慢性HBV感染患者T细胞亚群变化规律及可能的意义

Change and Significance of T cell subsets chronic HBV infected patients

目的通过对不同病理阶段的224例HBV感染患者CD4+、CD8+T细胞亚群、HBVDNA等指标的检测结果进行了回顾性分析,以期明确不同病理阶段T细胞亚群变化的规律及可能的临床意义。方法外周血CD4+和CD8+T细胞亚群检测采用流式细胞仪技术;HBVDNA检测采用荧光定量PCR检测;ELISA检测用于血清HBeAg和抗HBe评价。结果肝硬化患者(499.75±304.46,t=-3.12,P=0.041)和肝癌患者(442.10±241.81,t=4.1,P=0.038)CD4+T细胞,显著低于急性肝炎患者(682.21±299.74);肝硬化患者(303.45±225.84,t=3.75,P=0.033)和肝癌患者(296.59±279.51,t=5.39,P=0.026)CD8+T细胞,显著低于急性肝炎患者(542.83±277.35);59例肝硬化患者的CD4+T细胞(477.42±206.39)低于35例HBsAg阳性患者(512.37±261.87),但统计学差异不显著(t=0.76,P=0.62)。但前者CD8+T细胞亚群显著高于后者(369.35±203.14vs277.81±212.58;t=3.02,P=0.41);肝硬化和肝癌血清HBVDNA阳性患者,均显著低于慢性重型肝炎患者(t=4.21,P=0.038;t=3.92,P=0.041),但肝癌组与肝硬化组间无差异(t=0.49,P=0.37)。结论HBV感染肝硬化和肝癌患者CD4+和CD8+T细胞亚群较急性肝炎和健康对照人群显著降低,对于CD8+T细胞亚群显著降低的HBV感染患者,应该排除原发性肝癌的存在。

Objective The data of CD4^＋, CD8^＋T cell subsets and HBV DNA were analyzed,To study the change and significance of T cell subsets in chronic HBV infected patients. Methods CD4^＋and CD8^＋T cell subsets in peripheral blood mononuclear cells was determined with flow cytometry. The fluroescent quantitative PCR was used to detected the HBV DNA. ELISA kits were used to assay the HBeAg and anti-HBe in serum. Results The number of CD4^＋T cell in patients with liver cirrhosis （499.75 ± 304.46） and hepatic carcinoma （296.59 ± 279.51 ） were significantly lower than that of acute hepatitis patients （682.21 ± 299.74, P 〈 0.05）. The level of CD8^＋ T cells in patients with liver cirrhosis（303.45 ± 225.84） and hepatic carcinoma（296.59 ± 279.51 ） were obviously lower than that of patients with acute hepatitis （542.83 ± 277.35, P 〈 0.05）. There was no difference between the ntt number of CD4^＋ T cells in 59 cirrhotic patients with anti - HBe positive （477.42 ± 206.39） and those of 35 patients with HBeAg positive （512.37 ± 261.87）, however; the number CD8^＋ T cells of the former group was significantly higher than that of the latter group （was 277.81 ± 212.58; P = 0.41） ; HBV DNA load in sera of cirrhotic patients and hepatic carcinoma patients was remarkable lower than that of chronic severe hepatitis （ P = 0.05 ） . The value of HBV DNA between the group of hepatic carcinoma and cirrhosiswas similar （ P = 0.05）. Conclusion The level of CD4 ^＋ and CD8 ^＋ T cells in the group of cirrhosis and hepatic carcinoma are significantly lower than that of acute hepatitis and health positive control. HBV positive patieats with the number of CD8 ^＋ T cell being remarkable lower should be excluded from the possible existence of liver cancer.