关键词: 肝硬化, 肝肾综合征, 细胞因子, 淋巴细胞亚群, 短期预后

Abstract: Objective The aim of this study was to investigate serum cytokine level and peripheral blood lymphocyte subset changes in patients with decompensated liver cirrhosis and hepatorenal syndrome (HRS). Methods 84 patients with decompensated liver cirrhosis and 50 healthy persons were enrolled in our hospital between June 2019 and June 2022, and all patients were carefully managed and were followed-up for 90 days. Serum C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were detected by ELISA, and peripheral blood lymphocyte subsets were determined by FCM. Results The HRS was found in 35 cases in our series; serum bilirubin level and INR in patients with HRS were (32.4±5.3)μmol/L and (1.5±0.5), both significantly higher than [(20.4±4.7)μmol/L and (1.4±0.4), P<0.05] in patients without HRS or [(8.3±1.2)μmol/L and (1.0±0.3), P<0.05] in healthy individuals, while serum albumin level was (27.2±1.8) g/L, much lower than [(31.6±2.1)g/L, P<0.05] in patients without HRS or [(46.3±5.2)g/L, P<0.05] in healthy persons; serum Cys-C, sCr and BUN levels in patients with HRS were (1.4±0.5)mg/L, (148.3±22.8)μmol/L and (11.5±2.6)μmol/L, much higher than [(1.0±0.3)mg/L, (86.1±13.2)μmol/L and (5.7±2.1)μmol/L, P<0.05] in patients without HRS or [(0.7±0.2)mg/L, (78.3±10.3)μmol/L and (4.9±1.8)μmol/L, P<0.05] in healthy persons, while 24-hour creatinine clearance (24-cCr) was (35.8±9.3) mL/min, much lower than [(83.2±11.5)mL/min, P<0.05] in patients without HRS or [(90.7±14.3)mL/min, P<0.05] in healthy persons; serum CRP, IL-6 and TNF-α levels in patients with HRS were (6.4±1.0)g/L, (15.6±2.3)pg/mL and (60.2±14.3)pg/mL, much higher than [为(5.6±1.2)g/L, (7.8±1.3)pg/mL and (35.8±7.9)pg/mL, P<0.05] in patients without HRS or [(1.6±0.5)g/L, (5.2±1.0)pg/mL and (20.4±6.1)pg/mL, P<0.05] in healthy persons; the percentages of peripheral blood CD3⁺, CD4⁺ and CD8⁺ cells in patients with HRS were much lower than in patients without HRS or healthy persons (P<0.05), and the ratio of CD4⁺/CD8⁺ cells was much lower in healthy persons (P<0.05); the 90 day fatality in patients with HRS was 82.9% in our series, much higher than 22.2% in patients without HRS(P<0.05). Conclusion The short-term fatality of patients with decompensated liver cirrhosis and HRS is high, which might be related to the activation of cytokines, decreased immune functions and deteriorated renal functions.

Key words: Liver cirrhosis, Hepatorenal syndrome, Cytokines, Lymphocyte subsets, Prognosis