聚乙二醇干扰素与普通干扰素对慢性乙型肝炎患者外周血CD4^+CD25^(high)T淋巴细胞变化的影响  

Impact of pegylated interferon versus conventional interferon on the change in peripheral CD4^+CD25^(high)T cells in patients with chronic hepatitis B

作　　者：王海燕[1] 朱莉[1] 王银玲 朱月萍[1] 朱晓燕[1] 柴晓哲[1] 钱峰[1] 李明[1] 朱传武[1] WANG Haiyan;ZHU Li;WANG Yinling(Department of Hepatology,The Fifth People′s Hospital of Suzhou,Suzhou,Jiangsu 215007,China)

机构地区：[1]苏州市第五人民医院肝病科,江苏苏州215007

出　　处：《临床肝胆病杂志》2018年第1期53-57,共5页Journal of Clinical Hepatology

基　　金：苏州市科学技术局和苏州市卫生计生委兴卫基金项目(KJXW2011031);苏州市临床重点病种诊疗技术项目(LCZX201315)

摘　　要：目的比较聚乙二醇干扰素(PEG-IFNα-2a)与普通干扰素(IFNα-2b)抗病毒治疗对慢性乙型肝炎(CHB)患者外周血CD4^+CD25^(high)T淋巴细胞变化的影响。方法收集2012年6月-2015年6月于苏州市第五人民医院接受干扰素抗病毒治疗的HBeAg阳性CHB患者72例,按照患者自主选择的治疗方法分为PEG-IFNα-2a组(n=40)和IFNα-2b组(n=32),干扰素抗病毒疗程至少1年。采集治疗前和治疗12个月时的抗凝外周静脉血。另选取同期30例健康人作为对照。用流式细胞技术检测外周血CD4^+CD25^(high)T淋巴细胞的百分率。符合正态分布的计量资料多组间比较采用单因素方差分析;不符合正态分布的计量资料两独立样本比较采用Mann-Whitney U检验,配对资料比较采用Wilcoxon秩和检验。计数资料组间比较采用χ~2检验或Fisher确切检验。结果治疗12个月时,IFNα-2b组和PEG-IFNα-2a组的有效病例数分别为26例和32例。两组患者ALT复常率、HBeAg血清学转换率及HBV DNA阴转率比较,差异均无统计学意义(P值分别为>0.05、0.05、0.47)。治疗前,IFNα-2b组和PEGIFNα-2a组外周血CD4^+CD25^(high)T淋巴细胞水平均显著高于健康对照组(U值分别为235.5、238.0,P值均<0.05)。干扰素治疗12个月时,PEG-IFNα-2a组CD4^+CD25^(high)T淋巴细胞水平降低,与治疗前相比差异有统计学意义(Z=-2.515,P=0.012)。在获得HBeAg血清学转换的患者中,IFNα-2b组和PEG-IFNα-2a组比治疗前基线均显著降低(U值分别为121.0、204.5,P值均<0.05),而两组之间差异无统计学意义(P>0.05),且与健康对照组比较差异亦均无统计学意义(P值均>0.05)。结论干扰素抗病毒治疗可以降低CHB患者外周血CD4^+CD25^(high)T淋巴细胞频率,PEG-IFNα-2a对CD4^+CD25^(high)T淋巴细胞的下调作用比IFNα-2b更强,但对于治疗获得HBeAg血清学转换的患者,两类干扰素的下调作用没有呈现出显著性差异。To investigate the impact of pegylated interferon alpha-2a(PEG-IFNα-2a)versus conventional interferon alpha-2b(IFNα-2b)on the change in peripheral CD4^+CD25^high T cells in patients with chronic hepatitis B(CHB).Methods A total of 72 HBeAg-positive CHB patients who received interferon antiviral therapy in the Fifth People′s Hospital of Suzhou from June 2012 to June 2015 were enrolled,and according to the therapy selected by the patient,these patients were divided into PEG-IFNα-2a group with 40 patients and IFNα-2b group with 32 patients.The course of the interferon antiviral therapy was one year at least.The anticoagulant peripheral venous blood samples were collected before treatment and at month 12 of treatment.Another 30 healthy individuals were enrolled as controls.Flow cytometry was used to measure the percentage of peripheral CD4^+CD25^high T cells.A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two independent samples;the Wilcoxon rank-sum test was used for comparison of paired data.The chi-square test or Fisher's exact test was used for comparison of categorical data between groups.Results At month 12 of treatment,there were 26 valid cases in the IFNα-2b group and 32 valid cases in the PEG-IFNα-2a group.There were no significant differences between the two groups in normalization rate of alanine aminotransferase,HBeAg seroconversion rate,and HBV DNA clearance rate(P >0.05,P=0.05,P=0.47).Before treatment,the IFNα-2b group and the PEG-IFNα-2a group had a significantly higher median percentage of peripheral CD4^+CD25^high T cells than the healthy control group(U=235.5 and 238.0,both P<0.05).The PEG-IFNα-2a group had a significant reduction in the median percentage of peripheral CD4^+CD25^high T cells at month 12 of interferon therapy(Z=-2.515,P=0.012).As for the patients who achieved seroconversion of HBeAg,the IFNα-2b group

关 键 词：肝炎 乙型 慢性 干扰素Α T淋巴细胞 调节性 

分 类 号：R512.62[医药卫生—内科学]