Zhang Geng-Lin, Zhang Ting, Zhao Qi-Yi, Lin Chao-Shuang, Gao Zhi-Liang
Department of Infectious Diseases.
Guangdong Provincial Key Laboratory of Liver Disease.
Medicine (Baltimore). 2018 Oct;97(40):e12656. doi: 10.1097/MD.0000000000012656.
Our previous study demonstrated that Th17 cells increased significantly in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). However, their prognostic role in HBV-ACLF patients remains unknown.Sixty-eight consecutive HBV-ACLF patients were enrolled in this cohort study. Th17 cells were examined using flow cytometry. Disease severity scores were assessed. ROC curves were used to evaluate the value in predicting prognosis. Survival was analyzed using Kaplan-Meier curves. Predictors of mortality were determined by regression analysis.Th17 cells were significantly higher in HBV-ACLF patients compared to patients with chronic hepatitis B and normal controls (both P < .001). Also, Th17 cells were higher in nonsurviving HBV-ACLF patients than in surviving patients (P = .014). Th17 cells were positively correlated with CLIF-Consortium ACLF (CLIF-C ACLF) score (r = 0.240, P = .048). ROC curves showed that the frequency of Th17 cells had accuracy in predicting 90-day prognosis equivalent to MELD, MELD-Na and CLIF-C ACLF scores in HBV-ACLF (P = .34, P = .26, and P = .15, respectively). More importantly, the area under the ROC curve (AUROC) increased when Th17 cells were combined with MELD, MELD-Na or CLIF-C ACLF score than using Th17 cells alone (P = .021, P = .006, and P = .023, respectively). Kaplan-Meier analysis revealed that higher Th17 cells (≥5.9%) were closely associated with poor overall survival in HBV-ACLF (P = .0086). Additionally, multivariate regression analysis showed that the frequency of Th17 cells over 5.9% was an independent predictor of mortality (OR = 0.154, P = .025).Circulating Th17 cells positively correlated with disease severity in HBV-ACLF. The frequency of Th17 cells over 5.9% could serve as a prognostic biomarker for HBV-ACLF patients.
我们之前的研究表明，在乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）患者中，Th17细胞显著增加。然而，它们在HBV-ACLF患者中的预后作用仍不清楚。本队列研究纳入了68例连续的HBV-ACLF患者。采用流式细胞术检测Th17细胞。评估疾病严重程度评分。使用ROC曲线评估预测预后的价值。采用Kaplan-Meier曲线分析生存率。通过回归分析确定死亡的预测因素。与慢性乙型肝炎患者和正常对照相比，HBV-ACLF患者的Th17细胞显著更高（均P<0.001）。此外，未存活的HBV-ACLF患者的Th17细胞高于存活患者（P=0.014）。Th17细胞与CLIF-C联盟ACLF（CLIF-C ACLF）评分呈正相关（r=0.240，P=0.048）。ROC曲线显示，Th17细胞频率在预测HBV-ACLF患者90天预后方面的准确性与MELD、MELD-Na和CLIF-C ACLF评分相当（分别为P=0.34、P=0.26和P=0.15）。更重要的是，当Th17细胞与MELD、MELD-Na或CLIF-C ACLF评分联合使用时，ROC曲线下面积（AUROC）比单独使用Th17细胞时增加（分别为P=0.021、P=0.006和P=0.023）。Kaplan-Meier分析显示，较高的Th17细胞（≥5.9%）与HBV-ACLF患者总体生存率差密切相关（P=0.0086）。此外，多因素回归分析显示，Th17细胞频率超过5.9%是死亡的独立预测因素（OR=0.154，P=0.025）。循环Th17细胞与HBV-ACLF疾病严重程度呈正相关。Th17细胞频率超过5.9%可作为HBV-ACLF患者的预后生物标志物。
