The Changes Of T Cell Subsets After The Therapy Of Ursodeoxycholic Acid In The Patients With Primary Biliary Cirrhosis

Objective:To observe the changes of T cell subsets after the therapy of ursodeoxycholic acid in the patients with primary biliary cirrhosis.Methods:T cell subsets were detected in 35 cases of patients with PBC before orally using ursodeoxycholic acid (UDCA,German Fokker pharmaceutical companies) 13～15mg/Kg.day, three times per day. At the same time the patients took a liver protection drug three times a day orally, combined with fat-soluble vitamins, The salt and water were limited for patients with ascites. These patients were followed up for 6 to 24 months, (an average of 16 months).Complete blood count, biochemical liver function, AMA, immune globulin, CRP and T cell subsets were checked again after 6 months.Results:1. Inspection of T cell subsets:1.1 Results for PBC patients before using ursodeoxycholic acid:CD4+ cells accounts for 49.42%±10.23 in lymphocytes, increased significantly compared with the normal value (P<0.001);The percentage of CD8+cells in lymphocyte was 35.26%±9.16, slightly higher than normal value, the ratio was not significantly different (P>0.05);while CD4+/CD8+ratio was 2.04±0.54, significantly higher than normal (P<0.05); NK cells'percentage is 9.05%±1.37, has no significant c difference compared with normal (P> 0.05).1.2 Results for PBC patients after using ursodeoxycholic acid:CD4+ cell's percentage in lymphocytes compared with the baseline was decreased significantly (25.89%±9.23 vs 49.42%±10.23, P<0.001); CD8+cell's percentage in lymphocytes has no significant difference (25.26%±7.16 vs 35.26%±9.16, P>0.05); CD4+/CD8+ratio was decreased significently (2.04±0.54 vs 1.02±0.63, P<0.05);The percentage of NK cell was not significantly different (9.05±1.37 vs 13.05±1.53, P>0.05).2. Change of biochemical liver function index in PBC patients before and after treatment:PBC patients'AST, ALT, ALP, GGT, Tbil, CRP levels were higher than normal before treatment, especially the ALP, GGT, and decreased significantly after treatment, (P<0.01). The ALB, ESR of PBC patients were in normal range, while GLOB was slightly higher, but has no significantly change after therapy (P>0.05).3. Change of immune index in PBC patients before and after treatment: After the therapy IgM was significantly higher than normal (337.8±194.5 vs 312.6±142.7, P<0.01), IgG was elevated slightly, IgA was in the normal range after treatment, and showed no significant difference compared with baseline(1460±347.3 vs 1357±275.5, P>0.05), (388±121.5 vs 437±202.1, P> 0.05).4. Change of blood routine and renal function in PBC patients before and after treatment:The renal function and blood routine was not significantly different before and after treatment (P>0.05).5. Change of bile acid before and after treatment:Total bile acid concentration before treatment was 106.4±74.8, slightly higher than normal. After application of UDCA for 6 months, the bile acid concentration(342.1±132) was significantly increased compared with baseline (P<0.01).Conclusion:1. PBC patients have abnormal cellular immunity and humoral immunity, showed as the elevation of CD4+,CD8+,reduction of NK cells and the elevation of immunoglobulin in peripheral T cell subsets.2. Ursodeoxycholic acid can improve the ratio of peripheral blood T cell subsets and immunoglobulin's function by long-time therapy, it has immuno-modulating effects.3. Ursodeoxycholic acid can improve the biochemical indexes of liver function effectively.4. We can not find obvious side effects of ursodeoxycholic acid on the blood count and renal function, therapeutic doses of long-term application is safe and effective.5. Ursodeoxycholic acid can increase blood concentrations of TBA.