慢性乙型肝炎患者应用拉米夫定前后T淋巴细胞亚群、CD4^＋CD25^＋调节性T淋巴细胞及白细胞介素-10、干扰素-γ的变化  

Changes of T lymphocyte subsets, CD4^＋ CD25^＋ regulatory T lymphocytes and interleukin-10, interferon- gamma of chronic hepatitis B patients before and after lamivudine therapy

作　　者：赵彩彦[1] 刘振中[1] 李静[2] 王亚东[1] 张平平 周俊英[1] 赵萌[1] 

机构地区：[1]河北医科大学第三医院感染科,石家庄050051 [2]石家庄市第五医院感染1科

出　　处：《中华传染病杂志》2011年第8期480-485,共6页Chinese Journal of Infectious Diseases

摘　　要：目的观察慢性乙型肝炎（CHB）患者应用拉米夫定抗病毒治疗前后外周血T淋巴细胞亚群、CD4^＋CD25^＋调节性T淋巴细胞（CD4^＋CD25^＋Treg）及IL-10、IFN-γ水平的变化。方法选择CHB患者90例，在应用拉米夫定抗病毒治疗前及治疗后52周时，用流式细胞仪检测患者外周血T淋巴细胞亚群；在治疗前及治疗后12、24、36、52周时，用流式细胞仪检测外周血CD4^＋CD25^＋Treg频率，用双抗体夹心ELISA法检测IL-10、IFN-γ水平。组间及组内总体均数比较采用方差齐性的单因素方差分析或Dunnett’s检验，组内治疗前后两时段均数比较采用配对t检验。结果在90例CHB患者中，完全应答的32例患者的CD4^＋T淋巴细胞、CD8^＋T淋巴细胞及CD4^＋／CD8^＋。较治疗前升高（t=4．055、3．267、2．328，均P〈0．05），外周血CD4^＋CD25^＋Treg频率在0、12、24、36、52周时分别为（5．40±0．60）％、（4．99±0．59）％、（4．54±0．72）％、（3．86±0．95）％、（3．44±0．76）％；IFN-γ水平、IFN-γ／IL-10逐步上升，IL-10水平逐步下降。部分应答的43例患者的CD4^＋T淋巴细胞及CD4^＋／CD8^＋较治疗前升高（t=3．484、2．018，均P〈0．05），CD8^＋T淋巴细胞较治疗前无明显差异，外周血CD4^＋CD25^＋Treg频率在0、12、24、36、52周时分别为（5．65±0．60）％、（5．23±0．63）％、（4．65±0．98）％、（4．42±0．97）％、（4．32±0．82）％，IFN-γ水平、IFN—γ／IL-10升高，IL-10水平降低。无应答的15例患者的外周血CD4^＋T淋巴细胞、CD8^＋T淋巴细胞及CD4^＋／CD8^＋、外周血CD4^＋CD25^＋Treg频率及IFN-γ水平、IFN-y／IL-10、IL-10水平较治疗前无明显变化。结论应用拉米夫定治疗过程中，获得满意应答的CHB患者的外周血CD4^＋CD25^＋Treg频率下降，CD4^＋／CD8^＋、IFN-γ／IL-10的比例升高。Objective To explore the correlation between the efficacy of lamivudine （LAM） therapy and changes of T lymphocyte subsets, CD4^＋ CD25^＋ regulatory T lymphocytes （Treg）, and levels of interleukin-10 （IL-10） and interferon-gamma （IFN-γ） in the peripheral blood of patients with chronic hepatitis B （CHB）. Methods Ninety CHB patients were enrolled in this study. T lymphocyte subsets in the peripheral blood were detected by flow cytometry at baseline and week 52 of LAM therapy. The frequencies of CD4^＋ CD25^＋ Treg in the peripheral blood were detected by flow cytometry and levels of IL-10 and IFN-γ were detected by enzyme-linked immunosorbent assay （ELISA） at baseline, week 12, 24, 36 and 52. The comparisons of overall means between groups and within groups were done by analysis of variance or Dunnett＇s test. The comparison of means before and after LAM therapy was done by paired t test. Results In 32 complete-responders of 90 CHB patients, the proportions of CD4^＋T lymphocytes, CD8^＋T lymphocytes and CD4^＋/CD8^＋ ratio were increased significantly after LAM therapy （t = 4. 055.3. 267.2. 328, all P〈0.05）; the frequencies of CD4^＋ CD25^＋Treg at baseline, week 12, 24, 36 and 52 were （5.40±0.60）%, （4.99±0. 59）%, （4.54± 0.72） %, （3.86±0.95） % and （3.44±0.76） %, respectively; the levels of IFN-γ, IFN-γ/IL-10 ratio were increased, while the IL-10 level was decreased after LAM therapy. In 43 partial-responders, the proportion of CD4^＋T lymphocytes and ratio of CD4^＋/CD8^＋ were increased after LAM therapy （t= 3. 484,2. 018, both P〈0.05）; the proportion of CD8^＋T lymphocytes was not changed significantly after therapy; the frequencies of CD4 ^＋ CD25 ^＋ Treg at baseline, week 12, 24, 36 and 52 were （5.65 ± 0.60）%, （5.23±0.63）%, （4.65±0.98）%, （4.42±0.97）% and （4.32±0.82）%, respectively; IFN-γ level, IFN-γ/IL-10 ratio were increased, while IL-10 level was decreased. In 15 non- responders, the proportion of T

关 键 词：肝炎 乙型 慢性 CD4阳性T淋巴细胞 拉米夫定 白细胞介素10 干扰素Ⅱ型 T淋巴细胞亚群 受体 白细胞介素2 

分 类 号：R512.62[医药卫生—内科学]