自身免疫性肝炎患者外周血单个核细胞CD6及其配体激活的白细胞粘附分子水平变化临床价值研究*

doi:10.3969/j.issn.1672-5069.2024.03.013

摘要/Abstract

摘要： 目的探讨自身免疫性肝炎(AIH)患者外周血单个核细胞(PBMC)CD6阳性细胞百分比及其配体激活的白细胞粘附分子(ALCAM)水平变化的临床意义。方法 2020年3月～2022年3月我院收治的60例AIH患者,均接受肝活检,使用流式细胞仪检测PBMC CD6阳性细胞百分比,采用ELISA法检测血清ALCAM水平。结果本组AIH患者临床病情轻中度42例和重度18例,肝组织学检查发现<=1级肝组织炎症48例,≥2级12例,<=1期肝纤维化44例,≥2期16例;重度AIH患者血清总胆红素、谷丙转氨酶、谷草转氨酶和碱性磷酸酶水平分别为(94.5±8.3)μmol/L、(215.4±17.2)U/L、(161.5±14.2)U/L和(83.6±16.3)U/L,均显著高于轻中度组【分别为(31.1±4.3)μmol/L、(58.2±9.4)U/L、(49.5±8.3)U/L和(61.6±3.5)U/L,P<0.05】;重度组PBMC CD6阳性细胞百分比、血清ALCAM、IgG和IgM水平分别为(65.4±7.8)%、(22.5±2.1)ng/mL、(18.6±2.6)mg/dL和(1.7±0.3)mg/dL,均显著大于轻中度组【分别为(36.7±4.2)%、(15.4±1.2)ng/mL、(13.7±2.3)mg/dL和(0.7±0.1)mg/dL,P<0.05】;≥2级肝组织炎症组CD6阳性细胞百分比和血清ALCAM水平分别为(71.4±8.3)%和(25.4±3.2)ng/mL,均显著大于<=1级组【分别为(36.2±4.3)%和(14.8±1.4)ng/mL,P<0.05】,≥2期肝纤维化组CD6和血清ALCAM水平分别为(69.3±7.8)%和(24.7±3.4)ng/mL,均显著大于<=1期组【分别为(36.4±4.4)%和(14.9±1.8)ng/mL,P<0.05】;应用PBMC CD6阳性细胞百分比和血清ALCAM水平预测AIH患者肝组织显著性炎症的曲线下面积分别为0.98和0.95,其敏感度分别为100.0%和91.6%,特异度分别为87.5%和97.9%,预测显著性肝纤维化的曲线下面积为0.98和0.90,其敏感度分别为93.7%和75.0%,特异度分别为95.5%和100.00%。结论随着病情加重,AIH患者PBMC CD6阳性细胞百分比和血清ALCAM水平逐渐升高,应用这两项指标可评估肝组织炎症和纤维化严重程度,有利于指导临床决策。

关键词: 自身免疫性肝炎, CD6, 激活的白细胞粘附分子, 肝组织病理学

Abstract: Objective The aim of this study was to investigate the implication of peripheral blood mononuclear CD6 positive cell percentage and its ligand activated leukocyte adhesion molecule (ALCAM) levels in patients with autoimmune hepatitis (AIH). Methods 60 patients with AIH were enrolled in this study between March 2020 and March 2022, and all received liver biopsies. The peripheral blood mononuclear cells (PBMCs) were separated and the percentages of CD 6 positive cells were detected by FCM. Serum ALCAM levels were assayed by ELISA. Results Our series of patients with AIH included clinically mild/moderate disease in 42 cases and severe in 18 cases, and the histopathologically showed <= grade 1 of liver inflammatory activity in 48 cases and ≥grade 2 in 12 cases, and <= stage 1 of liver fibrosis in 44 cases and ≥stage 2 in 16 cases; total serum bilirubin, ALT, AST and ALP levels in patients with severe disease were(94.5±8.3)μmol/L, (215.4±17.2)U/L, (161.5±14.2)U/L and (83.6±16.3)U/L, all significantly higher than [(31.1±4.3)μmol/L, (58.2±9.4)U/L, (49.5±8.3)U/L and (61.6±3.5)U/L, P<0.05] in patients with mild/moderate diseases; the percentage of PBMC CD6 positive cells and serum ALCAM, IgG and IgM levels in patients with severe disease were(65.4±7.8)%, (22.5±2.1)ng/mL, (18.6±2.6)mg/dL and (1.7±0.3)mg/dL, all much higher than [(36.7±4.2)%, (15.4±1.2)ng/mL, (13.7±2.3)mg/dL and (0.7±0.1)mg/dL, respectively, P<0.05] in patients with mild/moderate disease; the percentage of CD6 positive cells and serum ALCAM levels in patients with ≥grade 2 were (71.4±8.3)% and (25.4±3.2)ng/mL, both significantly higher than [(36.2±4.3)% and (14.8±1.4)ng/mL, P<0.05] in patients with <=grade 1, and they were(69.3±7.8)% and (24.7±3.4)ng/mL in patients with ≥stage 2, both much higher than [(36.4±4.4)% and (14.9±1.8)ng/mL, P<0.05] in those with <=stage 1; the AUCs were 0.98 and 0.95, with the sensitivities (Se) of 100.0% and 91.6% and the specificities (Sp) of 87.5% and 97.9%, when the PBMC CD6 positive cells and serum ALCAM levels were applied to predict the significant histoactivities, and the AUCs were 0.98 and 0.90, with the Se of 93.7% and 75.0%, and Sp of 95.5% and 100.00%, when the two were applied to predict significant liver fibrosis. Conclusion The percentages of PBMC CD6 positive cells and serum ALCAM levels in patients with AIH increase, which might be correlated to intrahepatic liver inflammation and fibrosis.

Key words: Autoimmune hepatitis, CD6, Activated leukocyte adhesion molecule, Liver histopathology

刘恋, 吉飞跃, 陈诺儿. 自身免疫性肝炎患者外周血单个核细胞CD6及其配体激活的白细胞粘附分子水平变化临床价值研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 370-373.

Liu Lian, Ji Feiyue, Chen Nuo'er. Changes of peripheral blood mononuclear CD6 positive cell percentage and its ligand activated leukocyte adhesion molecule levels in patients with autoimmune hepatitis[J]. Journal of Practical Hepatology, 2024, 27(3): 370-373.

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自身免疫性肝炎患者外周血单个核细胞CD6及其配体激活的白细胞粘附分子水平变化临床价值研究^*

Changes of peripheral blood mononuclear CD6 positive cell percentage and its ligand activated leukocyte adhesion molecule levels in patients with autoimmune hepatitis

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