替比夫定对HBeAg+慢性乙型肝炎患者外周血树突状细胞及淋巴细胞亚群的影响  

Association of HBeAg negative conversion with the effect of telbivudine on peripheral blood dendritic cells and lymphocyte subsets in patients with HBeAg-positive chronic hepatitis B

作　　者：朱斌[1] 张平[1] 禹萌[1] 王天宝[1] 毛乾国[1] 

机构地区：[1]新乡医学院第一附属医院感染疾病科,河南省卫辉市453100

出　　处：《世界华人消化杂志》2011年第24期2577-2582,共6页World Chinese Journal of Digestology

摘　　要：目的:探讨替比夫定抗病毒治疗对HBeAg阳性慢性乙型肝炎患者细胞免疫功能的影响与HBeAg阴转的相关性.方法:治疗组,30例HBeAg阳性慢性乙型肝炎患者应用替比夫定抗病毒治疗48wk,30例健康体检者为对照组.在治疗前、治疗后12、24、48wk,对外周血DCs进行体外培养,流式细胞仪检测分析DC表面分子及淋巴细胞亚群水平.结果:30例患者抗病毒治疗48wk,26例HBVDNA阴转(86.7%HBVDNA<500copies/mL),有8例发生HBeAg阴转(26.7%).与治疗前比较,治疗12wk时DCs表面分子CD1a、CD40、CD83、CD86、MHC-D的表达无明显变化;治疗24、48wk时上调,与治疗前相比较有显著性差异(P<0.05),但均低于健康对照组.淋巴细胞亚群12wk时无明显变化;治疗24、48wk时,CD4+及CD4+/CD8+比值明显提高,与治疗前比较有显著性差异(P<0.05);CD3+T、CD8+T和CD19+B细胞未见明显改变.48wk时,HBeAg阴转患者与HBeAg未阴转患者比较,DCs表面分子CD1a、CD40、CD86,MHC-DR的表达,CD4+水平及CD4+/CD8+比值均明显升高(P<0.01).结论:替比夫定抗病毒治疗慢性乙型肝炎患者细胞免疫功能增强,提示替比夫定在抑制HBVDNA复制的同时,可能通过调节DCs和淋巴细胞亚群的功能,增强细胞免疫应答,提高HBeAg阴转率.AIM：To investigate the association of HBeAg negative conversion with the effect of cellular immunity in patients with HBeAg-positive chronic hepatitis B（CHB） after telbivudine treatment.METHODS：Thirty HBeAg-positive chronic hepatitis B patients were treated with telbivudine（LDT） for 48 wk,and thirty healthy people were used as controls.DCs were isolated from peripheral blood and cultured in vitro before treatment,12,24,and 48 wk after treatment.Subsequently,surface molecular markers on DCs and lymphocyte subsets were detected and quantified by flow cytometry.RESULTS：Of 30 patients undergoing telbivudine therapy for 48 wk,26（86.7%） had HBV DNA negative conversion（HBV DNA 500 copies/mL）,and 9（26.7%） had HBeAg negative conversion.The expression of surface molecular markers CD1a,CD40,CD83,and CD86 was not changed at 12 wk,but were up-regulated at 24 and 48 wk compared to pretherapy levels.However,the expression levels of these markers were lower in the treatment group than in the control group.Lymphocyte subsets were not changed significantly at 12 wk.The percentage of CD4＋ T cells and the CD4＋/CD8＋ ratio were increased significantly at 24 and 48 wk,while no significant changes were found in the percentages of CD3＋ T cells,D8＋ T cells,and D19＋ B cells.At 48 wk,compared to patients who did not have HBeAg negative conversion,the expression of CD1a,CD40,CD86 MHC-D,the percentage of CD4＋,and CD4＋/CD8＋ ratio were increased obviously（all P 0.01） in patients who had HBeAg negative conversion.CONCLUSION：Cellular immunity is enhanced in HBeAg-positive CHB patients after telbivudine therapy.Telbivudine not only restrains virus reproduction but also participates in cellular immunity and promotes HBeAg negative conversion by regulating the function of DCs and lymphocyte subsets.

关 键 词：HBEAG阳性慢性乙型肝炎 替比夫定 树突状细胞 淋巴细胞亚群 

分 类 号：R512.62[医药卫生—内科学]