Influence of Th17/Treg balance on progression of liver cirrhosis in patients with chronic hepatitis B

Objective: Our aim was to study the influence of T helper cell 17/regulatory T-cell (Th17/Treg) balance on progression of liver cirrhosis in patients with chronic hepatitis B (CHB). Methods: There were 86 patients diagnosed at our hospital with CHB and cirrhosis between January 2012 and March 2015. According to liver stiffness measurement (LSM), these patients were classified into low LSM group (7 kPa < LSM <= 12 kPa, n = 42) and high LSM group (12 kPa < LSM <= 18 kPa, n = 44). On the other hand, 30 healthy people examined at our medical center were taken as the control group (C group). In collecting general clinical data of the patients, enzyme linked immunosorbent assay (ELISA) and flow cytometry (FCM) were adopted to test serum levels of IL-10, TGF-beta, IL-17, and expression rates of Th17 and Treg cells in peripheral blood (PB). We also calculated Th17/Treg ratio. Meanwhile, one-way analysis of variation (ANOVA) was adopted to analyze differences of the above mentioned indicators among patients with different degrees of liver cirrhosis. Pearson's correlation analysis and Cox regression analysis were employed to study relation between Th17/Treg ratio and degree of liver cirrhosis. Results: FCM results showed that expression rates of Th17 and Treg cells and Th17/Treg ratio of C group were (1.4 +/- 0.8), (1.8 +/- 0.6), and (0.82 +/- 0.5). Rates of the low LSM group were (3.6 +/- 0.6), (3.3 +/- 0.3), (1.7 +/- 0.6) and rates of the high LSM group were (3.2 +/- 0.5), (1.4 +/- 0.3) and (2.9 +/- 0.7). Differences among the three groups were of statistical significance (P<0.05 or P<0.01). ELSIA results showed that serum levels of IL-10 of C group, the low LSM group, and high LSM group were (47 +/- 9) pg/mL, (78 +/- 17) pg/mL, and (116 +/- 21) pg/mL, respectively. Serum levels of TGF-beta of the three groups were (23 +/- 7) pg/mL, (69 +/- 10) pg/ml, and (123 +/- 15) pg/mL, showing obvious differences (P<0.05 or P<0.01). IL-17 levels of the low LSM group and high LSM group were remarkably higher than that of C group ((138 +/- 16) pg/mL vs. (118 +/- 11) pg/mL, (145 +/- 20) pg/mL vs. (118 +/- 11) pg/mL) but differences between the two was not statistically significant. Pearson's correlation analysis showed that Treg, Th17/Treg ratio, and related cytokines like IL-10 and TGF-beta were distinctly related to LSM (P<0.01) while Cox regression analysis showed that Th17/Treg ratio, IL-10, and TGF-beta were independent correlation factors for LSM. Conclusion: Th17/Treg balance is closely related to progression of liver cirrhosis in patients with CHB. It could be a critical indicator for clinical diagnosis of progression in patients with hepatitis B and liver cirrhosis and conditions of liver function.