目的：探讨慢加急性肝功能衰竭（ACLF）患者应用人工肝治疗后外周血 T 淋巴细胞亚型变化情况。方法连续性收治38例ACLF患者，其中18例接受人工肝支持治疗（ALSS）治疗的患者为治疗组，20例接受常规药物治疗的患者为对照组。分别于治疗前，治疗后1、2、3、4周检测两组患者肝、肾功能，凝血功能以及外周血 T淋巴细胞亚型水平。结果治疗组患者28 d生存率为66．6％（12／18），明显高于对照组的40．0％（8／20），差异有统计学意义（ P＜0．05）。两组患者治疗前外周血T淋巴细胞CD4＋／CD8＋比值比较，差异无统计学意义（ P＞0．05）。在对照组28 d存活的8例患者中，可见CD4＋ T淋巴细胞水平明显上升，而CD8＋ T淋巴细胞水平下降，CD4＋／CD8＋比值上升（P＜0．05）。而在治疗组存活的12例患者中，这种变化更为明显（P＜0．05）。两组患者天门冬氨酸氨基转移酶、肌酐、尿素以及国际化标准比值水平均较治疗前明显好转，差异有统计学意义（P＜0．05）。结论外周血T淋巴细胞亚型水平可以了解ACLF患者免疫功能情况，有助于评价临床疗效和预后情况。%Objective To analysis the changes of peripheral T‐lymphocyte subsets in acute‐on‐chronic liver failure patients (ACLF)with artificial liver support system (ALSS) .Methods Thirty‐eight ACLF patients were di‐vided into treatment group(n=18) and control group(n=20) .Patients in the treatment group were received ALSS treatment while patients in the control group were only received normal medical therapy .Hepatorenal function ,coag‐ulation function and peripheral T‐lymphocye subsets were measured in five time points (before treatment ,1 week ,2 weeks ,3 weeks and 4 weeks after treatment) .Results No significant difference could be found in sex ,age ,hepatore‐nal function between these two groups(P> 0 .05) .These 28 days death rate in treatment group and control group were 40 .0% and 66 .6% respectively .The levels of CD8+ decreased in the survivals of control group ,while the levels of CD4+ and ratio of CD4+ /CD8+ increased(P<0 .05) .These changes were more significantly in the survivals of treatment group(P<0 .05) .The levels of aspartate aminotransferase(AST) ,creatinive(SCr) ,urea(BUN) and inter‐national mormalized ratio (INR) of survivals were also declined in the end of 28 days(P<0 .05) .Conclusion Periph‐eral T‐lymphocyte subsets minght play an important role in the pathophysiology of ACLF and present reliable bio‐markers for evaluation of curative effect and prognosis .
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