Lou Yu-Feng, Dong Wei, Ye Bo, Lin Sha, Mao Wei-Lin
Department of Laboratory Medicine, Zhejiang University School of Medicine, Hangzhou, China.
Hepatogastroenterology. 2012 May;59(115):814-7. doi: 10.5754/hge10064.
BACKGROUND/AIMS: HBV-related acute-on-chronic liver failure (AoCLF) is associated with a high mortality rate. An artificial liver support system (ALSS) is a newly emerging therapeutic option, which can be implemented in routine patient care. In order to determine if any pretreatment immunological parameter could be an indicator to evaluate immune states for the outcome of the AoCLF patients, we analyzed the relationship between the level of T-lymphocyte subsets (CD4+, CD8+, CD4/CD8 ratio) and its therapeutic effect and prognosis.
Sixty-three patients with AoCLF were enrolled in 2 groups (ALSS plus routine-care, n=29 and routine-care only, n=34). In the ALSS group, there were 17 survivors (17/29), while in the routine-care group there were 11 survivors (11/34), both after 30 days of treatment. Twenty-three healthy donors were used as the control group. The number of CD4 and CD8 T cells was detected by flow cytometry and the ratio of CD4/ CD8 was calculated on admission and on days 7, 14, 21 and 30, during hospitalization.
More dramatic increased CD4/CD8 ratio in the ALSS survivors (form 0.92±0.18 to 1.26±0.24, p<0.01) than the medical survivors (form 0.86±0.16 to 1.09±0.16, p<0.05) after 30 days of treatment. A declined tendency was observed in nonsurvivors.
T-lymphocyte subsets may be important in the pathogenesis of the AoCLF and ALSS may represent a reliable hepatic support device for Ao- CLF.
背景/目的：乙型肝炎病毒相关慢加急性肝衰竭（AoCLF）的死亡率很高。人工肝支持系统（ALSS）是一种新兴的治疗选择，可应用于常规患者护理。为了确定是否有任何预处理免疫参数可作为评估AoCLF患者免疫状态及预后的指标，我们分析了T淋巴细胞亚群水平（CD4 +、CD8 +、CD4/CD8比值）与其治疗效果和预后之间的关系。
63例AoCLF患者分为两组（ALSS联合常规治疗组，n = 29；仅常规治疗组，n = 34）。治疗30天后，ALSS组有17例存活者（17/29），常规治疗组有11例存活者（11/34）。23名健康供者作为对照组。在住院期间，于入院时、第7天、第14天、第21天和第30天通过流式细胞术检测CD4和CD8 T细胞数量，并计算CD4/CD8比值。
治疗30天后，ALSS存活者的CD4/CD8比值升高更为显著（从0.92±0.18升至1.26±0.24，p<0.01），而药物治疗存活者的CD4/CD8比值升高不明显（从0.86±0.16升至1.09±0.16，p<0.05）。非存活者呈现下降趋势。
T淋巴细胞亚群可能在AoCLF的发病机制中起重要作用，ALSS可能是一种可靠的AoCLF肝支持装置。
