CAJ | 학술논문

目的探讨CD4+CD25+调节性T淋巴细胞(Tregs)、辅助性T17细胞(Th17)、白细胞介素6 (IL-6)在HBV相关慢加急性肝衰竭(ACLF)疾病进展及预后中的价值. 方法检索CNKI、万方、维普、PubMed、Embase、SCI数据库中Treg细胞与ACLF相关研究文献,按照纳入及排除标准筛选文献,选择NOS标准评价文献质量,按照PICOS原则提取资料,采用RevMan 5.1软件进行Meta分析. 结果共纳入9个病例对照研究,Meta分析显示:ACLF患者外周血CD4+CD25+Treg细胞频率高于慢性乙型肝炎(CHB)组患者[MD=0.59,95％可信区间(CI)为(1.68 ～ 2.85)]及健康对照组(HC) [MD=1.12,95％ CI为(1.42 ～ 3.66)],但差异无统计学意义(P值均＞0.05);而ACLF患者外周血Th17细胞频率高于CHB患者[MD=1.73,95％ CI为(0.21 ～ 3.26)]及HC[MD=1.62,95％ CI为(0.52 ～ 2.72)],差异有统计学意义(P值均＜0.05).ACLF患者外周血IL-6含量高于CHB患者[MD=11.69,95％ CI为(1.98 ～ 21.40)]及HC[MD=13.17,95％ CI为(1.38 ～ 24.95)],差异有统计学意义(P值均＜0.05). 结论 CD4+CD25+Treg细胞可能为影响ACLF疾病进展及预后的重要保护因素;而Th17细胞及IL-6为影响ACLF疾病进展及预后的危险因素.
목적 탐토CD4+CD25+조절성T림파세포(Tregs)、보조성T17세포(Th17)、백세포개소6 (IL-6)재HBV상관만가급성간쇠갈(ACLF)질병진전급예후중적개치. 방법 검색CNKI、만방、유보、PubMed、Embase、SCI수거고중Treg세포여ACLF상관연구문헌,안조납입급배제표준사선문헌,선택NOS표준평개문헌질량,안조PICOS원칙제취자료,채용RevMan 5.1연건진행Meta분석. 결과 공납입9개병례대조연구,Meta분석현시:ACLF환자외주혈CD4+CD25+Treg세포빈솔고우만성을형간염(CHB)조환자[MD=0.59,95％가신구간(CI)위(1.68 ～ 2.85)]급건강대조조(HC) [MD=1.12,95％ CI위(1.42 ～ 3.66)],단차이무통계학의의(P치균＞0.05);이ACLF환자외주혈Th17세포빈솔고우CHB환자[MD=1.73,95％ CI위(0.21 ～ 3.26)]급HC[MD=1.62,95％ CI위(0.52 ～ 2.72)],차이유통계학의의(P치균＜0.05).ACLF환자외주혈IL-6함량고우CHB환자[MD=11.69,95％ CI위(1.98 ～ 21.40)]급HC[MD=13.17,95％ CI위(1.38 ～ 24.95)],차이유통계학의의(P치균＜0.05). 결론 CD4+CD25+Treg세포가능위영향ACLF질병진전급예후적중요보호인소;이Th17세포급IL-6위영향ACLF질병진전급예후적위험인소.
Objective To investigate the role ofCD4+CD25+ T regulatory (Treg) cells,T helper (Th)17cells and interleukin (IL)-6 in the progression of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) and determine their value as prognostic markers.Methods The Chinese National Knowledge Infrastructure (CNKI),WanFang,Chinese Scientific Journals (VIP),PubMed,Embase and Web of Science databases were searched for English language case-control studies on the relationship between regulatory T lymphocytes and ACLF.The quality of included studies was assessed using the Newcastle-Ottawa scale.The meta-analysis was designed according to the PICOS approach recommended by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement.RevMan software,version 5.1,was used to perform the meta-analysis.Results Nine case-cohort studies were selected for inclusion in the metaanalysis.The results of the meta-analyses showed that the level of CD4+CD25+ Treg cells was not significantly different between patients with HBV-related ACLF and patients with chronic hepatitis B (CHB) (mean difference (MD) =0.59,95％ confidence interval (CI)-1.68,2.85,P =0.61) nor between patients with HBVrelated ACLF and healthy controls (MD =1.12,95％ CI:-1.42,3.66,P =0.39).Thus,it appears that ACLF patients do not have a higher level of CD4+CD25+ Treg cells than CHB patients or healthy controls.However,the ACLF patients did appear to have a significantly higher level of Th17 cells than both the CHB patients (MD =1.73,95％ CI:0.21,3.26,P =0.03) and the healthy controls (MD =1.62,95％ CI:(0.52,2.72,P =0.004).In addition,the ACLF patients also had significantly higher level than both the CHB patients (MD =11.69,95％CI:1.98,21.40,P =0.02) and the healthy controls (MD =13.17,95％ CI:1.38,24.95,P =0.03).Conclusion CD4+CD25+ Treg cells may be an important protective factor in the progression and prognosis of HBV-related ACLF,while Thl7 cells and IL-6 may be risk factors for further progression and worsened prognosis.