阿德福韦酯治疗慢性乙型肝炎患者血清免疫学的观察  

Observation of serum immunology in patients with chronic hepatitis B treated with adefovir dipivoxil

作　　者：罗丹 李华东 LUO Dan;LI Hua-dong(Wuhan JinYinTan Hospital,Wuhan 430023,China)

机构地区：[1]武汉金银潭医院,武汉430023

出　　处：《医药论坛杂志》2019年第12期5-8,12,共5页Journal of Medical Forum

基　　金：湖北省卫计委科研项目资助(WJ2015MB166)。

摘　　要：目的观察阿德福韦酯(ADV)治疗的慢性乙型肝炎患者血清免疫学变化及临床意义。方法收集武汉市金银潭医院2013年1月-2015年7月收治的108例慢性乙型肝炎患者,分别使用双抗体夹心ELISA法和实时荧光聚合酶链反应(PCR)进行检测并记录在治疗前患者肝功能、血清中免疫细胞因子IFN-γ和IL-4以及血HBV DNA的水平,与治疗后第4、12、24及48周末的水平相比较。结果应用阿德福韦酯治疗12周以后,患者肝功能恢复明显,ALT和AST水平明显降低(t=7.2397、P=0.0000;t=5.6292、P=0.0000),至24周末时,转氨酶水平基本降至正常范围,且一直持续到48周末。HBV DNA含量在治疗的第4周末,较治疗前明显下降,差异有统计学意义(t=14.3082、P=0.0000),直至48周末无反弹。在应用阿德福韦酯治疗之后患者血清IFN-γ及IL-4水平随HBV DNA滴度的下降而上升,在治疗的24周末和48周末,细胞因子IFN-7逐渐升高,较治疗前的差异有统计学意义(t=3.6326、P=0.0003;t=6.9326、P=0.0000)。细胞因子IL-4的变化趋势与IFN-γ相似。在24,48周末,ADV应答组的IFN-7与治疗前相比差异具有统计学意义(t=3.5844、P=0.0003;t=7.2359、P=0.0000),在48周末,IL-4也明显上升(t=7.2212、P=0.0000);在48周末,无应答组IFN-γ与治疗前相比差异具有统计学意义(t=6.2862、P=0.0073),IL-4与治疗前无差异(t=1.9144、P=0.0554);应答组IFN-γ和IL-4在48周末均高于无应答组(t=7.2649、P=0.0000;t=4.4431、P=0.0000)。结论阿德福韦酯治疗后,慢乙肝患者肝功能复常、病毒载量下降、CD4+T淋巴细胞活性重建,可能与机体的部分免疫功能恢复甚至增强有关。Objective To observe the serum immunological changes and clinical significance of Chronic hepatitis B patients treated with adefovir dipivoxil(ADV).Methods A total of 108 cases of patients with chronic hepatitis B(CHB)participation in wuhan city medical treatment center from January 2013 to July 2015 were collected;respectively,using double antibody sandwich ELISA method and real-time fluorescent polymerase chain reaction(PCR)to detect and record the levels of liver function,serum immune cytokine IFN-gamma and IL-4 and HBV DNA in patients with chronic hepatitis B before treatment,And They were compared with the levels at the fourth,12th,24th and 48th weekends after treatment.Results After 12 weeks of treatment with adefovir dipivoxil,the liver function of the patients recovered significantly and the levels of ALT and AST decreased significantly(t=7.2397、P=0.0000;t=5.6292、P=0.0000).At the end of 24 weeks,the level of transaminase basically decreased to the normal range,and continued until the 48th week of treatment.HBV DNA content decreased significantly at the end of treatment and did not rebound until the end of 48 weeks,The difference was statistically significant(t=14.3082;P=0.0000).After adefovir dipivoxil treatment,serum levels of IFN-gamma and IL-4 increased with the decrease of HBV DNA titer,and cytokines IFN-gamma gradually increased at the end of 24 and 48 weeks after treatment,and the difference was statistically significant compared with that before treatment(t=3.6326,P=0.0003,n=6.9326,P=0.0000).The change trend of cytokine IL-4 was similar to that of IFN-γ.The difference of IFN-γ between the two response groups at the end of 24th weeks and 48th weeks was statistically significant(Z=3.5844,P=0.0003,P=7.2359,P=0.0000),and the level of IL-4 also increased significantly at the end of the 48th weeks(t=7.2212,P=0.0000).At the end of 48th week,In non-response group there was significant difference between the IFN-γ and pre-treatment(Z=6.2862、P=0.0073).but there was no significant difference between

关 键 词：慢性乙型肝炎 阿德福韦酯 谷丙转氨酶 谷草转氨酶 乙肝病毒核酸 干扰素-Γ 白介素-4 

分 类 号：R512.6[医药卫生—内科学]