LAK细胞治疗慢性活动型乙型肝炎的疗效与机理研究

EFFICACY AND MECHANISM OF LAK CELL THERAPY FOR CHRONIC ACTIVE HEPATITIS B

目的观察淋巴因子激活杀伤细胞（ＬＡＫ细胞）治疗慢性活动型乙型肝炎（ＣＡＨ）的疗效，探讨治疗机理。方法ＬＡＫ细胞治疗４０例患者，治疗前、疗程结束时，分别检测ＨＢＶＭ，ＡＬＴ，Ｔ细胞亚群，Ｂ细胞，ＩＬ－２，ｍＩＬ－２Ｒ，ＮＫ及ＬＡＫ细胞活性。疗程结束１ａ复查ＨＢＶＭ。对照组４０例。结果ＬＡＫ治疗组疗程结束时，ＨＢｅＡｇ和ＨＢＶＤＮＡ转阴率分别为２２．５％和４０．０％，与对照组相比差异显著（Ｐ均＜０．００１）。疗程结束１ａ复查ＨＢｅＡｇ、ＨＢＶＤＮＡ转阴率分别达４０．０％和６８．６％。治疗后患者ＣＤ＋４细胞数及ＣＤ＋４／ＣＤ＋８比值，ＩＬ－２水平及ｍＩＬ－２Ｒ表达，ＮＫ细胞及ＬＡＫ细胞活性均较治疗前明显升高（Ｐ均＜０．０１）。尤以ＨＢｅＡｇ转阴者，ＩＬ－２升高更显著（Ｐ均＜０．００５）。结论ＬＡＫ细胞疗法有增强免疫功能、调节免疫紊乱和清除乙肝病毒的效用，但主要不是ＬＡＫ细胞的溶细胞作用。

Objective To observe the therapeutic effect of lymphokine activated killer cells (LAK cell) on chronic active hepatitis B (CAH)and study the mechanism of the therapy.Methods LAK cell infusion was used to treat 40 cases of CAH. HBVM, ALT, T cell subgroups, B cell, IL-2, mIL-2R, NK and LAK activities were determined before and after the therapeutic course, and the HBVMs were rechecked 1 year later.Controls,another 40 cases of CAH, were treated ordinarily.Results At the end of the LAK therapy, HBeAg and HBV DNA became negative in 22.5% and 40.0% respectively, much higher than those in the control(P<0.01),and about 1 year later,they two became negative in 40.0% and 68.6% respectively. The CD + 4 the percentage and the ratio of CD + 4/CD + 8, the IL-2 level and the expression of mIL-2R, the LAK and NK activities were all enhanced markedly after the treatment (P<0.01). The increase of IL-2 level was particularly higher in the patients whose HBeAg became negative than in those with persistent positive HBeAg(P<0.005).Conclusion The observations suggest that the so-called “LAK therapy” may enhance CAH patients'immunity and play an important role in eliminating the HBV as well, which, however, can not be solely attributed to the cytolytic action of the activated killer cells.