拉米夫定疗程中慢性乙型肝炎患者血清IL-12水平和Th平衡变化及其意义

Changes of serum IL-12 level and Th balance of chronic hepatitis B patients and the significance in the course of lamivudine therapy

目的 探讨慢性乙型肝炎患者拉米夫定治疗前后血清IL -12水平和辅助性T细胞 (Th)平衡变化及其临床意义。方法 根据患者对拉米夫定治疗的应答情况分组进行回顾性研究 ,利用双抗体夹心ELISA法检测治疗前后不同时相点血清IL -12、γ干扰素 (IFHγ)、IL -4水平 ,以与正常对照校对后的IFNγ/IL -4作为Th平衡指标 ,取健康献血员作对照。结果 治疗前血清IL -l2水平低于健康对照 ,Th平衡表现为Th2优势应答 ;治疗后HBeAg阳性完全应答组在治疗的第 3个月有明显的血清IL -12水平高峰 ,Th平衡得以恢复并保持Thl优势应答 ,HBeAg阳性部分应答组和HBeAg阴性组Th平衡仍以Th2 为优势应答。结论 拉米夫定治疗应答和血清IL -12水平及Th平衡的恢复程度有关 ,治疗后慢性乙型肝炎患者抗HBV免疫有所恢复 ,血清lL -l2水平可作为早期预测拉米夫定疗效的免疫学指标 ,治疗后Th平衡的恢复是完全应答实现的保证。

Objective To investigatethe changes of serum IL-12 level and Th balance of chronic hepatitis B (CHB) patients in the course of lamivudine therapy and the related significance. Methods According to the differ ent responses to lamivudine therapy, patients were divided into three groups: group I ( n = 10), HBeAg positive CHB and complete response group; group Ⅱ (n = 10), HBeAg positive CHB and non-complete response group;group Ⅲ ( n = 5), HBeAg negative CHB group. Sera were collected from patients with chronic hepatitis B before and after lamivudine therapy and healthy blood donors. Then serum IL-12, IFNγ, and IL-4 levels were measured by ELISA method. The ratio of IFNγ/IL-4 was selected as the marker of Th balance after comparison with that of the normal control. Results Before therapy, serum IL-12 level in chronic hepatitis B patients was lower than that of the healthy blood donors, and Th balance tendency was to Th2 direction. After lamivudine therapy, serum IL-12 level was increased. The highest point of IL-12 was observed in complete response group at the third month after therapy.The tendency of Th balance was to Th 1 direction in complete response group and to Th 2 direction in non-complete response group and HBeAg negative group. Conclusion After lamivudine therapy, the immunity response to HBV of chronic hepatitis B patients can be recovered. The response degree to therapy is associated with the level of serum IL-l2 and Th balance recovery level after lamivudine therapy. Serum IL-12 level may be an appropriable marker to predict the effect of lamivudine therapy in earlier period of the whole course. The recovery of Th balance is the assurance of complete response.