CAJ | 학술논문

目的探明乙型肝炎肝硬化原位肝移植患者外周血辅助性T淋巴细胞17 (Th17)细胞水平与术后并发症的关系. 方法选择乙型肝炎肝硬化行原位肝移植患者51例,于术前、术后7、14及21 d,采用流式细胞术检测外周血Th17细胞频数,术后同步检测肝脏生物化学、他克莫司(FK506)血药浓度及血清降钙素原(PCT)水平.结果根据术后并发症发生情况分为:急性排斥反应、术后感染、一过性胆汁淤积及无并发症组,依次为12、10、12和17例.Th17细胞频数分析显示:急性排斥反应组呈逐渐递增趋势,显著高于手术前水平(P＜ 0.01),并与排斥反应活动指数及PCT呈正相关(r=0.759,P=0.004;r=0.768,P=0.010);术后感染组术后14d内Th17细胞频率变化与急性排斥反应组趋势一致,至术后21 d显著降低至接近手术前水平;一过性胆汁淤积组、无并发症组术后Th17细胞频率呈缓慢下降趋势,与术前比较差异显著(P＜0.01).急性排斥反应组FK506血药浓度于肝移植术后14d显著低于其余各组(P=0.000).结论外周血Th17细胞频率可作为肝移植术后并发症的监测指标之一,综合分析FK506血药浓度、Th17细胞水平及PCT,可早期发现肝移植术后排异反应、严重感染等并发症,指导抗排异药物剂量的调整及抗感染措施的实施,改善预后.
목적 탐명을형간염간경화원위간이식환자외주혈보조성T림파세포17 (Th17)세포수평여술후병발증적관계. 방법 선택을형간염간경화행원위간이식환자51례,우술전、술후7、14급21 d,채용류식세포술검측외주혈Th17세포빈수,술후동보검측간장생물화학、타극막사(FK506)혈약농도급혈청강개소원(PCT)수평.결과 근거술후병발증발생정황분위:급성배척반응、술후감염、일과성담즙어적급무병발증조,의차위12、10、12화17례.Th17세포빈수분석현시:급성배척반응조정축점체증추세,현저고우수술전수평(P＜ 0.01),병여배척반응활동지수급PCT정정상관(r=0.759,P=0.004;r=0.768,P=0.010);술후감염조술후14d내Th17세포빈솔변화여급성배척반응조추세일치,지술후21 d현저강저지접근수술전수평;일과성담즙어적조、무병발증조술후Th17세포빈솔정완만하강추세,여술전비교차이현저(P＜0.01).급성배척반응조FK506혈약농도우간이식술후14d현저저우기여각조(P=0.000).결론 외주혈Th17세포빈솔가작위간이식술후병발증적감측지표지일,종합분석FK506혈약농도、Th17세포수평급PCT,가조기발현간이식술후배이반응、엄중감염등병발증,지도항배이약물제량적조정급항감염조시적실시,개선예후.
Objective To investigate the relationship between level of Th17/CD4+ T cell ratio in peripheral blood and postoperative complications in patients with hepatitis B virus (HBV)-related cirrhosis after orthotopic liver transplantation (OLT).Methods Fifty-one patients with HBV-related cirrhosis who received OLT were enrolled in this study.Flow cytometry analysis was performed to measure the proportion of Th17 cells to CD4+T cells at the following time points:pre-OLT,and post-OLT days 7,14 and 21.The relevant hepatic biochemistry indexes,serum concentration of FK506 and level of procalcitonin (PCT) were detected for all patients after OLT.Results The transplant recipients were divided into four groups according to the postoperative complication,which included acute rejection (AR,n =12),postoperative infection (POI,n =10),transient intrahepatic cholestasis (TIHC,n =12) and no complications (n =17).The Th17/CD4+ T cell frequencies were notably higher in the AR patients after OLT (vs.before OLT,P ＜ 0.01) and this increase was positively correlated with rejection activity index (RAI;r =0.759,P =0.004).Up to post-OLT day 14,the frequencies of Th1 7/CD4+T cells in the POI group were similar to those of the AR group but they decreased to near-baseline level at post-OLT day 21.Furthermore,the percentage of Th17/CD4+T cells in the POI group was positively correlated with PCT (r =0.768,P =0.010).The frequencies of Th17/CD4+T cells in the TIHC and no complications groups showed a slowly decreasing trend after OLT and became markedly lower than the before OLT levels (P ＜ 0.01).The concentration of FK506 in the AR group was significantly lower than that in the other groups at post-OLT day 14 (P =0.000).Conclusions Th17/CD4+T cell level in peripheral blood might be a useful marker for risk assessment and monitoring of OLT postoperative complications,such as acute rejection and postoperative infection,in the early stage,and might help to improve patient prognosis by allowing for timely application of anti-rejection and antibacterial agents.