Abstract: Objective The aim of this study was to explore the polarization of peripheral blood macrophages and peripheral blood mononuclear lymphocyte (PBMC) thioredoxin-interacting protein (TXNIP)/nucleotide-binding oligo-merization domain-like receptor protein 3 (NLRP3) mRNA changes in patients with hepatitis B virus acute-on-chronic liver failure (HBV-ACLF). Methods 57 patients with HBV-ACLF and 43 patients with chronic hepatitis B (CHB) were enrolled in our hospital between June 2019 and June 2020, and the percentages of peripheral blood M1 and M2 macrophages were detected by flow cytometry. The PBMC TXNIP, NLRP3 and cysteine protease-1 (caspase-1) mRNA were assayed by real-time fluorescence quantification RT-PCR. Serum interleukin-6 (IL)-6, IL-10 and tumor necrosis factor-α (TNF-α) were detected by ELISA. Results The percentage of M1 macrophages and M1/M2 cell ratio in patients with HBV-ACLF were (3.5±0.4)% and (1.2±0.2), significantly higher than [(2.1±0.2)% and (0.6±0.1), P<0.05], while the percentage of M2 macrophages was (2.5±0.3)%, significantly lower than [(4.1±0.4)%, P<0.05] in patients with CHB; serum IL-6 and TNF-α in patients with HBV-ACLF were (37.9±4.2) ng/L and (2.3±0.2) pg/mL, significantly higher than [(28.8±3.6) ng/L and (1.2±0.1) pg/mL, respectivley, P<0.05], while serum IL-10 level was (1.4±0.2) pg/mL, significantly lower than [(2.9±0.3) pg/mL, P<0.05] in patients with CHB; the PBMCs NLRP3, TXNIP and caspase-1 mRNA in patients with HBV-ACLF were (0.5±0.1), (0.7±0.1) and (1.2±0.1), all significantly lower than [(0.8±0.2), (1.0±0.1) and (1.6±0.2), respectively, P<0.05] in patients with CHB; the percentage of PBMC M1 macrophages in 15 dead patients was (4.1±0.4) %, significantly higher than [(3.3±0.3)%, P<0.05], while the percentage of M2 macrophages, PBMCs NLRP3 and TXNIP mRNA were (1.9±0.2)%, (0.2±0.1) and (0.4±0.1), significantly lower than [(2.7±0.3)%,(0.6±0.1) and (0.8±0.1), respectively, P<0.05] in 42 survivals. Conclusion The peripheral blood macrophages are polarized in the pro-inflammatory direction and the down-regulation of TXNIP and NLRP3 mRNA might be related to immunosuppression in patients with HBV-ACLF.

Key words: Acute-on-chronic liver failure, Macrophage polarization, Thioredoxin-interacting protein, Nucleotide-binding oligo-merization domain-like receptor protein 3, Prognosis