急性乙型肝炎患者乙型肝炎病毒清除的临床观察  

Clinical observation of hepatitis B virus clearance in patients with acute hepatitis B

作　　者：肖宏[1] 吴景迪[1] 陈晓飞[1] 

机构地区：[1]复旦大学附属公共卫生临床中心,上海201508

出　　处：《肝脏》2007年第6期445-447,共3页Chinese Hepatology

摘　　要：目的探讨急性乙型肝炎患者血清乙型肝炎病毒(HBV)清除及临床转归的机制。方法动态观察29例住院急性乙型肝炎患者肝功能、HBV DNA、HBV血清标志物的变化,检测其T细胞亚群并与慢性乙型肝炎患者进行比较。结果急性乙型肝炎早期患者HBV广泛抑制,两例患者HBV得到清除,随肝功能的恢复所有患者HBV DNA在较短时间内转阴、HBeAg与HBV DNA几乎同时转阴,肝功能恢复正常时有22例患者HBeAg发生血清学转换,11例患者HBsAg转阴,2例发生HBsAg血清学转换。急性乙型肝炎患者CD3+细胞、CD4+细胞高于慢性乙型肝炎患者,但差异无统计学意义,而CD8+细胞则显著高于慢性乙型肝炎患者(t=2.382,P<0.05)。结论非细胞毒机制在急性乙型肝炎早期HBV DNA的清除中具有重要作用,特异性细胞免疫反应对彻底清除HBV DNA、防止感染慢性化起更重要的作用。Objective To study the mechanisms of the hepatitis B virus（HBV） clearance with clinical data. Methods Hepatic function parameters,HBV DNA levels and HBV markers in serum were analyzed in 29 patients with acute hepatitis B, the T lymphocyte subsets in peripheral blood were detected and compared with those in chronic hepatitis B. Results The HBV was generally inhibited and was eliminated in two patients in the early period of acute hepatitis B. HBV DNA disappeared in a short time from the onset paralleling recovery of hepatic function parameters in all cases. HBeAg became negative in the same time with HBV DNA and seroconvered in 22 cases, HBsAg became negative in 11 cases and seroconvered in 2 cases when hepatic function parameters became normal. The numbers of CD8^＋ Lymphocytes were significantly higher than those in chronic hepatitis B （ t = 2. 382, P 〈 O. 05 ）. Conclusion Noncytotoxic mechanisms play a important role in hepatitis B virus clearance during the early phase of disease, and HBV- special CD8^＋ T cells were crucial required in terminating acute HBV infection.

关 键 词：急性乙型肝炎 乙型肝炎病毒 T细胞亚群 非细胞毒机制 

分 类 号：R512.62[医药卫生—内科学] R511[医药卫生—临床医学]