乙型病毒性肝炎临床转归与机体细胞免疫功能状况的相关性研究  

Correlation of hepatitis B clinical prognosis and organism cellular im-mune function situation

作　　者：曾跃红[1] 田海清[1] 王新华[2] 李龙平[2] 易凯[2] 张华[2] 周勇军[2] 

机构地区：[1]湖南省益阳市中心医院肝胆外科,湖南益阳413000 [2]湖南省益阳市中心医院检验科,湖南益阳413000

出　　处：《中国医药导报》2015年第5期8-11,21,共5页China Medical Herald

基　　金：湖南省卫生厅重点课题基金资助项目(编号B2008093)

摘　　要：目的 探讨乙型病毒性肝炎患者外周血T淋巴细胞亚群、血清干扰素-γ（IFN-γ）和肿瘤坏死因子-α（TNF-α）的变化与疾病临床转归的关系。方法 收集2009年1~12月益阳市中心医院诊治的352例乙肝病毒性肝炎患者,并选择同期健康人82例作为对照。采用流式细胞仪检测外周血T淋巴细胞亚群（CD3＋、CD4＋、CD8＋）,ELISA法检测细胞外血清IFN-γ和TNF-α,比较乙肝病毒性肝炎患者与健康人外周血T淋巴细胞亚群及IFN-γ和TNF-α水平。结果 不同HBV-DNA载量的患者CD3＋、CD4＋、CD8＋、CD4＋/CD8＋、IFN-γ和TNF-α水平与健康人比较,差异均有统计学意义（P〈0.05）。急性或亚急性肝衰竭、慢性HBV感染、隐匿性HBV感染患者CD3＋、CD4＋、CD8＋、CD4＋/CD8＋、IFN-γ和TNF-α水平与健康人比较,差异均有统计学意义（P〈0.05）。212例HBc-Ig M阳性HBV患者经保肝护肝基础治疗（106例）和IFN-α治疗（106例）6个月后,患者的CD3＋、CD4＋、IFN-γ和TNF-α水平仍较健康人显著升高,差异有统计学意义（P〈0.05）,但CD4＋/CD8＋的比较差异无统计学意义（P〉0.05）。IFN-α治疗患者治疗6个月和随访1、3、5年时,HBV-DNA阴转率均高于保肝护肝基础治疗患者（P〈0.05）。结论 乙型病毒性肝炎患者存在细胞免疫功能紊乱,其功能状态直接影响临床转归,动态监测患者T淋巴细胞亚群和血清IFN-γ、TNF-α对乙型病毒性肝炎的诊断、治疗、预后评估及个体化治疗都有重要的意义。Objective To explore the correlation between the change of T cell subgroups, serum IFN-y TNF-a in pa- tients with hepatitis B and clinical prognosis. Methods From January to December 2009, in the Center Hospital of Yiyang City, 352 patients with hepatitis B were selected, and 82 healthy people were selected as control at the same time. Flow cytometcr was used to detect the T cell subgroups （CD3＋, CD4＋, CD8＋）, and the level of serum 1FN-y/ and TNF-a were detected by ELISA, the results were compared. Results The levels of CD3＋, CD4＋, CD8＋, CD4＋/CD8＋, IFN-y and TNF-a in different HBV-DNA capacity patients were compared with those in healthy people, the differences were statistically significant （P 〈 0.05） The levels of CD3＋, CD4＋, CD8＊,CD4＋/CD8＋, IFN-y and TNF-a in acute or subacute liver failure, chronic HBV infection, delitescence HBV infection patients were compared with those in healthy people, the differences were statistically significant （P 〈 0.05）. 212 patients with HBc-IgM positive HBV were given liver pro- tection basic treatment （106 cases） and IFN-ot treatment （106 cases） for 6 months, the CD3＋,CD4＋,IFN-y,/and TNF-a levels were significantly higher than those in healthy people, the differences were statistically significant （P 〈 0.05）, but the difference of CD4＋/CD8＋ was not statistically significant （P 〉 0.05）. HBV-DNA negative rates of patients given IFN-a treatment at 6 months finished, follow-up 1, 3, 5 years were higher than those patients given liver protection ba- sic treatment （P 〈 0.05）. Conclusion The disorder of cellular immunity in patients with hepatitis B was confirmative. The functional status may to directly affect the hepatitis B prognosis. Dynamic monitoring of the T cell subgroups andserum IFN-y TNF-a on hepatitis B patients, which has important clinical significance to diagnosis, treatment, prognosis and individual therapy.

关 键 词：乙型肝炎病毒 细胞免疫功能 转归 

分 类 号：R512.62[医药卫生—内科学]