异体骨髓间充质干细胞治疗乙型肝炎终末期肝病的短期疗效及对Th1/Th2的影响  

Short-term effect of allogeneic mesenchymal stem cells in patients with end stage of liver diseases due to HBV and effects on the balance of Th1/Th2 axis

作　　者：于君[1] 彭亮[2] 林炳亮[2] 张耿林[2] 王培培[2] 曹会娟[2] 高志良[2] 罗光汉[1] 

机构地区：[1]广西医科大学第一附属医院感染科,南宁530021 [2]中山大学附属第三医院感染科

出　　处：《中华实验和临床感染病杂志（电子版）》2012年第1期13-17,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：国家"十一五"计划:艾滋病和病毒性肝炎等重大传染病防治科技重大专项项目(2008ZX10002-005)

摘　　要：目的初步探讨异体骨髓间充质干细胞(MSCs)治疗终末期肝病的短期疗效及其对Th1/Th2平衡的影响。方法 35例乙型肝炎终末期肝病患者分为两组,干细胞治疗(治疗组)13例,均采用内科综合基础上加用MSCs移植治疗;对照组22例,予以内科综合治疗。观察治疗前,治疗后2和4周的丙氨酸氨基转氨酶(ALT)、总胆红素(TBil)、白蛋白(ALB)与凝血酶原活动度(PTA)等指标变化。应用流式细胞仪检测患者外周血IFN-γ与IL-4的水平,分析Th1/Th2的变化。比较两组患者治疗前后生化指标及治疗组Th1/Th2的变化情况。结果 13例患者干细胞移植全部成功且未出现不良反应和并发症,治疗组后4周无死亡病例。治疗组患者的肝功能及凝血功能恢复优于对照组,其中ALT、PTA与对照组比较差异具有统计学意义(P<0.05);而ALB、TBil与对照组比较差异无统计学意义(P>0.05)。治疗组患者干细胞治疗后IFN-γ均升高,其中慢性乙型肝炎肝衰竭患者干细胞治疗后IL-4升高,而乙型肝炎肝硬化患者干细胞治疗后IL-4下降。治疗组干细胞治疗后Th1/Th2较治疗前升高。结论 MSCs治疗乙型肝炎终末期肝病是安全有效的,对Th1/Th2轴可能有免疫调节作用,但其机制有待进一步研究。Objective To evaluate the short-term effect of allogeneic mesenchymal stem cells （MSCs） in treatment of the end stage liver disease and effects on the balance of Th 1 / Th 2 axis . Methods Total of 35 patients were divided into two groups, 13 patients were in the group of MSCs combined with internal medical therapy. The others were in the control group. The improvenment of liver function and coagulation were compared before and 2, 4 weeks after transplantion. IFN-γ-producing cells （Thl cells ） and IL-4-producing cells （Th2 cells） from the peripheral blood were detected by flow eytometry in the treatment group and the ratio of Th1/Th2 asix was analysed. Results The stem cells transplantation were successful in all patients,with no side effects. Four weeks after transplantation, there was no death. The improvement of liver function and blood coagulation in transplantation group were better than control group. Compared with control group, the levels of ALT and PTA in the treatment group were statistically significant （P 〈 0.05 ）. But there was no significant difference in ALB and TBil （P 〉 0.05）. The level of Thl cells increased after stem cells transplantation. Th2 cells level in patients with liver failure were higher after stem cells transplantation than baseline. In patients with liver cirrhosis, the level of Th2 cells decreased after transplantation. All the ratio of Th1/Th2 increased in the treatment group. Conclusions Transpantation of allogeneie MSCs can improve liver function of patients with the end stage liver disease due to HBV. And it may have some immune-regulation on the balance of Th1/Th2 axis, though the exact mechanism need further investigation.

关 键 词：间质干细胞 终末期肝病 肝炎病毒 乙型 Th1-Th2平衡 

分 类 号：R657.3[医药卫生—外科学]