慢性乙型肝炎患者肝脏局部免疫与外周血免疫关系研究

Relations between Liver Tissue Immunity and Peripheral Blood Immunity of Patients with Chronic Hepatitis B

目的通过检测慢性乙型肝炎患者外周血及肝组织内CD4+T细胞和CD8+T细胞的数量及功能,比较二者之间的联系。方法(1)用流式细胞仪检测60例HBV感染者和20例正常人外周血中T细胞亚群的数量。(2)选取60例慢性肝炎患者的肝脏石蜡标本。免疫组化方法检测CD4+T、CD8+T淋巴细胞和树突状细胞,分析免疫细胞的类型、数目及分布情况,并作相应比较。结果(1)HBV感染组外周血T细胞亚群测定值中,CD4+T细胞和CD4+T/CD8+T比值明显低于对照组(P<0.05);CD8+T细胞升高,明显高于对照组(P<0.05);(2)免疫组化结果显示CD4+T细胞多见于汇管区,CD4+T细胞数量少于CD8+T细胞数量。树突状细胞形态不规则,绝大部分DC分布于坏死灶和汇管区间质中与淋巴细胞伴行,肝细胞内一般不常见,坏死灶越多,淋巴细胞浸润越多的病例中DC细胞也越多。外周血CD4+T、CD8+T的数量与肝脏局部免疫细胞的分布数量不具有相关性(r=0.95;r=0.94)。结论评价慢性肝炎肝脏免疫微环境状况应当综合评价免疫细胞的类型、亚型和功能状态及相互作用等多种因素,在分析、判断疾病进程和治疗上有一定意义。

Objective To detect the quantity and ability of CD4^＋T and CD8^＋ T cells in peripheral blood and liver tissues distribution and quantity of dendritic cells（DC） and subgroup lymphocytes in CHB site and prognosis of patients with chronic Hepatitis B.Methods（1）The quantity of CD4^＋T and CD8^＋ T cells in peripheral blood was detected by flow cytometry（FCM） in 36 patients with hepatitis B and 20 cases of controls;（2）Immunohistochemisty was done on 64 specimens of patients with chronic Hepatitis B to count the S-100 protein positive DC and CD4^＋T,CD8^＋T in ten high power fields within a specimen.and to observe the relationship of prognosis of patients and the types,the quantity and the distributing of immunocytes.Results it is familiar that CD4^＋T exist in the portal areas,but the CD4^＋T is not as mush as CD8^＋T.And the shape of the DCs is irregular.Almost all of the DCs distribute in areas of necrosis and Interstitial areas associated with lymphocytes,usually not in liver cells.The number of DC is more in the cases of those that have more necrotic areas and lymphocytes infiltration.The progress and the number of CD4^＋T and CD8^＋T have positive relationship（r=0.95,r=0.94）.Conclusion it is helpful in the process of analyzing,deciding and treating if we should consider the type,Lymphocyte subpopulation,the function and relationship of the immunologic cells and more as evaluating the immune-micro-environment of chronic hepatitis.