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目的慢性乙型肝炎(乙肝)急性肝衰竭(慢加急性肝衰竭,ACLF)的发病机制尚不清楚,本文主要研究ACLF患者的免疫特点及其与预后的关系。方法选取ACLF患者75例,慢性乙型肝炎(CHB)患者31例,乙型肝炎肝硬化(LC)患者36例,健康志愿者30例,采用流式细胞仪检测外周血CD3+、CD4+、CD8+T细胞、NK细胞、NKT细胞等细胞亚群计数,用SPSS10.0软件对其进行统计学分析。结果ACLF组外周血淋巴细胞总数、CD4+、CD8+T细胞、NKT细胞与健康对照组及慢性乙肝组相比,均具有显著性差异(P<0.001或P<0.01或P<0.05)。ACLF组外周血NK细胞与健康对照组相比,具有显著性差异(P<0.01)。ACLF患者死亡组中淋巴细胞总数、CD4+、CD8+T细胞、NK细胞计数均低于存活组各细胞计数,二者具有显著性差异(P<0.05)。结论ACLF患者外周血免疫活性细胞的减少可能是ACLF病情急剧进展的驱动因素。
Objective The pathogenesis of acute liver failure (acute and chronic hepatic failure, ACLF) in chronic hepatitis B (hepatitis B) is not yet clear. This article mainly studies the immune characteristics of ACLF and its relationship with prognosis. Methods 75 patients with ACLF, 31 patients with chronic hepatitis B (CHB), 36 patients with hepatitis B cirrhosis (LC) and 30 healthy volunteers were enrolled in this study. Flow cytometry was used to detect CD3 +, CD4 +, CD8 + T cells, NK cells, NKT cells and other cell subsets count, using SPSS10.0 software for statistical analysis. Results The total number of peripheral blood lymphocytes, CD4 +, CD8 + T cells and NKT cells in ACLF group were significantly different from those in healthy control group and chronic hepatitis B group (P <0.001 or P <0.01 or P <0.05). Compared with healthy control group, NK cells in ACLF group had significant difference (P <0.01). The total number of lymphocytes, CD4 +, CD8 + T cells and NK cells in ACLF patients were significantly lower than those in survivors (P <0.05). Conclusion The decrease of peripheral blood immunocompetent cells in patients with ACLF may be the driving factor for the sharp progression of ACLF.