维生素D对慢性乙型肝炎患者免疫功能及抗病毒疗效的影响  

Effect of serum Vitamin D levels on cellular immunity and antiviral effects in chronic hepatitis B patients

作　　者：何丽杰[1] 王静[1] 笪宇蓉[1] 

机构地区：[1]天津医科大学,天津300070

出　　处：《中国免疫学杂志》2016年第5期729-733,共5页Chinese Journal of Immunology

摘　　要：目的:探讨25羟维生素D3对慢性乙型肝炎患者外周血T淋巴细胞免疫功能及抗病毒疗效的影响。方法:收集慢性乙型肝炎患者70例。采用电化学发光法测定血清25羟维生素D、荧光定量聚合酶链反应技术检测乙型肝炎病毒(Hepatitis B virus,HBV)血清标志物,采用免疫荧光标记法测定外周血T淋巴细胞亚群数目。根据血清维生素D水平将患者分为维生素D低水平组、中水平组和高水平组,分别对3组患者给予长效干扰素治疗6个月,并于相应时间检测T淋巴细胞亚群数目、肝功能、病毒学指标。结果:3组患者在性别、年龄两两比较上无统计学差异。随着血清维生素D水平的升高,CD3^+、CD4^+、CD4^+/CD8^+显著性升高,而CD8^+逐渐降低,组间比较差异有统计学意义(P<0.05)。干扰素的治疗能明显改善T细胞各亚群,并且高水平组改善更明显。干扰素的治疗能明显改善患者的病毒学指标,高水平组患者能获得较好的病毒学应答。随着血清维生素D水平的升高,HBeAg、HBsAg阳性率以及HBV DNA的含量逐渐降低,低水平组与中等水平组、高水平两组比较差异有统计学意义(P<0.05)。然而不同水平维生素D组,患者的肝功能无明显差异。结论:维生素D可能参与慢性乙型病毒性肝炎免疫功能的调节并与免疫耐受的形成有关,高水平的维生素D可以获得持续的病毒学应答,这可能为慢性乙型病毒性肝炎发病机制的研究和治疗提供新的思路。Objective： To study the effect of vitamin D on peripheral blood T lymphocyte subsets and antiviral effects in chronic hepatitis B patients. Methods： The clinical data for 70 patients with chronic hepatitis B were analyzed. These patients were divided into three groups based on serum 25-hydroxy vitamin D level. Serum 25-hydroxy vitamin D was determined by electrochemical luminescence,and hepatitis B virus serological markers was determined by fluorescence quantitative polymerase chain reaction. Subsets of T lymphocytes were determined by flow cytometry. Results： The age and ratio of gender had no difference during these three groups. The proportion of CD3＋,CD4＋T lymphocyte and the ratio of CD4＋/ CD8＋increased（ P〈0. 05） significantly as the increase of 25-hydroxy vitamin D levels,but the proportion of CD8＋decreased. Interferon treatment could improve the T cells subgroup,and high level of serum25-hydroxy vitamin D group improved more obviously. The treatment of interferon could obviously improve the hepatitis B virus serological markers,high level group of serum 25-hydroxy vitamin D could obtain better virological response. The positive of HBe Ag,HBs Ag and the titer of HBV DNA decreased with the increase of serum vitamin D,and the difference between the high and low level of 25-hydroxy vitamin D groups were significant. However,there were no significant difference between 3 groups of serological markers of liver function. Conclusion： Vitamin D may play a part in the immune tolerance in the nature course of chronic HBV infection,and high levels of vitamin D may be able to achieve sustained virological response. This findings may shed light on the immunotherapy of chronic hepatitis B.

关 键 词：25羟维生素D3 T淋巴细胞亚群 病毒学应答 

分 类 号：R512.62[医药卫生—内科学]