Li Juan, Hu Chun-Hua, Chen Yi, Zhou Mi-Mi, Gao Zhi-Jie, Fu Meng-Jun, Wang Jing, Li Jian-Zhou, Chen Tian-Yan, Zhao Ying-Ren, He Ying-Li
Department of Infectious Diseases, School of Medicine, First Affiliated Teaching Hospital, Xi'an Jiaotong University, Xi'an, China.
School of Medicine, Institution of Hepatology, First Affiliated Teaching Hospital, Xi'an Jiaotong University, Xi'an, China.
Front Med (Lausanne). 2021 Jul 27;8:689865. doi: 10.3389/fmed.2021.689865. eCollection 2021.
Acute-on-chronic liver failure (ACLF) is a rare, but dramatic clinical syndrome. There is substantial evidence suggesting that immunity-mediated inflammation plays an important role in HBV-ACLF. Our aim was to characterize the proportion and cell counts of peripheral blood lymphocyte subsets in acute-on-chronic liver failure patients caused by HBV infection. One hundred and seventeen patients were enrolled in this study, including those with HBV-related ACLF (HBV-ACLF; = 70), and HBV related non-ACLF patients (HBV non-ACLF; = 47). Demographics, clinical and laboratory data at hospital admission were retrospectively analyzed. The percentage and cell count of peripheral lymphocyte subsets were evaluated by flow cytometry. Comparison analysis was performed by -test or non-parametric Mann-Whitney -test. Actuarial probabilities of death were calculated by the Kaplan-Meier method. Both circulating lymphocyte count and lymphocyte percentage were significantly reduced in patients with HBV-ACLF ( < 0.001). The CD8 T cell, CD4 T cell, and CD16CD56 NK cell counts were significantly decreased in HBV-ACLF. Consistently, flow cytometric analysis showed that CD8 T cell counts were significantly decreased in non-survivors, while no significant differences were found in CD4 T cell, CD19 B cell, or CD56CD16 NK cell counts. Furthermore, the group with the lower CD8 T cell count displayed a significantly higher mortality rate compared with the group with the higher CD8 T cell count. The abnormal prevalence of lymphocyte subsets may be important in the pathogenesis of HBV-ACLF. The decrease in CD8 T cell counts may be related to poor survival in HBV-ACLF patients.
慢加急性肝衰竭（ACLF）是一种罕见但严重的临床综合征。有大量证据表明，免疫介导的炎症在HBV-ACLF中起重要作用。我们的目的是确定由HBV感染引起的慢加急性肝衰竭患者外周血淋巴细胞亚群的比例和细胞计数特征。本研究纳入了117例患者，包括HBV相关慢加急性肝衰竭患者（HBV-ACLF；n = 70）和HBV相关非慢加急性肝衰竭患者（HBV非ACLF；n = 47）。回顾性分析了入院时的人口统计学、临床和实验室数据。通过流式细胞术评估外周淋巴细胞亚群的百分比和细胞计数。采用t检验或非参数Mann-Whitney U检验进行比较分析。采用Kaplan-Meier法计算死亡的精算概率。HBV-ACLF患者的循环淋巴细胞计数和淋巴细胞百分比均显著降低（P < 0.001）。HBV-ACLF患者中CD8 T细胞、CD4 T细胞和CD16CD56 NK细胞计数显著降低。一致地，流式细胞术分析显示，非存活者的CD8 T细胞计数显著降低，而CD4 T细胞、CD19 B细胞或CD56CD16 NK细胞计数无显著差异。此外，与CD8 T细胞计数较高的组相比，CD8 T细胞计数较低的组死亡率显著更高。淋巴细胞亚群的异常患病率可能在HBV-ACLF的发病机制中起重要作用。CD8 T细胞计数的降低可能与HBV-ACLF患者的不良生存有关。
