Study On The Relationship Between Immune Index And Alcoholic Liver Disease

BackgroundAlcoholic liver disease(ALD)is a liver disease caused by long-term heavy drinking,and has become the second largest cause of liver disease in China.ALD diagnosis is generally based on a comprehensive judgment,including a clear history of alcohol consumption,significant symptoms and signs,and the support of abnormal auxiliary examinations.The initial stage of ALD is often fatty liver,and this period is easy to be ignored.Partial patients see a doctor because of hepatitis.When some people realize,ALD has already developed liver fibrosis and liver cirrhosis phase,or some patients may be brought about liver failure as result of serious drink and need to be admitted to hospital treatment.Early identification of ALD severity is important because early selection of appropriate therapy is beneficial to patient outcomes.To be sure,immune factors play a subtle role in the progression of ALD,and many researchers believe that abnormalities of the immune system in severe alcoholic hepatitis and chronic acute liver failure play a critical role in the progression of the disease.A large number of studies have confirmed that some patients with severe alcoholic hepatitis and chronic acute liver failure can benefit from glucocorticoid in the short term,but the effect of glucocorticoid on long-term benefits has not yet been evaluated by definite big data.Therefore,a growing body of research has focused on the role of the immune system in ALD disease progression.They believe that their own immune factors,combined or not combined with other immune factors,play a promoting role in the liver tissue damage of the occurrence and development of ALD,and it is clear that there is abnormal regulation of the complement pathw-ay in ALD.Specific immunological indicators that can reflect the immune damage and severity of alcoholic liver disease have not been found.Based on clinical practice,serum immunoglobulin and complement(C3,C4)are the most studied and easily detected immune indicators.Immunoglobulin from human serum easily obtained and used to detect,content is relatively stable in the healthy human body,and it can be according to the occurrence of certain diseases that affect the level of change.The content of C3 and C4 in complement is relatively stable and the level in serum is roughly parallel to the total amount,which is often used as a clinical indicator to reflect the level of complement system and the immune function of the body.For ALD patients,the correlation between the baseline level of Ig of all types and C3C4 and the severity of ALD is still unclear.We pay more attention to the predictive effect of indicators in severe AH patients.Ig and C3C4 are serological indicators reflecting human immune function,and their application value in ALD is worth further exploring.ObjectiveTo study the diagnostic value and to evaluate the severity of the disease of immunoglobulin and complement C3 and C4 in alcoholic liver disease.MethodsIn this study,54 ALD patients admitted to the department of infectious diseases of shandong provincial hospital were retrospectively analyzed between January 2017 and March 2019 after screening with strict inclusion and exclusion,criteria,and 15 healthy subjects were collected as the control group.First,the significance of immunoglobulins(Ig G,Ig A,Ig E,Ig M)and complement(C3C4)levels in alcoholic liver disease was observed.Secondly,according to clinical diagnosis and ALD commonly used various integral models,the association between serum Ig subclassification and complement(C3C4)level of subjects in each group and disease progression and poor prognosis was compared.Finally,the correlation with liver enzyme,cholinase and coagulation index was compared.Results1.The abnormal rate of IgA is as high as 65%,the abnormal rate of IgE is 61%,the abnormal rate of IgG is 48%(all increased indicators),and IgM is only 9%.The abnormal rate of complement C3 was 41%,the reduced rate was 35%,and the abnormal rate of complement C4 was only 15%.The level of IgA in ALD group was 5.06(3.30-6.73)(G/L),and that in control group was 2.40(1.67-3.51)(G/L),P=0.000,with significant difference(P<0.05).The level of IgM in ALD group was 1.27(0.90-1.79)(G/L),and that in control group was 1.11(0.73-1.34)(G/L),P=0.132,no significant difference.The IgE level in ALD group was 188.50(54.83-382.75)(IU/ML),and that in control group was 61.40(41.30-86.20)(IU/ML),P=0.055,with no significant difference.The level of IgG in ALD group was 15.40(11.88-19.40)(G/L),and that in control group was 12.9(9.03-14.60)(G/L),P=0.015,with significant difference(P<0.05).The level of C3 in ALD group was 0.88(0.66-1.19)(G/L),and that in control group was 1.09(1.05-1.44)(G/L),P=0.043,with significant difference(P<0.05).The level of C4 in ALD group was 0.19(0.13-0.25)(G/L),and that in control group was 0.25(0.21-0.34)(G/L),P=0.006,with significant difference(P<0.05).In summary,IgA,IgG,C3 and C4 were significantly different in alcoholic liver disease group and control group.2.Comparing the immunoglobulin indexes of ALD patients with different severity,IgG of mild alcoholic hepatitis was significantly different from that of alcoholic cirrhosis,p<0.05;Compared with severe alcoholic hepatitis,there was no significant difference in each immunoglobulin subclassification index(p>0.05).There was a significant difference in IgE between alcoholic cirrhosis and severe alcoholic hepatitis,p<0.05.There were significant differences in IgE between the three groups,p<0.05.Regarding the indicators of complement,compared with alcoholic cirrhosis,C3 and C4 were significantly different in mild alcoholic hepatitis,p<0.05.Compared with severe alcoholic hepatitis,C3 and C4 showed significant difference(p<0.05).Compared with severe alcoholic hepatitis,alcoholic cirrhosis showed no significant difference in C3 and C4,p>0.05.IgE,C3 and C4 were significantly different among the three groups,p<0.05.3.According to maddery decision function,grouping the collected cases,IgE showed a significant difference in the two groups,P<0.05.In the end-stage liver disease model(MELD)score grouping,there were significant differences in IgA and IgG between the two groups(P<0.05).According to child-pugh grading,patients were divided into grade A,grade B and grade C,in which grade A was significantly different from grade B in IgA and IgG,P<0.05.IgA and IgE were significantly different between grade A and grade C,P<0.05.IgA,IgE and C3 were significantly different between grade B and C,P<0.05.IgA and IgE were significantly different between the three groups(P<0.05).4.Serum immunoglobulin and complement levels in patients with alcoholic liver disease were correlated with liver function,renal function indexes,coagulation function,blood routine,and commonly used models for evaluating the prognosis of alcoholic liver disease.IgE was positively correlated with TBIL,DBIL,PT,Maddrey decision function,and child-pugh score,P<0.05,and it was negatively correlated with ALB,P<0.05.IgM was positively correlated with GLO and INR,P<0.05,and it was a negative correlation with ALT,P<0.05.IgA was positively correlated with GLO,PT,INR,maddery decision function,child-pugh grading and MELD integration,P<0.05;and it was negatively correlated with ALB and PTA,P<0.05.IgG was positively correlated with GLO,PT,PTA,INR,maddery decision function and child-pugh grading,P<0.05;and it was negatively correlated with ALP and PLT,P<0.05.Complement C3 was positively correlated with AST,GGT,ALP,PTA,INR and PLT,P<0.05;and it was negatively correlated with CR,PT,maddery decision function,MELD integration,P<0.05.Complement C4 was positively correlated with AST,GGT,ALP,PTA,INR and PLT,P<0.05;and it was negatively correlated with PT,INR,maddery decision function,and MELD integration,P<0.05.The results indicated that humoral immune index was correlated with liver function and coagulation function.Conclusions1.There are immunoglobulin and complement abnormalities in ALD,which are related to alcohol-mediated immune changes and inflammation in the body.2.The levels of IgA and IgE are related to the severity of ALD,especially in the stage of liver cirrhosis and even severe hepatitis,which can be significantly increased,suggesting poor prognosis of ALD.3.C3 and C4 are reduced or normal in mild alcoholic hepatitis patients,but significantly reduced in long-term alcohol exposure,especially in alcoholic cirrhosis and severe alcoholic hepatitis.The decrease of C3 and C4 indicates poor prognosis..