慢性乙型重肝病人免疫与肝生化指标变化的意义  

The significance of the stage of immunity and the hepatic function parameters in patients with chronic severe hepatitis B

作　　者：吴景迪[1] 沈芳[1] 肖宏[1] 陈晓飞[1] 陈沭[1] 

机构地区：[1]上海市（复旦大学附属）公共卫生临床中心肝炎科,上海201508

出　　处：《世界感染杂志》2007年第4期288-291,共4页World Journal of Infection

摘　　要：目的探讨慢性乙型重型肝炎早期、中期、晚期病人的免疫和肝生化指标变化与预后的关系。方法检测120例慢性重型肝炎病人（早期60例，中期40例，晚期20例）和120例慢性乙型肝炎病人的T细胞亚群、HBV DNA载量、免疫学及肝功能指标，并总结分析其临床意义。结果晚期慢性乙型重型肝炎病人细胞免疫状态最差，与慢性乙型肝炎病人相比差异显著，NK细胞分别为（7．47±4．19）％vs（13．29±4．68）％，P〈0．05；CD4／CD8比值为（0．39±0．16）vs（1．12±0．26），P〈0．05；CD3^＋（73．11±13．16）％vs（56．12±9．54）％；P〈0．05；CD8^＋（56．74±13．91）％vs（34．26±10．58）％，P〈0．05；晚期慢性乙型重型肝炎的肝功能损害与慢性乙型肝炎相比同样有显著性差异：白蛋白分别为（20．82±3．46）g／L vs（43．11±5．74）g／L，P〈0．05；血清总胆红质（TB）（519．42±156．18）μmol／Lvs（25．91±17．38）μmol／L，P〈0．05；凝血酶元活动度（PTA）（15．21±6．38）％vs（92．45±10．56）％，P〈0．05。结论慢性乙型重型肝炎晚期病人的CD4／CD8、NK细胞显著下降，病人淋巴细胞亚群的失衡可加重肝脏的损伤。Objective To investigate the features of T subset cells and hepatic function parameters in patients with severe hepatitis B, the relation between the features and the prognosis. Methods We analyzed the change of T subset cells, hepatic function parameters, HBV-DNA level and HB.V marker in sera from 20 patients with severe hepatitis B （early stage 60, middle stage 40, advanced stage 20） and 120 chronic hepatitis B Result The state of cell immunity was the worst in the patients with severe hepatitis B at advanced state, compared with the patients with chronic hepatitis B, the percent of NK cell （7.47±4.19）% vs （13.29±4.68）%, （P〈0.05）; the percent of CD3^＋cell （73.11±13.16）% vs （60.12±9.54）%, （P〈0.05）; and CD8^＋cell （56.74±13.91）% vs （34.26±10.58）%, （P〈0.05）; and the level of CD4^＋/CD8^＋ [（0.39±0.16）% vs （1.12±0.26）%, P〈0.05] were significantly decreased; the degree of liver injury was also obviously different between the patients with severe hepatitis at advanced stage and the patients with chronic hepatitis B： the level of ALB was significantly decreased （26.82±3.46）g/L vs （43.11±5.74）g/L, （P〈0.05）; the TB was significantly increased （519.42±156.18）μmol/L vs （25.91±17.38）μmol/L, （P〈0.05）; and PTA [（15.21±6.38）% vs （92.45±10.56）%, P〈0.05] was obviously lengthened. Conclusion The percent of NK cell and the level of CD4/CD8 were evidently decreased in patients with severe hepatitis B at advanced stage, and the imbalance T subset cells could aggravate liver injury.

关 键 词：慢性乙型重型肝炎 淋巴细胞 肝生化指标 凝血酶原活动度 

分 类 号：R512.62[医药卫生—内科学] R392.11[医药卫生—临床医学]