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目的探讨原发性胆汁性肝硬化(PBC)患者肝硬化期外周血淋巴细胞总数及T细胞亚群的特点并分析影响因素及临床意义。方法对86例肝硬化期PBC患者的临床资料、实验诊断数据进行回顾性分析,比较40例代偿期和46例失代偿期PBC患者肝功、免疫学指标和外周血淋巴细胞亚群特点,对可能的影响因素进行相关性分析。结果失代偿期PBC患者年龄、血清总胆红素(TBil)水平、血清总IgA水平、Mayo评分高于代偿期患者(P<0.05),而ALT、ALB、外周血淋巴细胞绝对数(LYMPH)、淋巴细胞百分率(LYMPH%)、T淋巴细胞绝对数(CD3+)、T辅助细胞绝对数(CD3+CD4+)和T抑制细胞绝对数(CD3+CD8+)均低于代偿期患者(P<0.05);LYMPH、LYMPH%、CD3+、CD3+CD4+和CD3+CD8+结果中,失代偿期减低者频率均高于代偿期(45.7%vs.10%,34.8%vs.7.5%,58.7%vs.17.5%,45.7%vs.5%,60.9%vs.27.5%,P<0.05),失代偿期增高者频率均低于代偿期(54.3%vs.90%,6.5%vs.27.5%,0 vs.20%,2.2%vs.22.5%,2.2%vs.10%,P<0.05)。在可能的影响因素中,年龄、Mayo评分、上消化道出血、脾大或脾切除、腹水等肝硬化失代偿表现对结果影响呈负相关;而ALT、ALB对结果影响呈正相关。结论随着肝硬化程度的加深,PBC患者外周血淋巴细胞总数及T细胞亚群数量降低;从淋巴细胞定量角度分析,随着疾病的进展,PBC患者免疫水平下降。
Objective To investigate the total number of peripheral blood lymphocytes and T cell subsets in cirrhotic patients with primary biliary cirrhosis (PBC) and analyze the influencing factors and clinical significance. Methods The clinical data and experimental diagnosis data of 86 patients with PBC in cirrhosis were retrospectively analyzed. The liver function, immunological parameters and peripheral blood lymphocyte subsets in 40 patients with decompensated and 46 patients with decompensated PBC were compared , The possible influencing factors were analyzed. Results The age of patients with decompensated PBC, the level of total bilirubin (TBil), the level of total serum IgA and the Mayo score were higher than those of decompensated patients (P <0.05), while the absolute numbers of ALT, ALB, peripheral blood lymphocytes LYMPH, LYMPH%, T lymphocyte absolute number (CD3 +), T helper cell absolute number (CD3 + CD4 +) and T suppressor cell absolute number (CD3 + CD8 +) were lower than those in compensated patients <0.05). Among the LYMPH, LYMPH%, CD3 +, CD3 + CD4 + and CD3 + CD8 + patients, the frequency of decompensation was higher than that of decompensation (45.7% vs.10%, 34.8% vs.7.5%, 58.7 % vs.17.5%, 45.7% vs.5%, 60.9% vs.27.5%, P <0.05). The frequency of decompensated period was lower than that of compensated period (54.3% vs.90%, 6.5% vs. 27.5%, 0 vs. 20%, 2.2% vs.22.5%, 2.2% vs. 10%, P <0.05). Among possible factors, the age, Mayo score, upper gastrointestinal bleeding, splenomegaly or splenectomy, ascites and other cirrhosis showed negative correlation between the effect of decompensation and the results; ALT and ALB had a positive correlation with the results. Conclusion With the deepening of the degree of cirrhosis, the total number of peripheral blood lymphocytes and the number of T lymphocytes in PBC patients decreased. From the quantitative analysis of lymphocytes, the immunity level of PBC patients decreased as the disease progressed.