T淋巴细胞线粒体损伤指数在自身免疫性肝炎患者中的临床意义及影响因素

摘要/Abstract

摘要： 目的分析T淋巴细胞线粒体损伤指数对自身免疫性肝炎患者的临床意义及其影响因素。方法 2021年10月至2023年10月南京医科大学第四附属医院收治的自身免疫性肝炎T淋巴细胞线粒体损伤患者60例,无线粒体损伤患者40例。罗氏全自动生化免疫分析仪检测血生化指标。免疫荧光法检测ANA滴度、IgG。安捷伦流式细胞仪测量外周血中T淋巴细胞线粒体并进行分析。辅助性T淋巴细胞(Th细胞)和抑制性T淋巴细胞(Ts细胞)的线粒体损伤根据比较线粒体染色值的内置算法确定。多因素logistic回归分析自身免疫性肝炎患者发生T淋巴细胞线粒体损伤的独立危险因素。应用受试者工作特征曲线下面积(AUC)评估T淋巴细胞线粒体损伤对自身免疫性肝炎患者的临床诊断价值。结果损伤组的ALT、ANA滴度阳性率、IgG、CD4⁺淋巴细胞计数、CD8⁺淋巴细胞计数、Th细胞线粒体损伤率和Ts细胞线粒体损伤率分别为(142.6±42.5)U/L、93.3%、(19.6±4.8)g/L、(468.8±22.3)×10⁶/L、(292.6±32.3)×10⁶/L、86.7%、83.3%,均高于未损伤组的(123.5±31.2)U/L、37.5%、(16.2±2.3)g/L、(417.6±32.1)×10⁶/L、(265.1±29.3)×10⁶/L、25.0%、50.0%,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,ALT、IgG、ANA滴度阳性率、CD4⁺淋巴细胞计数和CD8⁺淋巴细胞计数是自身免疫性肝炎患者发生T淋巴细胞线粒体损伤指数的独立危险因素(OR=3.438、3.804、3.504、3.114、3.699,P<0.05)。ROC曲线分析结果显示,Th细胞线粒体损伤、Ts细胞线粒体损伤诊断自身免疫性肝炎的AUC分别为0.808、0.754。结论 ALT、IgG、ANA滴度阳性率、CD4⁺淋巴细胞计数和CD8⁺淋巴细胞计数是自身免疫性肝炎患者发生T淋巴细胞线粒体损伤指数的独立危险因素,Th细胞线粒体损伤、Ts细胞线粒体损伤对自身免疫性肝炎具有较高的临床诊断价值。

关键词: T淋巴细胞, 线粒体损伤, 自身免疫性肝炎, 临床意义, 影响因素

Abstract: Objective To investigate the clinical relevance of the T-lymphocyte mitochondrial damage index in autoimmune hepatitis patients and to identify factors influencing T-lymphocyte mitochondrial damage. Methods A total of 60 patients with autoimmune hepatitis admitted to our hospital between October 2021 and October 2023 were enrolled in this study. Levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), and albumin (ALb) were measured using a Roche cobas 8000 Fully automated biochemical immunoassay analyzer(c701/c702). Antinuclear antibody (ANA) titers and immunoglobulin G(IgG) levels, were assessed via immunofluorescence. Mitochondrial status in peripheral blood T-lymphocytes was evaluated using an Agilent NovoCyte D3000 flow cytometer. Mitochondrial damage in helper T-lymphocytes (Th cells) and suppressor T-lymphocytes (Ts cells) was quatified through a built-in algorithm that compared mitochondrial staining values. Independent risk factors for T-lymphocyte mitochondrial damage in autoimmune hepatitis were analyzed using multifactorial logistic regression. Additionally, receiver operating characteristic (ROC) curve analysis was applied to assess the clinical diagnostic value of T-lymphocyte mitochondrial damage in these patients. Results In the injured group, the positive rates for ALT, ANA titers, IgG, CD4⁺ lymphocyte count, CD8⁺ lymphocyte count, mitochondrial damage rate of Th cells, and mitochondrial damage rate of Ts cells were (142.6±42.5) U/L, 93.3%, (19.6±4.8) g/L, (468.8±22.3) ×10⁶/L, (292.6± 32.3) × 10⁶/L, 86.7%, and 83.3%, respectively. These values were significantly higher than those in the uninjured group, which presented values of (123.5 ± 31.2) U/L, 37.5%, (16.2 ± 2.3) g/L, (417.6 ± 32.1) × 10⁶/L, (265.1 ± 29.3) × 10⁶/L, 25.0%, and 50.0%, respectively (P<0.05). Multifactorial logistic regression analysis indicated that elevated ALT, IgG, ANA titer positivity, CD4⁺ lymphocyte count, and CD8⁺ lymphocyte count were independent risk factors for T-lymphocyte mitochondrial damage in autoimmune hepatitis patients (OR=3.438, 3.804, 3.504, 3.114, 3.699, P<0.05). ROC curve analysis demonstrated that mitochondrial damage in both Th cells and Ts cells has high diagnostic value in identifying autoimmune hepatitis. Conclusion ALT, IgG, ANA titer positivity, CD4⁺ lymphocyte count, and CD8⁺ lymphocyte count are independent risk factors for T-lymphocyte mitochondrial damag in autoimmune hepatitis patients. Early detection of these indices is crucial for diagnosing T-lymphocyte mitochondrial damage. Additionally, mitochondrial damage in Th and Ts cells shows high diagnostic value for autoimmune hepatitis and can be used clinically to predic its occurrence.

Key words: T lymphocytes, Mitochondrial damage, Autoimmune hepatitis, Clinical significance, Influencing factors

陈克岩, 吴婷, 杨灿. T淋巴细胞线粒体损伤指数在自身免疫性肝炎患者中的临床意义及影响因素[J]. 肝脏, 2024, 29(11): 1409-1412.

CHEN Ke-yan, WU Ting, YANG Can. Clinical significance and determinants of T lymphocyte mitochondrial damage index in autoimmune hepatitis patients[J]. Chinese Hepatolgy, 2024, 29(11): 1409-1412.

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