替比夫定与恩替卡韦治疗e抗原阳性慢性乙型肝炎Treg/Th17比率变化及与e抗原消失关系对比研究  

Comparative study of the relationship between changes of Treg/Th17 ratio and hbeag lost in patients with chronic hepatitis B with HBe Ag positive receiving antivirial treatment of telbivudine/entecavir

作　　者：李成伟[1] 卢丹[2] 那妍[1] 夏华[1] 陈佳佳[1] 王本鑫[3] 娄宪芝[1] 

机构地区：[1]沈阳医学院附属中心医院感染科,辽宁沈阳110024 [2]沈阳医学院附属中心医院呼吸科,辽宁沈阳110024 [3]沈阳医学院附属中心医院检验科,辽宁沈阳110024

出　　处：《中国实用内科杂志》2016年第12期1074-1076,共3页Chinese Journal of Practical Internal Medicine

基　　金：辽宁省科技厅科学技术计划(2013225086);沈阳市卫生局科研课题(2012)

摘　　要：目的研究替比夫定与恩替卡韦治疗e抗原(HBe Ag)阳性慢性乙型肝炎(CHB)患者Treg/Th17比率变化及与HBe Ag消失的关系及其对比。方法收集2013年1月至2014年12月在沈阳医学院附属中心医院感染科接受治疗的HBe Ag阳性CHB患者,将其随机分为替比夫定及恩替卡韦组,其中替比夫定组34例,恩替卡韦组27例,在治疗前及治疗4周、12周、24周、36周、48周,分别检测乙肝标志物、肝功能、HBV DNA,Treg细胞频数、Th17细胞频数。同时选取20名健康人作为对照组。结果 Treg/Th17比率在第4周开始下降,至第12周达到最低值。CHB患者在各时间点Treg/Th17比率均低于健康对照组。在治疗12周时Treg/Th17比率与HBe Ag消失有显著相关性,替比夫定组12周时Treg/Th17比率低于恩替卡韦组。48周时替比夫定组HBe Ag消失率(64.7%,22/34)高于恩替卡韦组(37.0%,10/27)。结论 12周时Treg/Th17比率水平低的患者更容易发生HBe Ag消失,12周时Treg/Th17比率可能作为48周HBe Ag消失的预测因子。替比夫定组的Treg/Th17比率(12周)水平低于恩替卡韦组,替比夫定的免疫调节作用强于恩替卡韦。Objective To observe relationship between changes of Treg/Th17 ratio and HBeAg lost in HBeAg positive chronic hepatitis B patients receiving LdT/ETV antiviral treatment and make comparative study between LdT group and ETV group. Methods HBeAg positive chronic hepatitis B patients were randomly assigned to receive LdT or ETV. LdT group had 34 patients, and ETV group had 27 patients.Peripheral blood Treg cell frequency and Th17 cell frequency, HBV-DNA, ALT levels, and Hepatitis B virus markers were detected before and after LdT/ETV treatment for 4, 12, 24, 36, 48 weeks. Peripheral blood Treg cell frequency and Th17 cell frequency of 20 health volunteers were detected as well. Results Treg/Th17 ratio decreased from the 4th week and reached the lowest point at the 12th week.Treg/Th17 ratio of CHB patients was lower than healthy control group at each time point.At the 12th week Treg/ Th17 ratio showed significant correlation with HBeAg lost. At the 12th weeks,Treg/Th17 ratio of LdT group was lower than that of ETV group. At 48 weeks, HBeAg lost of LdT group （64.7%, 22/34） was higher than that of ETV group（37.0%, 10/27）. Conclusion At 12 weeks, the patients of lower Treg/Th17 ratio are more likely to develop HBeAg lost.Treg/Th17 ratio at 12 weeks can be a predictors of HBeAg lost. At 12 week Treg/Th17 ratio of LdT group was lower than ETV group＇s, immunomodulatory effects of LdT was higher than ETV＇s.

关 键 词：慢性乙型肝炎 E抗原阳性 替比夫定 恩替卡韦 Treg/Th17 

分 类 号：R512.62[医药卫生—内科学]