Th1、Th2在慢乙肝重叠戊肝感染导致重症化中的作用

The Role of Th1 and Th2 in Patients with Chronic Hepatitis B and HEV Infection

目的研究慢性乙型肝炎重叠戊肝感染的临床及免疫指标的变化特点与临床转归。方法选择慢性乙肝重叠戊型肝炎患者及同期单纯慢性乙肝患者各30例,分为重叠感染组和对照组,采用ELISA法检测戊型肝炎病毒以及乙肝病毒e系统状态,PCR法检测HBV-DNA,对慢性乙型肝炎重叠戊肝感染患者进行肝功能、免疫指标IL-4、TNF-α、IFN-γ、Th1/Th2的检测,并与单纯慢性乙型肝炎进行对照分析,观察两组在治疗8周时的肝功能恢复情况。结果重叠感染戊肝患者发生重症肝炎的人数多(9例vs 6例,P<0.05),e抗原转阴比例高(2例vs 1例),ALT、TBIL恢复较差,免疫指标提示与对照组相比,重叠感染组IL-4水平降低(P<0.05)、TNF-α、IFN-γ变化不大(P>0.05),Th1/Th2水平明显增高(P<0.05)。结论慢性乙型肝炎重叠HEV感染后病情趋向重症化,可能是由于抗炎性细胞因子IL-4表达减少,细胞免疫增强导致肝细胞大量损害所致。

Objective To study the clinical features and immune components of chronic hepatitis B patients with hepatitis E virus super-infection. Method 30 cases of chronic hepatitis B patients diagnosed with hepatitis E infection and 30 chronic hepatitis B patients at the same period were studied. ELISA was used to detect the antigens and antibodies of hepatitis E and hepatitis B virus. HBV-DNA was detected by RT-PCR. The liver function, IL-4, TNF-α, IFN-γ, Th1/Th2 of serum were measured and compared between the two groups of patients at the first and 8th week after treatment. Result Patients with HEV super-infection had a higher incidence of developing severe hepatitis （9 cases versus 6 cases, P〈0.05）, a high proportion of HBV e antigen serum conversion （n=2 versus 1 cases） and a high level of serum ALT and TBIL. Compared to the control group, the level of IL-4 was low （P〈 0.05） ; the levels of TNF-α, IFN-γ were not changed （P〉0.05） and the ratio of Th1/Th2 increased significantly （P 〈0.05）. Conclusion HEV super-infection would in the severity of chronic hepatitis B infection. It may be due to the reduced production of anti-inflammatory cytokines IL-4 and the increased in cellular immunity which caused a large number of liver cells damage.