Objective To evaluate the changes of CD4+ CD25+ regulatory cells (Treg) in peripheral blood and the serum levels of transforming growth factor beta-1 (TGF-β1)in elderly patients with hepatocellular carcinoma. Methods The ratios of Treg in the peripheral blood of patients aged over 80 years from 22 hepatocellular carcinoma,26 metastatic liver cancer,20 healthy controls,were determined by flow cytometry.Meanwhile,the serum levels of TGF-β1 were detected by ELISA.Results The ratio of Treg to total CD; T cells in the peripheral blood [(9.71±3.23)％ vs.(5.81±1.18)％,P＜0.01]and the serum levels of TGF-β1 [(78.10±29.41)ng/L vs.(7.78± 3.54) ng/L,P＜0.01]of elderly patients with hepatocellular carcinoma were significantly higher than those in the healthy controls.Meanwhile,the ratio of Treg to total CD[ T cells in the peripheral blood [(9.71±3.23)％ vs.(7.36±2.07) ％,P＜0.05]and the serum levels of TGF-β1[(78.10± 29.41 )ng/L vs.(19.33± 10.90) ng/L,P＜ 0.01 ]in the patients with hepatocellular carcinoma was increased as compared with those in metastatic liver cancer (P＜0.05 or P＜0.01).The correlation indicated that the ratio of Treg to total CD4+ T cells in the peripheral blood were positively related with TGF-β1 levels and tumor clinical stage(r=0.698 and 0.782,P＜ 0.01 ),but negatively with Karnofsky performance status score(KPS) (r=-0.643,P＜0.01). Conclusions The ratio of Treg to total CD4+ T cells in the peripheral blood from elderly hepatocellular carcinoma is increased and correlated with TGF-βl level,tumor clinical stage and KPS.It might helpful to determine the prognosis of elderly hepatocellular carcinoma by detecting the ratio of Treg to total CD4+ T cells in the peripheral blood.

Objective:To compare the cost-effectiveness of hospitalized Chinese patients undergoing nucleic acid screening strategies for hepatitis B and hepatitis C, immunological screening strategy, and no screening strategy under different willingness to pay (WTP). The results might aid to decision-making for the optimal strategy.Methods:In this study, nucleic acid screening, immunological screening and no screening were used as screening strategies, and China′s GDP in 2021 (80 976 yuan) was used as the threshold of WTP to construct a Markov model. After introducing parameters related to the diagnosis and treatment of hepatitis B and C in inpatients, a cohort population of 100 000 inpatients was simulated by TreeAge Pro 2021 software, the total cost, total health effects, incremental cost-effectiveness ratio and average cost-effectiveness ratio of different screening strategies were calculated, and cost-effectiveness analysis was conducted. Univariate and probabilistic sensitivity analysis were used to assess the impact of parameter uncertainty on the final results.Results:Compared with the non-screening strategy, the incremental total cost of the hepatitis B immunological screening strategy for cohort patients was 11 049 536 yuan, and the incremental cost-effectiveness ratio was 24 762 yuan/quality-adjusted life years (QALY), while the total incremental cost of nucleic acid screening was 19 208 059 yuan, and the incremental cost-effectiveness ratio was 29 873 yuan/QALY; the incremental cost-effectiveness ratio of nucleic acid screening and immunological screening was 45 834 yuan/QALY. Compared with the non-screening strategy, the incremental cost-effectiveness ratio of hepatitis C immunological screening strategy was 5 731 yuan/QALY, the incremental cost-effectiveness ratio of nucleic acid screening strategy was 8 722 yuan/QALY, the incremental cost-effectiveness ratio of nucleic acid screening and immunological screening was 45 591 yuan/QALY. The results of probabilistic sensitivity analysis showed that when the cost of nucleic acid testing exceeded 214.53 yuan, it was not cost-effective to perform hepatitis B nucleic acid screening under the WTP as 1 fold GDP. When the cost of nucleic acid testing exceeded 132.18 yuan, it was not cost-effective to conduct hepatitis C screening under the WTP as 1 fold GDP.Conclusions:Nucleic acid screening strategy can achieve more cost-effectiveness and is worthy of vigorous promotion. Compared with no screening, both the nucleic acid and immunological screening strategies are cost-effective, and hepatitis nucleic acid screening is the optimal strategy for hospitalized patients.