Phenotypic alterations of regulatory T cells in autoimmune hepatitis: Causal or associated with treatment and remission?
Phenotypic alterations of regulatory T cells in autoimmune hepatitis: Causal or associated with treatment and remission?
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DOI：
10.1002/hep.27301
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发表时间：
2015-02
期刊：
影响因子：
13.5
通讯作者：
M. Sebode;M. Peiseler;C. Weiler-Normann;C. Schramm;A. Lohse;J. Herkel
中科院分区：
文献类型：
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作者：
M. Sebode;M. Peiseler;C. Weiler-Normann;C. Schramm;A. Lohse;J. Herkel
用于慢性病毒性肝炎的疾病进展。然而，这与Kuniholm等人的研究结果相反。在我们小组最近的一项研究中，通过瞬时弹性成像评估，与无/轻度纤维化的患者相比，肝硬化HCV患者的sCD 163和sCD 206（脱落甘露糖受体）水平较高。然而，sCD 206在预测肝硬化方面不如sCD 163，支持sCD 163可能是慢性病毒性肝炎中最好的巨噬细胞特异性生物标志物的观点。在我们发表的报告中，所有患者的肝活检数据都是可用的，我们关注sCD 163与炎症和纤维化的组织学评分之间的关系。由于这个原因，sCD 163和APRI/FIB-4之间的关联被省略了，但我们很高兴在这里介绍它们。与Kuniholm等人的数据一致，在我们的551例HCV患者中，sCD 163（经化学转化）与APRI（r 50.64; P< 0.001）和FIB-4（r 50.59; P< 0.001）密切相关。在203例HBV患者中，sCD 163与APRI相关（r50.51; P< 0.001），并有与FIB-4相关的趋势（r50.14; P50.09）。为了研究sCD 163与纤维化之间的调整关系，我们以纤维化评分为因变量，sCD 163、APRI和FIB-4（均经过对数转换）为解释变量，进行了多元有序逻辑回归分析。在该模型中，我们观察到在校正APRI和FIB-4后，sCD 163与HCV和HBV感染患者的纤维化评分之间存在明显的显著相关性（表1）。综上所述，数据表明sCD 163与APRI和FIB-4相关，但具有超出两种模型的纤维化预测能力，并且这通过基于sCD 163的纤维化评分的非常好的性能进一步说明，特别是在HCV患者中。最后，我们完全同意Kuniholm等人的观点，即需要对sCD 163和其他巨噬细胞标志物进行纵向研究，最好是在反复肝活检的抗病毒治疗下进行，以进一步阐明巨噬细胞的作用和巨噬细胞标志物在慢性病毒性肝炎中的预后价值。KONSTANTIN KAZANKOV，医学博士HOLGER JON Müller，医学博士，博士，博·马丁·毕比博士，理学硕士，博士亨德里克·维尔普，医学博士，D.Sc.，FRCP，FEBGH Jacob乔治，MBBS，Ph.D.，FRAP HENNING GRINBARK，医学博士，博士奥胡斯大学医院肝病和胃肠病学系奥胡斯，丹麦奥胡斯大学医院临床生物化学系奥胡斯，丹麦奥胡斯大学医院生物统计学系奥胡斯，丹麦悉尼大学和韦斯特米德医院Storr肝脏单位澳大利亚韦斯特米德
for disease progression in chronic viral hepatitis. However, this is in contrast with the findings of Kuniholm et al. In a recent study from our group, HCV patients with cirrhosis, as assessed by transient elastography, had higher levels of sCD163 and sCD206 (the shed mannose receptor), compared to those with no/mild fibrosis. However, sCD206 was inferior to sCD163 in cirrhosis prediction, supporting the notion that sCD163 may be the best macrophagespecific biomarker in chronic viral hepatitis. In our published report, liver biopsy data were available for all patients and we focused on the relationship between sCD163 and the histological scores for inflammation and fibrosis. For this reason, the associations between sCD163 and APRI/FIB-4 were omitted, but we are pleased to present them here. Consistent with the data by Kuniholm et al., sCD163 (logarithmically transformed) was strongly associated with APRI (r 5 0.64; P< 0.001) and FIB-4 (r 5 0.59; P< 0.001) in our 551 HCV patients. In the 203 HBV patients, sCD163 was associated with APRI (r 5 0.51; P< 0.001) and showed a trend toward association with FIB-4 (r 5 0.14; P 5 0.09). To investigate the adjusted relationship between sCD163 and fibrosis, we performed multiple ordered logistic regression analysis with the fibrosis score as the dependent variable and sCD163, APRI, and FIB-4 (all logarithmically transformed) as the explanatory. In this model, we observed a clear significant association between sCD163 and the fibrosis score after adjustment for APRI and FIB-4, both in patients with HCV and HBV infection (Table 1). Taken together, the data indicate that sCD163 correlates with APRI and FIB-4, but possesses the capability for fibrosis prediction beyond both models, and this is further illustrated by the very good performance of sCD163-based fibrosis scores, particularly in HCV patients. Finally, we entirely agree with Kuniholm et al. that longitudinal studies of sCD163 and other macrophage markers, preferably under antiviral treatment with repeated liver biopsies, are needed to further elucidate the role of macrophages and the prognostic value of macrophage markers in chronic viral hepatitis. KONSTANTIN KAZANKOV, M.D. HOLGER JON MØLLER, M.D., PH.D., D.Sc. BO MARTIN BIBBY, M.Sc., PH.D. HENDRIK VILSTRUP, M.D., D.Sc., FRCP, FEBGH JACOB GEORGE, MBBS, Ph.D., FRACP HENNING GRØNBÆK, M.D., PH.D. Department of Hepatology and Gastroenterology Aarhus University Hospital Aarhus, Denmark Department of Clinical Biochemistry Aarhus University Hospital Aarhus, Denmark Department of Biostatistics Aarhus University Aarhus, Denmark The Storr Liver Unit University of Sydney and Westmead Hospital Westmead, Australia