Zhang Geng-Lin, Zhang Ting, Zhao Qi-Yi, Xie Chan, Lin Chao-Shuang, Gao Zhi-Liang
Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China,
Guangdong Provincial Key Laboratory of Liver Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China,
Ther Clin Risk Manag. 2018 Oct 30;14:2127-2136. doi: 10.2147/TCRM.S184809. eCollection 2018.
IL-17-producing CD8 T (Tc17) cells promote inflammation and have been identified in chronic hepatitis. However, the role of Tc17 cells in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (HBV-ACLF) remains unclear.
The frequency of Tc17 cells in blood samples from 66 patients with HBV-ACLF was determined by flow cytometry. The levels of Tc17 cell-related cytokines were measured by FlowCytomix assays. The prognostic prediction accuracy was evaluated by the receiver operating characteristic (ROC) curve analysis. Survival was analyzed using Kaplan-Meier curves. Mortality predictors were determined by the Cox regression analysis.
The frequency of Tc17 cells was markedly higher in patients with HBV-ACLF than in those with chronic hepatitis B and normal control subjects. Increased frequencies of Tc17 cells may indicate liver injury and were positively correlated with disease severity. The Tc17 cell frequency was significantly higher in non-surviving patients with HBV-ACLF than in surviving patients. The ROC curve analysis showed that Tc17 cell frequency accurately predicted 90-day survival in patients with HBV-ACLF, with an accuracy equivalent to those of the Model for End-Stage Liver Disease (MELD), MELD-Na, and Chronic Liver Failure Consortium ACLF scores. Kaplan-Meier analysis showed an association between the increase in circulating Tc17 cells and poor overall survival in patients with HBV-ACLF. Moreover, the multivariate Cox regression analysis showed that Tc17 cell frequency was an independent predictor of overall survival in patients with HBV-ACLF.
Tc17 cells may play a proinflammatory role in HBV-ACLF pathogenesis. Furthermore, the increased frequency of circulating Tc17 cells could be an independent prognostic biomarker in patients with HBV-ACLF.
产生白细胞介素-17的CD8 T（Tc17）细胞可促进炎症反应，且已在慢性肝炎中被发现。然而，Tc17细胞在乙型肝炎病毒（HBV）相关慢加急性肝衰竭（HBV-ACLF）患者中的作用仍不清楚。
采用流式细胞术测定66例HBV-ACLF患者血样中Tc17细胞的频率。通过流式细胞仪多因子检测法测定Tc17细胞相关细胞因子的水平。采用受试者工作特征（ROC）曲线分析评估预后预测准确性。使用Kaplan-Meier曲线分析生存率。通过Cox回归分析确定死亡预测因素。
HBV-ACLF患者的Tc17细胞频率明显高于慢性乙型肝炎患者和正常对照者。Tc17细胞频率增加可能提示肝损伤，且与疾病严重程度呈正相关。HBV-ACLF非存活患者的Tc17细胞频率显著高于存活患者。ROC曲线分析表明，Tc17细胞频率可准确预测HBV-ACLF患者90天生存率，其准确性与终末期肝病模型（MELD）、MELD-Na和慢性肝衰竭联盟ACLF评分相当。Kaplan-Meier分析显示，循环中Tc17细胞增加与HBV-ACLF患者总体生存率差有关。此外，多变量Cox回归分析表明，Tc17细胞频率是HBV-ACLF患者总体生存的独立预测因素。
Tc17细胞可能在HBV-ACLF发病机制中发挥促炎作用。此外，循环中Tc17细胞频率增加可能是HBV-ACLF患者的独立预后生物标志物。
