慢性乙肝合并肺结核患者外周血单个核细胞HBV pgRNA的表达与免疫功能的相关性  

Correlation of expression of HBV pgRNA in peripheral blood mononuclear cells with immune function in patients with chronic hepatitis B complicated with pulmonary tuberculosis

作　　者：张志锋 薛珉[2] 徐瑞芳[1] 张红云[1] 张曹庚 ZHANG Zhi-feng;XUE Min;XU Rui-fang;ZHANG Hong-yun;ZHANG Cao-geng(Department of Infection;Department of Respiration,Minhang Hospital Affiliated to Fudan University(Central Hospital of Minhang District),Shanghai 201199,China)

机构地区：[1]复旦大学附属闵行医院(上海市闵行区中心医院)感染科,上海201199 [2]复旦大学附属闵行医院(上海市闵行区中心医院)呼吸科,上海201199

出　　处：《临床肺科杂志》2021年第5期734-737,共4页Journal of Clinical Pulmonary Medicine

基　　金：上海市闵行区科学技术委员会课题(编号:2018MHZ008)。

摘　　要：目的研究慢性乙肝(CHB)合并肺结核患者外周血单个核细胞(PBMCs)HBV前基因组RNA(pgRNA)的表达及其与免疫功能的相关性。方法将2018年3月-2019年3月我院结核门诊新确诊的40例CHB合并肺结核患者随机分为两组,对照组(n=20)采用2HRZE/4HR方案进行常规抗结核治疗,治疗组(n=20)在此基础上采用拉米夫定预防性抗病毒,连续治疗6个月。比较两组患者PBMCs中HBV DNA、HBV RNA表达水平,以及CD3^(+)、CD4^(+)、CD8^(+)T细胞水平,分析HBV DNA、HBV RNA与CD3^(+)、CD4^(+)、CD8^(+)T细胞相关性。结果治疗后2个月,两组PBMCs中HBV DNA、HBV RNA水平较治疗前显著升高,治疗组治疗后6个月PBMCs中HBV DNA、HBV RNA水平较治疗后2个月显著下降,与治疗前比较均差异无显著性(P>0.05),且均显著低于对照组(P<0.05)。治疗后2个月,两组免疫功能指标均较治疗前有不同程度下降,治疗后6个月,免疫功能指标均较治疗前、治疗后2个月显著下降(P<0.05);治疗组治疗后2、6个月CD3^(+)、CD4^(+)、CD8^(+)T、IFN-γ均显著高于对照组(P<0.05)。PBMCs中HBV DNA、HBV RNA与CD3^(+)、IFN-γ呈显著负相关(P<0.05)。结论预防性抗病毒治疗可有效降低PBMCs中HBV pgRNA表达,抑制抗结核治疗过程中CHB再激活,改善机体免疫功能。Objective To study the expression of HBV pregenomic RNA(pgRNA)in peripheral blood mononuclear cells(PBMCs)of patients with chronic hepatitis B(CHB)complicated with pulmonary tuberculosis and its correlation with immune function.Methods A total of 40 newly diagnosed patients with CHB complicated with tuberculosis in the tuberculosis outpatient department of our hospital from March 2018 to March 2019 were randomly divided into two groups.The control group(n=20)was received routine anti-tuberculosis treatment with 2HRZE/4HR regimen,and the treatment group(n=20)received preventive antiviral treatment with lamivudine,all for 6 months.The expression levels of HBV DNA and HBV RNA as well as the levels of CD3^(+),CD4^(+) and CD8^(+) T cells in PBMCs of the two groups were compared,and the correlation between HBV DNA and HBV RNA and CD3^(+),CD4^(+) and CD8^(+) T cells was analyzed.Results 2 months after treatment,the levels of HBV DNA and HBV RNA in PBMCs in the two groups were significantly higher than that before treatment,and the levels of HBV DNA and HBV RNA in PBMCs in the treatment group 6 months after treatment were lower than 2 months after treatment,with no significant difference(P>0.05),and significantly lower than that in the control group(P<0.05).2 months after treatment,the immune function indexes of both groups decreased to different degrees compared with before treatment.And 6 months after treatment,the immune function indexes decreased significantly compared with that before treatment and 2 months after treatment(P<0.05).CD3^(+),CD4^(+) and CD8^(+) and IFN-γin the treatment group were significantly higher than those in the control group at 2 and 6 months after treatment(P<0.05).HBV DNA and HBV RNA in PBMCs were negatively correlated with CD3^(+) and IFN-γ(P<0.05).Conclusion Prophylactic antiviral therapy can effectively reduce the expression of HBV pgRNA in PBMCs,inhibit the reactivation of CHB during anti-tuberculosis treatment,and improve the immune function.

关 键 词：慢性乙肝 肺结核 外周血单个核细胞 HBV pgRNA 

分 类 号：R521[医药卫生—内科学] R512.62[医药卫生—临床医学]