本文選題：肝炎 + 乙型　； 參考：《中國肝臟病雜志(電子版)》2016年03期

【摘要】：目的分析乙型肝炎相關(guān)慢加急性肝衰竭(HBV-ACLF)患者的免疫狀態(tài)及其與預(yù)后的相關(guān)性。方法選取2014年1月至2014年12月本院收治的72例HBV-ACFL患者為觀察組(HBV-ACLF組),并按照預(yù)后分為好轉(zhuǎn)組(38例)和惡化組(34例),同期選取72例重度慢性乙型肝炎(CHB)患者作為對照組(CHB組),分析兩組患者免疫球蛋白、補體及T淋巴細(xì)胞亞群等免疫指標(biāo)的差異及其與預(yù)后的關(guān)系。結(jié)果與對照組相比,觀察組患者的AST、TBil和Fibroscan彈性值更高,抗病毒治療者更少(χ~2=4.50,P=0.03)。觀察組Ig G和Ig A分別為(19.96±6.13)g/L和(3.19±1.27)g/L,顯著高于對照組(F=12.13、12.85,P均=0.001),而C3、C4、CD3~+和CD4~+T細(xì)胞計數(shù)分別為(0.38±0.26)g/L、(0.07±0.06)g/L、(908.72±376.33)細(xì)胞/μl和(428.97±1183.36)細(xì)胞/μl,顯著低于對照組(F=46.33、24.62、16.27、3.60,P均0.05)。惡化組與好轉(zhuǎn)組相比,男性患者更多(χ~2=8.05,P=0.005),均未進行抗病毒治療,多伴有并發(fā)癥(χ~2=3.99,P=0.046),ALT和AST水平更高(F=4.69、5.43,P=0.04、0.03),C3水平更低[(0.24±0.07)g/L vs(0.51±0.34)g/L](F=12.14,P=0.001),其余免疫指標(biāo)無統(tǒng)計學(xué)差異(P均0.05)。Logistic分析發(fā)現(xiàn)C3水平下降與HBV-ACLF患者的病情惡化相關(guān),其余免疫指標(biāo)與預(yù)后無關(guān)。結(jié)論 HBV-ACLF患者存在免疫球蛋白升高、補體下降及T細(xì)胞損耗等免疫紊亂情況,C3水平下降與病情惡化有一定相關(guān)性。
[Abstract]:Objective to analyze the immune status and prognosis of patients with chronic hepatitis B associated with acute hepatic failure (HBV-ACLF). Methods from January 2014 to December 2014, 72 patients with HBV-ACFL in our hospital were selected as the observation group and divided into two groups according to the prognosis: 38 cases in the improvement group and 34 cases in the worsening group. 72 patients with severe chronic hepatitis B were selected as the control group. The immunoglobulin of the two groups was analyzed. The difference of complement and T lymphocyte subsets and its relationship with prognosis. Results compared with the control group, the elasticity of ASTTBil and Fibroscan in the observation group was higher than that in the control group, and the number of patients treated with antiviral therapy was lower (蠂 2 4.50). The levels of IGG and IgA were 19.96 鹵6.13)g/L and 3.19 鹵1.27g / L, respectively, which were significantly higher than those of the control group (F12.131312.85) P 0.001g / L, while the counts of C _ 3C _ 4C _ 4 ~ and CD _ 4T cells were 0.38 鹵0.26g / L, 908.72 鹵376.33) cells / 渭 l and 428.97 鹵1183.36 cells / 渭 l, respectively, which were significantly lower than those of the control group. Compared with the improvement group, there were more male patients in the worsening group (蠂 2 + 8.05% P < 0.005), and none of the patients were treated with antiviral therapy. The levels of alt and AST were higher than those of FG 4.69 and 5.43. The level of C3 was lower [0.24 鹵0.07)g/L vs(0.51 鹵0.34)g/L] F _ (12.14 鹵0.34)g/L) P _ (0.001). There was no significant difference in the other immunological markers (P all 0.05).Logistic analysis showed that the decrease of C _ 3 level was related to the deterioration of HBV-ACLF, and the other immunological indexes were not related to the prognosis. Conclusion the increase of immunoglobulin, the decrease of complement and T cell depletion, and the decrease of C3 level in patients with HBV-ACLF may be related to the deterioration of the disease.
【作者單位】： 成都市公共衛(wèi)生臨床醫(yī)療中心肝炎科;
【基金】：四川省醫(yī)學(xué)科研青年創(chuàng)新課題計劃(Q14020) 四川省衛(wèi)生和計劃生育委員會科研課題(150035)
【分類號】：R512.62;R575.3

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