associated with the development and progression of CHC and LC and have certain significance in the prevention and treatment of CHC patients with LC.
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