CAJ | 학술논문

目的：探讨乙型肝炎相关的慢加急性肝衰竭（acute －on －Chronic hepatitis B liver failure，ACHBLF）患者外周血树突状细胞（DCs）水平与临床转归的关系。方法收集2010年6月－2014年9月北京佑安医院收治的 ACHBLF 患者70例，以3个月后的临床预后结局分为存活组和死亡组。多因素 Logistic 回归分析影响患者预后的临床指标，同时采用流式细胞术检测外周 DCs 亚群绝对数（107）及百分比（％）；两独立样本 t 检验或秩和检验比较两组 DCs 水平差异并通过线性相关及多因素回归分析确定其是否可作为慢加急性肝衰竭临床转归的独立预测因素。结果TBil 是影响慢加急性肝衰竭3个月预后的临床指标[比值比（OR）＝1．008，95％可信区间（95％CI）：1．003～1．014，P ＝0．003）。存活组外周血髓样 DCs（mDCs）绝对数[（7．3±6．2）×107]明显高于死亡组[（4．1±4．0）×107]（t ＝2．336，P ＜0．05）；存活组患者外周血浆系 DCs（pDCs）绝对数[（0．8±0．6）×107]也明显高于死亡组[（0．4±0．5）×107]（t ＝2．307，P ＜0．05）；mDCs 百分比（Z ＝－0．080，P ＞0．05）及 pDCs 百分比（t ＝－0．248，P ＞0．05）在两组间差异无统计学意义。mDCs 和 pDCs 绝对数与 TBil 无线性相关关系（R2值分别为0．009和0．059），mDCs 与 pDCs 绝对数可纳入多因素回归方程，结果显示 mDCs（OR ＝0．789，95％CI：0．665～0．935，P ＝0．006）和 TBil（OR ＝1．013，95％CI：1．006～1．020，P＜0．001）是慢加急性肝衰竭预后的独立预测因素。结论ACHBLF 患者外周血 mDCs 及 pDCs 绝对数存活组高于死亡组，mDCs 绝对数是慢加急性肝衰竭预后的独立预测因素。DCs 数量的差异可能是影响肝衰竭患者临床转归的原因之一。
목적：탐토을형간염상관적만가급성간쇠갈（acute －on －Chronic hepatitis B liver failure，ACHBLF）환자외주혈수돌상세포（DCs）수평여림상전귀적관계。방법수집2010년6월－2014년9월북경우안의원수치적 ACHBLF 환자70례，이3개월후적림상예후결국분위존활조화사망조。다인소 Logistic 회귀분석영향환자예후적림상지표，동시채용류식세포술검측외주 DCs 아군절대수（107）급백분비（％）；량독립양본 t 검험혹질화검험비교량조 DCs 수평차이병통과선성상관급다인소회귀분석학정기시부가작위만가급성간쇠갈림상전귀적독립예측인소。결과TBil 시영향만가급성간쇠갈3개월예후적림상지표[비치비（OR）＝1．008，95％가신구간（95％CI）：1．003～1．014，P ＝0．003）。존활조외주혈수양 DCs（mDCs）절대수[（7．3±6．2）×107]명현고우사망조[（4．1±4．0）×107]（t ＝2．336，P ＜0．05）；존활조환자외주혈장계 DCs（pDCs）절대수[（0．8±0．6）×107]야명현고우사망조[（0．4±0．5）×107]（t ＝2．307，P ＜0．05）；mDCs 백분비（Z ＝－0．080，P ＞0．05）급 pDCs 백분비（t ＝－0．248，P ＞0．05）재량조간차이무통계학의의。mDCs 화 pDCs 절대수여 TBil 무선성상관관계（R2치분별위0．009화0．059），mDCs 여 pDCs 절대수가납입다인소회귀방정，결과현시 mDCs（OR ＝0．789，95％CI：0．665～0．935，P ＝0．006）화 TBil（OR ＝1．013，95％CI：1．006～1．020，P＜0．001）시만가급성간쇠갈예후적독립예측인소。결론ACHBLF 환자외주혈 mDCs 급 pDCs 절대수존활조고우사망조，mDCs 절대수시만가급성간쇠갈예후적독립예측인소。DCs 수량적차이가능시영향간쇠갈환자림상전귀적원인지일。
Objective To investigate the relationship between the count of peripheral blood dendritic cells (DCs)and clinical outcome in pa-tients with acute -on -chronic hepatitis B liver failure (ACHBLF).Methods This study included 70 patients with ACHBLF admitted to our hospital from June 2010 to September 2014.These patients were divided into survival group and death group according to their clinical outcomes at 3 months.Multivariatelogistic regression analysis was used to determine the clinical indices as prognostic factors.Flow cytometry was used to measure the number (107 )and percentage (%)of subsets of DCs in peripheral blood.Comparison of DCs between the two groups was made by two -independent -samples t test or rank sum test,and linear correlation and multivariate regression analysis was performed to determine whether DCs could be used as an independent predictor of the clinical outcome of ACHBLF.Results Total bilirubin (TBil)was a clinical prognostic factor for ACHBLF at 3 months (OR =1.008,95% CI:1.003 -1.014,P =0.003).The number of myeloid DCs (mDCs)in pe-ripheral blood was significantly higher in the survival group than in the death group [(7.3 ±6.2)×107 vs (4.1 ±4.0)×107 ,t =2.336,P <0.05],and the number of plasmacytoid DCs (pDCs)in peripheral blood was also significantly higher in the survival group than in the death group [(0.8 ±0.6)×107 vs (0.4 ±0.5)×107 ,t =2.307,P <0.05).There were no significant differences in the percentages of mDCs and pDCs between the two groups (Z =-0.080,P >0.05;t =-0.248,P >0.05).The numbers of mDCs and pDCs showed no linear relationship with TBil (R2 =0.009 and 0.059,respectively).The numbers of mDCs and pDCs could be included in the multivariate regression equa-tion,and the results showed that mDCs (OR =0.789,95% CI:0.665 -0.935,P =0.006)and TBil (OR =1.013,95% CI:1.006 -1.020,P <0.001)were independent prognostic predictors for ACHBLF.Conclusion The numbers of mDCs and pDCs in peripheral blood are higher in surviving patients with ACHBLF than in those who die,and the number of mDCs is an independent prognostic predictor.The number of DCs may be an influencing factor for the clinical outcome of patients with ACHBLF.