联合用药对慢性乙型肝炎患者外周血T细胞亚群和YMDD变异的影响  

Effect of drug combination on peripheral blood T-cell subsets and YMDD in patients with CHB

作　　者：赵帅[1] 刘泽世[1] 魏从真[1] 陈正立[1] 耿玉兰[1] 

机构地区：[1]河北医科大学第一医院检验科,河北石家庄050031

出　　处：《中国卫生检验杂志》2015年第2期165-167,172,共4页Chinese Journal of Health Laboratory Technology

基　　金：河北省卫生厅科研立项(20130565)

摘　　要：目的观察恩替卡韦联合拉米夫定对慢性乙型肝炎患者外周血T细胞亚群和HBV-YMDD变异的影响。方法将60例治疗前未检测出HBV-YMDD变异并且HBV-DNA均为阳性的慢性乙肝患者随机分为研究组和对照组,研究组给予拉米夫定50 mg/d和恩替卡韦0.5 mg/d;对照组只给予拉米夫定100 mg/d,疗程12个月。分别在治疗前和治疗后第3个月、6个月、9个月、12个月检测患者外周血T细胞亚群、HBV-DNA含量及HBV-YMDD变异情况。结果与对照组相比,研究组患者在治疗后第3个月、6个月、9个月、12个月,外周血CD4+水平显著上升,差异有统计学意义(P<0.05);第6个月、9个月、12个月,CD8+水平显著下降(P<0.01),CD4+/CD8+比值上升(P<0.01),HBVDNA阴转率高(P<0.05);治疗后第3个月、6个月、9个月、12个月,HBV-YMDD变异例数少(P<0.05),差异均有统计学意义。结论恩替卡韦联合拉米夫定用药治疗慢性乙型肝炎更能有效的改善外周血T细胞亚群的功能、抑制HBV-DNA病毒的复制、减少HBV-YMDD变异。对乙肝患者更安全有效,值得推广应用。Objective To observe the effects of entecavir add- on lamivudine on patients of chronic hepatitis B（ CHB） and its influence on the peripheral blood T- cell subsets and HBV- YMDD. Methods Sixty CHB patients with HBV- DNA all positive and without HBV- YMDD mutations were selected into this study and randomly divided into the study group and the control group. The study group were treated with entecavir add- on lamivudine 0. 5 mg / d while the control with lamivudine 0. 5 mg / d only for a period of 12 months. Peripheral blood T- cell subsets counts,serum HBV- DNA content and serum HBV- YMDD mutation level were detected and analyzed before treatment and at the 3rd,6th,9th,12 thmonth after treatment,respectively.Results Compared with the control group,levels of CD4^＋T cells in the study group were markedly higher at the 3rd,6th,9th,12 thmonth after treatment the differences had statistical significance（ P〈0. 05）; Levels of CD8^＋T cells decreased obviously（ P〈0. 01） while the ratio of CD4^＋/ CD8^＋was markedly increased at the 6^th,9^th,12^th month after treatment（ P〈0. 01）; The negative conversion rate of HBV- DNA was high（ P〈0. 05）; HBV- YMDD mutations in the study group were obviously lower at the 3^rd,6^th,9^th,12^th month after treatment（ P〈0. 05）,the difference had statistical significance. Conclusion Entecavir add- on lamivudine can up- regulate peripheral blood T- cell function,inhibit replication of HBV- DNA and reduce mutation of HBV- YMDD,which suggests that drug combination therapy is safe,effective and worthy of application and dissemination.

关 键 词：联合用药 HBV-YMDD变异 外周血T细胞亚群 慢性乙型肝炎 

分 类 号：R512.62[医药卫生—内科学]