| Background The infection of hepatitis B virus causes a series of complex immuneresponse,and the cell immunity is an important factor for the outcome. Regulatory T cells(Treg) belonging to CD4~+subsets have the function of immune regulatory includingimmune incompetence and immunosuppressive by contacting among cells and secretion ofinhibitory cytokines,which also have the function of anti-inflammatory. CD8~+T cells playan important role in the process of clearing HBV.The activation of CD8~+T cells depends onCD4~+T cells.Glucocorticoid can reduce hepatocyte injury through inhibiting the productionof monocyte/macrophage and B cells.But it is still controversial about the application ofglucocorticoid on severe hepatitis B.At the same time, the effect of glucocorticoid on T cellsubsets is rarely reported and the mechanism remains unknown. Interleukin12（IL-12) isone of the most important cytokines which associated with cellular immunity and humoralimmunity.It has not been reported that the effect of glucocorticoid treated pre-liver failure.Objective To explore the changes of CD4~+T,CD8~+T and Treg in peripheral blood of patientswith HBV-associated subacute-on-chronic liver failure（HBV-SACLF）,and the mechanismof glucocorticoid on pre-liver-failure.Methods Detected the ratio of CD4~+T,CD8~+T and Treg from peripheral blood cells byfluorescence-activated cell sorter in30HBV-SACLF patients,15CHB patients12healthadults.HBV-SACLF patients were divided into infection group and non-infectiongroup,and detected above indicators;76pre-liver-failure patients were divided intoglucocorticoid group (GC group) and non-glucocorticoid (NG group),and detected aboveindicators.Detected the expression of IL-12from the serum by ELISA. Results1.The ratios of CD4~+T,CD8~+T and Treg on peripheral blood cells in30HBV-SACLFpatients,15CHB patients and12health adults were as follows:1)CD4~+T:(28.06±6.86)%,(36.03±9.53)%,(45.47±0.68)%.The ratios of CD4~+T in CHB group weresignificantly higher than HBV-SACLF group, and lower than control-group(p1=0.02,p2<0.001,p3=0.02);2)CD8~+T:(29.10±3.64)%,(25.71±5.75)%,(20.10±5.80)%.The ratios ofCD8~+T in CHB group were significantly lower than HBV-SACLF group,whether higherthan control group(p1=0.02,p2<0.001,p3=0.019);3)Treg:(2.55±0.57)%,(3.69±1.08)%,(3.21±0.12)%.The ratio of Treg in HBV-SACLF group were significantly lower comparedwith CHB group and normal group(p1=0.01,p2<0.001). There were no significantdifferences between CHB group and normal group(p3=0.113).2.The ratios of CD4~+T,CD8~+T and Treg in infection group of HBV-SACLF patients wereas follows:(25.33±7.79)%,(30.90±2.94)%,(2.31±0.38)%;and in non-infection group ofHBV-SACLF patients were as follows:(1.19±3.91)%,(26.93±3.16)%,(2.82±0.63)%.Therewere significant differences between the two groups(p1=0.014,p2=0.001,p3=0.015).3.There were no significant differences between the GC group and NG group beforetreatment.The ratios of CD4~+T,CD8~+T and Treg in GC group after treatment were asfollows:(35.44±5.36)%,(24.40±5.68)%,(3.09±0.42)%.There were significant differencescompared with pre-therapy(p1<0.001,p2=0.001,p3=0.004).The ratio of CD4~+T in NGgroup after treatment was (31.35±5.44)%.There were significant differences comparedwith pre-therapy(p1=0.004).And the changes on CD8~+T and Treg were notclearly(p2=0.435,p3=0.482).4.There were no significant differences of IL-12between the GC group and NG groupbefore treatment.The value of IL-12in GC group was(28.98±7.81)pg/ml aftertreatment.There was significant difference compared with pre-therapy(p<0.001).The valueof IL-12in NG group was(46.33±22.22)pg/ml after treatment.There was no significantdifference compared with pre-therapy(p=0.212).5.The incidence rate of severe hepatitis in GC group was13.16%and that in NG group was 34.21%, there was significant difference between two groups (p<0.05).Conclusion1.The ratios of CD4~+T and Treg on peripheral blood cells in HBV-SACLF patients weredramatic decline.The ratio of CD8~+T was markedly increased.It indicated that the hepaticfailure patients had severe immune imbalance.2.The ratios of CD4~+T and Treg in infection group of HBV-SACLF patients were lowerthan non-infection group.The ratio of CD8~+T was higher than non-infection group.Itindicated that the infection increased immune imbalance,and make disease to worse.3.The ratios of CD4~+T and Treg in GC group were higher than NG group,and The ratio ofCD8~+T was lower than NG group.And the incidence rate of severe hepatitis in GC groupwas significant decreased which indicated that glucocorticoid promoted the recovery ofillness through Immunomodulatory.4.The expression of IL-12in GC group was lower than NG group after treatment.Itindicated that glucocorticoid relieved inflammation through inhibiting the production of IL-12. |
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