慢性乙型肝炎患者胸腺肽治疗前后血清Th1/Th2细胞因子水平变化及临床意义

Changes of Th1/Th2 cytokines levels in serum in patients with chronic hepatitis B before and after treatment of thymosin

目的:探讨慢性乙型肝炎患者应用胸腺肽治疗前后血清中Thl/Th2型细胞因子水平的变化,阐明其与病情、疗效及病毒学的关系。方法:慢性活动性乙肝患者(治疗组)19例,正常对照组10例,治疗组每周2和5注射胸腺肽α1mL,于治疗前、治疗13周、21周应用流式细胞仪技术检测细胞因子水平、HBV DNA、肝功生化指标,正常对照者随机检测1次,观察治疗前后患者血清IL-2、IFN、TNF、IL-4、IL-6及IL-10的变化,并分析细胞因子含量与生化应答及病毒学应答的关系。结果:应用胸腺肽治疗后,患者Th细胞分泌的细胞因子(IL-2、IFN、TNF、IL-4、IL-6、IL-10)较治疗前增多(P<0.05),应答组Th1细胞因子(IL-2、IFN、TNF)的水平高于无应答组,无应答组Th2细胞因子(IL-4、IL-6、IL-10)的水平高于应答组(P<0.05)。按生化学应答分析,细胞因子水平能反应患者治疗效果,病毒载量应答组细胞因子水平低于部分应答组,部分应答组低于无应答组,应答组细胞因子水平低于无应答组,细胞因子增长趋势与病毒学应答治疗效果呈反向趋势(P<0.05)。结论:慢性乙型肝炎患者应用胸腺肽治疗后血清中Thl/Th2型细胞因子的变化有助于机体对HBV DNA的清除。

Objective To investigate the changes of Th1/Th2 cytokines levels in serum in patients with chronic hepatitis B patients befroe and after treatment of thymosin,and clarify the relationship with state of illness,curative effect and virological response.Methods 19 patients with chronic active hepatitis B were chosen as treatment group,10 cases as normal control group.The patients in treatment group were treated with injection of thymosin α 1 mL,in the pre-treatment,13 and 21 weeks after treatment the cytokine levels,HBV DNA,and biochemical indicators of liver function were detected by flow cytomertry on Tuesday,Friday every week;in normal control group the serum IL-2,IFN,TNF,IL-4,IL-6,IL-10 indicators were determined and the relationship between cytokine levels and biochemical responses and virological response was analyzed.Results After thymosin treatment,the cytokine levels secreted by Th cells were increased compared with pre-treatment （P〈0.05）,the levels of Th1 cytokines （IL-2,IFN,TNF） in reponse group were higher than those in non-response group,the levels of Th2 cytokines （IL-4,IL-6,IL-10） in non-response group were higher than those in response group （P〈 0.05）.According to biochemical response analysis,the cytokine levels in patients could reflect the curative effect,the cytokine levels in response group were lower than those in partial response group,the cytokine levels in part response group were lower than those in non-response group,the cytokine levels in response group were lower than those in non-response group,the increase of cytokine levels had negative correlation with curative effect of virological response （P〈0.05）.Conclusion The changes of the levels of serum Th1/Th2 cytokines in patients with chronic hepatitis B after treatment of thymosin may contribute to the removal of HBVDNA in body.