摘要
目的 探讨肝硬化患者T淋巴细胞亚群水平变化与肝功能Child-Pugh分级及并发症的相关性。方法 选取2020年1月-2024年8月在云南省第三人民医院诊治的肝硬化患者51例，健康体检者54例，比较肝硬化组和对照组之间T淋巴细胞亚群（CD3+T、CD4+T、CD8+T百分比及CD4+T/CD8+T比率）的差异性；将肝硬化患者按肝功能分级分为Child-Pugh分级A组14例，B组21例，C组26例，按并发症类型将其分为无并发症组13例，消化道出血组14例，腹水组24例，比较多组间外周血T淋巴细胞亚群（CD3+T、CD4+T、CD8+T百分比及CD4+T/ CD8+T比率）的差异性。结果 肝硬化患者CD3+T细胞百分比（65.05±14.65 VS 72.68±6.28，P＜0.05）、CD4+T细胞百分比（34.56±7.13 VS 44.08±5.28，P＜0.05）、CD4+T/CD8+T比率（1.30（0.84~1.70）VS 1.50（1.20~2.00），P＜0.05）低于对照组；Child-Pugh分级A组CD3+T细胞百分比（80.12±6.69 VS 67.08±8.50 VS 49.19±9.69，P＜0.05）、CD4+T细胞百分比（42.07±2.50 VS 35.45±4.46 VS 26.83±4.48，P＜0.05）和CD4+T/CD8+T比率（1.85（1.58~2.15）VS 1.30（1.10~1.50）VS 0.82（0.725~0.890），P＜0.05）明显高于B、C组；Child-Pugh分级C组CD3+T细胞百分比（49.19±9.69 VS 67.08±8.50 VS 80.12±6.69，P＜0.05）、CD4+T细胞百分比（26.83±4.48 vs 35.45±4.46 VS 42.07±2.50，P＜0.05）和CD4+T/CD8+T比率（0.82（0.725~0.890）VS 1.30（1.10~1.50）VS 1.85（1.58~2.15），P＜0.05）明显低于A、B组；Child-Pugh分级C组CD8+T细胞百分比（31.63±8.79 VS 23.23±6.55，P＜0.05）高于Child-Pugh分级A组。无并发症组CD3+T细胞百分比（77.02±9.46 vs 61.82±11.81 VS 59.48±17.31，P＜0.05）、CD4+T细胞百分比（42.00（40.65~43.5） VS 33.25（28.58~37.13） VS 29.5（26.95~36.73），P＜0.05）、CD4+T/CD8+T比率（1.80（1.55~2.05）VS 1.10（0.80~1.48） VS 0.95（0.82~1.45），P＜0.05）明显高于腹水组和消化道出血组，腹水组和消化道出血组相比，组间差异无统计学意义（P＞0.05）。Spearman相关性分析显示，肝硬化组T淋巴细胞亚群与肝功能Child-Pugh分级呈负相关（P＜0.05），CD3+T、CD4+T细胞百分比和CD4+T/CD8+T比率与并发症发生呈负相关（P＜0.05）。结论 T淋巴细胞亚群水平变化可反映肝硬化患者的病情严重程度，且与肝硬化肝功能恶化、并发症发生具有一定的相关性。
关键词： 肝硬化；T淋巴细胞；免疫功能；Child-Pugh分级；并发症
Abstract
Objective To explore the correlation between changes in T lymphocyte subset levels and liver function Child-Pugh classification and complications in patients with liver cirrhosis. Methods Fifty-one patients with liver cirrhosis and 54 patients with healthy physical examination diagnosed and treated in the Third People's Hospital of Yunnan Province from January 2020 to August 2024 were selected to compare the differences in the percentages of T lymphocyte subsets (CD3+T, CD4+T, CD8+Tand CD4+T/CD8+T ratios) between cirrhosis and control groups; cirrhosis patients were categorized according to the grading of liver function into Child- Pugh classification group A 14 cases, group B 21 cases, group C 26 cases, according to the type of complications will be divided into the no complications group 13 cases, digestive bleeding group 14 cases, ascites group 24 cases, compare the differences in the percentage of peripheral blood T lymphocyte subpopulations (CD3 + T, CD4 + T, CD8 + T and CD4 + T / CD8 + T ratio) between multiple groups. Results Percentage of CD3+ T cells (65.05±14.65 VS 72.68±6.28, P<0.05), percentage of CD4+ T cells (34.56±7.13 VS 44.08±5.28, P<0.05), and CD4+T/CD8+T ratio (1.30 (0.84~1.70) VS 1.50 ( 1.20~2.00), P < 0.05) were lower than those in the control group; the percentage of CD3+ T cells (80.12±6.69 VS 67.08±8.50 VS 49.19±9.69, P < 0.05), CD4+ T cells (42.07±2.50 VS 35.45±4.46 VS 26.83±4.48, P<0.05) and CD4+T/CD8+T ratio (1.85 (1.58-2.15) VS 1.30 (1.10-1.50) VS 0.82 (0.725-0.890), P<0.05) were significantly higher than those in Groups B and C. In Group C of the Child-Pugh classification, the percentage of CD3+T cells ( 49.19±9.69 VS 67.08±8.50 VS 80.12±6.69, P<0.05), percentage of CD4+T cells (26.83±4.48 VS 35.45±4.46 VS 42.07±2.50, P<0.05), and CD4+T/CD8+T ratio (0.82 (0.725~0.890)VS 1.30 (1.10~1.50) VS 1.85 (1.58~2.15), P < 0.05) were significantly lower than those in Groups A and B. The percentage of CD8+ T cells in the Child-Pugh classification C group (31.63±8.79 VS 23.23±6.55, P < 0.05) was higher than that in the Child-Pugh classification A group. The percentage of CD3+ T cells (77.02±9.46 vs. 61.82±11.81 VS 59.48±17.31, P<0.05), CD4+ T cells (42.00 (40.65~43.5) VS 33.25 (28.58~37.13) VS 29.5 (26.95~36.73) in the group without complications, P <0.05) and CD4+T/CD8+T ratio (1.80 (1.55~2.05) VS 1.10 (0.80~1.48) VS 0.95 (0.82~1.45), P <0.05) were significantly higher than those in the ascites group and the gastrointestinal bleeding group. Spearman correlation analysis showed that T lymphocyte subsets in the cirrhosis group were negatively correlated with the Child-Pugh grading of liver function (P < 0.05), and the percentages of CD3+T, CD4+T cells and CD4+T/CD8+T ratio were negatively correlated with the occurrence of complications (P < 0.05). Conclusion Changes in the level of T lymphocyte subpopulations can reflect the severity of cirrhotic patients' disease and have a certain correlation with the deterioration of cirrhotic liver function and the occurrence of complications.
Key words： Cirrhosis; T lymphocytes; Immune function; Child-Pugh classification; Complications
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