| Background The fatality rate of Subacute-on-chronic liver failure (SACLF) wasabout60-80%. Its pathogenesis was complex, and it was believed that immunoregulatorydisorder leading to liver lesions was important. The abnormal immune of lymphocytes andregulation of cytokine network mediated by subpopulation of T lymphocytes played animportant role in the process. Recently, a new effector Th17belonging to CD4+subsetswas concerned widely, which was a strong pro-inflammatory factor characterized bysecretion of interleukin17(IL-17). Regulatory T cells (Treg) belonging to CD4+subsetshad the function of immune regulatory including immune incompetence andimmunosuppressive functions by contacting among cells and secretion of inhibitorycytokines,which also had the function of anti-inflammatory. Cytotoxic T lymphocytes(CD8+CD28+, CTL) played an important role in anti-virus and autoimmune, mainlythrough cytotoxic mechanism and non-cytotoxic mechanism to kill target cells specifically.The study about Th17, Treg and CTL in CHB had been reported, whether the dynamicchanges of the above three factors involved in the hepatitis B-related SACLF(HBV-SACLF) in different stages the and the correlation of each other had not beenreported.Objective To explore the dynamic changes and correlation of Th17, Treg and CTL inperipheral blood of patients with HBV-SACLF and study the relationship with prognosis.Methods Detected the ratio of Th17, Treg and CTL from peripheral blood cells in39HBV-ACLF patients,20CHB patients and15health adults by fluorescence-activated cell sorter; compared the above indicators among the three groups; observed dynamicchanges of Th17, Treg and CTL during the nonage, metaphase and advanced stage ofHBV-SACLF; studied the correlation of prognosis of Th17, Treg and CTL cells betweensurvival group and death group. Detected the expression of IL-17from the serum of39HBV-SACLF patients,20CHB patients and15health adults by ELISA; observed dynamicchanges of IL-17during the nonage, metaphase and advanced stage of HBV-SACLF.Results1. The ratios of Th17, Treg and CTL on peripheral blood cells in39HBV-ACLFpatients,20CHB patients and15health adults were as follows:1)Th17:(4.04±1.22)%,(1.94±0.43)%,(1.01±0.25)%; The ratios of Th17in CHB group were significantlyhigher than control group, whether lower than HBV-SACLF group (p1=0.03, p2<0.001,p3=0.034).2)Treg:(3.79±1.49)%,(8.25±1.23)%,(5.76±1.15)%; The ratio of Treg inHBV-SACLF group were significantly lower compared with CHB group and normal group(p1<0.001, p2=0.006, p3=0.007).3)CTL:(21.12±5.35)%,(13.61±1.41)%,(16.73±1.20)%; The ratio of CTL in HBV-SACLF group were significantly higher compared withCHB group and normal group(p1<0.001, p2=0.012, p3=0.009).2. The ratios of Th17, Treg and CTL cells in the nonage, metaphase and advancedstage of39HBV-SACLF patients were as follows:1)Th17:(3.05±0.71)%,(4.07±0.90)%,(5.18±1.10)%; The ratios of Th17increased gradually, There were also significantdifferences among the three periods(p1=0.003, p2=0.009).2)Treg:(5.18±0.68)%,(3.99±0.72)%,(1.87±0.64)%; The ratios of Treg decreased gradually, There were alsosignificant differences among the three periods(p1=0.001, p2=0.000).3)CTL:(22.62±4.99)%,(19.08±3.63)%,(14.48±4.39)%; The ratio of Th17increased gradually, Therewere also significant differences among the three periods(p1=0.046, p2=0.003).3. The ratios of Th17cells between the survival group and the death group inHBV-ACLF patients were as follows:(3.44±0.97)%,(4.56±1.20)%; which had astatistical significance(P=0.003). Th17had positive correlation with prognosis(r=0.501,P=0.029). 4. Correlation analysis of Th17, Treg and CTL of HBV-SACLF patients: Th17hadsignificant negative correlation with Treg (r=-0.532, P <0.001); Treg had significantpositive correlation with CTL (r=0.339, P=0.035); Th17had non-significant correlationwith CTL(r=-0.246, P=0.131).5. The expression of IL-17in39HBV-ACLF patient,20CHB patients and15healthadults were as follows:289.2±83.3,153.3±79.6,62.5±28.5(pg/ml); There were alsosignificant differences among the three periods(p1=0.019, p2=0.000).6.The ratios of IL-17in the nonage, metaphase and advanced stage of39HBV-SACLF patients were as follows:214.7±47.5,267.7±56.8,317.4±88.1(pg/ml);There were also significant differences among the three periods(p1=0.011, p2=0.007).Conclusion The expression of Th17and IL-17obviously steped up in HBV-SACLFpatients, which escalated in the progression of liver failure, had a significant positivecorrelation with prognosis; Treg decreased in HBV-SACLF and declined gradually in theprocess of liver failure, Treg had a significant negative correlation with Th17; CTLincreased in the proportion of HBV-SACLF and declined gradually in the process of liverfailure, CTL had a significant positive correlation with Treg. Dynamic changes of Th17,Treg and CTL from peripheral blood may be in favour of evaluating immune state, whichwas also profit for the guidance of treatment and prognosis evaluation in HBV-SACLFpatients. |
