Revised: September 4, 2012
Accepted: November 14, 2012
Published online: February 27, 2013
AIM: To compare lymphocyte subsets between healthy controls and alcoholics with liver disease.
METHODS: The patient cohort for this study included individuals who were suspected to have alcoholic liver disease (ALD) and who had undergone liver biopsy (for disease grading and staging, doubts about diagnosis, or concurrent liver disease; n = 56). Normal controls included patients who were admitted for elective cholecystectomy due to non-complicated gallstones (n = 27). Formalin-fixed, paraffin-embedded liver biopsy specimens were sectioned and stained with hematoxylin and eosin and Perls’ Prussian blue. The non-alcoholic steatohepatitis score was used to assess markers of ALD. Lymphocyte population subsets were determined by flow cytometry. T lymphocytes were identified (CD3+), and then further subdivided into CD4+ or CD8+ populations. B lymphocytes (CD19+) and natural killer (NK) cell numbers were also measured. In addition to assessing lymphocyte subpopulation differences between ALD patients and controls, we also compared subsets of alcoholic patients without cirrhosis or abstinent cirrhotic patients to normal controls.
RESULTS: The patient cohort primarily consisted of older men. Active alcoholism was present in 66.1%. Reported average daily alcohol intake was 164.9 g and the average lifetime cumulative intake was 2211.6 kg. Cirrhosis was present in 39.3% of the patients and 66.1% had significant fibrosis (perisinusoidal and portal/periportal fibrosis, bridging fibrosis, or cirrhosis) in their liver samples. The average Mayo end-stage liver disease score was 7.6. No hereditary hemochromatosis genotypes were found. ALD patients (n = 56) presented with significant lymphopenia (1.5 × 109/L ± 0.5 × 109/L vs 2.1 × 109/L ± 0.5 × 109/L, P < 0.0001), due to a decrease in all lymphocyte subpopulations, except for NK lymphocytes: CD3+ (1013.0 ± 406.2/mm3vs 1523.0 ± 364.6/mm3, P < 0.0001), CD4+ (713.5 ± 284.7/mm3vs 992.4 ± 274.7/mm3, P < 0.0001), CD8+ (262.3 ± 140.4/mm3vs 478.9 ± 164.6/mm3, P < 0.0001), and CD19+ (120.6 ± 76.1/mm3vs 264.6 ± 88.0/mm3, P < 0.0001). CD8+ lymphocytes suffered the greatest reduction, as evidenced by an increase in the CD4+/CD8+ ratio (3.1 ± 1.3 vs 2.3 ± 0.9, P = 0.013). This ratio was associated with the stage of fibrosis on liver biopsy (rs = 0.342, P = 0.01) and with Child-Pugh score (rs = 0.482, P = 0.02). The number of CD8+ lymphocytes also had a positive association with serum ferritin levels (rs = 0.345, P = 0.009). Considering only patients with active alcoholism but not cirrhosis (n = 27), we found similar reductions in total lymphocyte counts (1.8 × 109/L ± 0.3 × 109/L vs 2.1 × 109/L ± 0.5 × 109/L, P = 0.018), and in populations of CD3+ (1164.7 ± 376.6/mm3vs 1523.0 ± 364.6/mm3, P = 0.001), CD4+ (759.8 ± 265.0/mm3vs 992.4 ± 274.7/mm3, P = 0.003), CD8+ (330.9 ± 156.3/mm3vs 478.9 ± 164.6/mm3, P = 0.002), and CD19+ (108.8 ± 64.2/mm3vs 264.6 ± 88.0/mm3, P < 0.0001). In these patients, the CD4+/CD8+ ratio and the number of NK lymphocytes was not significantly different, compared to controls. Comparing patients with liver cirrhosis but without active alcohol consumption (n = 11), we also found significant lymphopenia (1.3 × 109/L ± 0.6 × 109/L vs 2.1 × 109/L ± 0.5 × 109/L, P < 0.0001) and decreases in populations of CD3+ (945.5 ± 547.4/mm3vs 1523.0 ± 364.6/mm3, P = 0.003), CD4+ (745.2 ± 389.0/mm3vs 992.4 ± 274.7/mm3, P = 0.032), CD8+ (233.9 ± 120.0/mm3vs 478.9 ± 164.6/mm3, P < 0.0001), and CD19+ (150.8 ± 76.1/mm3vs 264.6 ± 88.0/mm3, P = 0.001). The NK lymphocyte count was not significantly different, but, in this group, there was a significant increase in the CD4+/CD8+ ratio (3.5 ± 1.3 vs 2.3 ± 0.9, P = 0.01).
CONCLUSION: All patient subsets presented with decreased lymphocyte counts, but only patients with advanced fibrosis presented with a significant increase in the CD4+/CD8+ ratio.