Lymphocyte subset alterations in patients with alcoholic hepatitis.
Twenty-three patients with alcoholic hepatitis (AH) were entered into a study to evaluate the relationship between alcoholic hepatitis, malnutrition, and immune status. In order to quantify these variables, objective parameters of nutritional status and lymphocyte phenotype and function were used. On admission to hospital, the mean number of CD4 helper/inducer cells, CD8 suppressor/cytotoxic cells, and CD3 lymphocytes were significantly reduced compared to age matched, non-hospitalized laboratory controls. In order to ascertain whether this abnormality was reversible, 12 patients, who were willing to remain in the hospital for 30 days, were treated for this entire period with oral nutritional supplementation using a commercially available preparation high in calories, protein, and branch chain amino acids. After 30 days of this therapy and abstinence, the number of CD4 cells increased from a mean (+/- SD) of 658 +/- 428 to 815 +/- 599/mm3. There was no difference in results of the lymphocyte transformation test comparing pre- and post-therapy values using either fetal calf or autologous serum. For all groups tested, cells cultured in autologous serum exhibited a significantly decreased response to mitogen compared to cells cultured in fetal calf serum. Both the total nutritional and the protein depletion (kwashiorkor) scores improved significantly during the 30 days of nutritional supplementation (p less than 0.0009 and p less than 0.0004, respectively). Therefore, we have observed an alteration in the numbers of helper lymphocytes in patients admitted with AH. This abnormality was modifiable by abstinence and nutritional supplementation over a brief period of hospitalization.
Roselle
G A
GA
Veterans Administration Medical Center, Cincinnati, Ohio 45220.
Mendenhall
C L
CL
Grossman
C J
CJ
Weesner
R E
RE
D006519:Hepatitis, Alcoholic / Q000178:diet therapy / Q000276:immunology*; D006801:Humans; D008213:Lymphocyte Activation; D008214:Lymphocytes / Q000145:classification* / Q000276:immunology; D010343:Patient Admission; D011488:Protein Deficiency / Q000178:diet therapy / Q000276:immunology; D013223:Statistics as Topic; D013695:Temperance