The Correlation Between Frequency Of Peripheral Blood T Lymphocytes And Prognosis Of Patients With HBV-ACLF And The Immunological Mechanism Of The Treatment By Principle Of Strengthening Vital Qi And The Spleen Based On The Deficiency In Vital Qi

Objective:To investigate the relationship between peripheral blood T lymphocyte frequency and prognosis of hepatitis B virus associated acute on chronic liver failure(HBV-ACLF) based on the previous research. And to explore the immunological mechanism of improving the prognosis of the treatment by principle of strengthening Vital qi and the spleen based on the deficiency in Vital qi.Methods:97 patients with HBV-ACLF from chronic hepatitis B or liver cirrhosis (the diagnosis based on<Guidelines for prevention and treatment of liver failure>, which revised in 2012) in the departments of liver diseases of the second hospital of Nanjing were selected and randomly divided into treatment group (31 patients) and control group (66 patients). The control group was treated with internal medicine of Western Medicine, and the treatment group was treated by Principle of Strengthening Vital Qi and the Spleen Based on the Mechanism of Deficiency in Vital Qi combined with Integrated internal medicine of Western Medicine. The course of treatment was 4W. TCM syndrome integral, routine blood test, liver function, coagulation function, MELD score, frequency of CD3+, CD4+, CDg+(CTL) T lymphocytes and CD4+CD25+Treg cells and other immunology index of the patients in the two groups before and after treatment were observed.At the same time, the normal (23 people) and chronic hepatitis B patients (23 patients) were recruited as the control to ACLF.Results:1) Compared with the normal and chronic hepatitis B patients, the total number of peripheral white blood cells of HBV-ACLF was significantly increased, while the percentage of lymphocytes and CD3+T lymphocytes were significantly decreased.2) The total number of peripheral white blood cells and lymphocyte ratio, CD3+T lymphocyte and CD4+CD25+Treg cells frequency and its changes were correlated with the laboratory indexes reflecting the degree and progression of HBV-ACLF, including TBil, PTA and MELD scores.3) Compared with the control group, the TBIL, ALT and MELD scores of the treatment group treated by Principle of Strengthening Vital Qi and the Spleen Based on the Mechanism of Deficiency in Vital Qi had improved significantly, the curative effect and TCM syndrome integral increased, lymphocytes and T lymphocytes frequency increased obviously, and the amplitude of changes was also significantly larger than that of the control group.Conclusion:1) HBV-ACLF once the occurred, the white blood cells, lymphocytes and T lymphocytes showed the different characteristics from the normal and chronic hepatitis patients: Peripheral white blood cell count increased significantly, but proportions of lymphocytes and T lymphocyte frequency decreased significantly, which reflected the immune system after the liver failure was in a state of "exhaust", and was coincided with the Mechanism of Deficiency in Vital Qi.2) The characteristics and changes of white blood cells, lymphocytes and T lymphocytes of the patients with HBV-ACLF was correlated with the severity of HBV-ACLF:The total number of peripheral white blood cells increased more and lymphocyte ratio and T lymphocyte frequency decreased less, the disease was more serious.3) The characteristics and changes of white blood cells, lymphocytes and T lymphocytes of the patients with HBV-ACLF was correlated with the prognosis of HBV-ACLF:The white blood cell increased and lymphocyte ratio and the frequency of T lymphocyte decreased more slowly, the aggravated degree of the disease was lighter and the prognosis was better, on the contrary conditions, the aggravated degree and prognosis would be worse.4)The treatment by Principle of Strengthening Vital Qi and the Spleen Based on the Mechanism of Deficiency in Vital Qi can improving the "exhaust" state of T lymphocytes frequency, eventually improve the prognosis: After The treatment, the serum level of TCM syndrome score, liver function and MELD scores were significantly improved, which eventually improved the prognosis. Improving the "exhaust" state of lymphocytes and T lymphocytes frequency and their immune function was part of the effective immunological mechanism.