活化Th细胞及HBeAg与慢性乙肝肝损伤及纤维化关系的探讨

Association of activated CD4^＋ cell and HBeAg with liver damage and cirrosis in patients with chronic hepatitis B

目的探讨活化Th细胞（CD4^＋HLA-DR^＋）及HBeAg与慢性乙型肝炎肝脏损伤及纤维化的关系。方法检测58例慢性乙型肝炎患者和18例既往感染患者（HBsAg阴性而HBcAb阳性者）CD4^＋抗原和HLA-DR抗原双阳性淋巴细胞，血小板（PLT）数和血清丙氨酸氨基转移酶（ALT）和天门冬氨酸氨基转移酶（AST）活度，计算AST／PLT比值。结果既往感染患者、HBeAg阴性及阳性慢性乙肝患者活化CD4^＋细胞数量明显低于对照者（P〈0．05），且呈显著递减（P〈0．05），HBeAg阴性及阳性者AST，ALT以及AST／PLT值明显高于对照者（p〈0．02）和既往感染者（P〈0．02），且HBeAg阳性患者明显高于阴性患者（P〈0．05），此二组活化CD4^＋细胞与ALT，AST和AST／PLT呈明显负相关（P〈0．05）。结论活化Th细胞降低可以作为慢性乙肝患者预测肝脏损伤进展的有用指标，HBeAg可以辅助评价肝损伤和纤维化的发展程度。

Objective To study the association of the CD4^＋ cell counts and HBeAg with liver damage and cirrosis in patients with chronic hepatitis B（ CHB）. Method To measure the lymphocytes both CD4 and HLA-DR positive of 58 patients with CHB and 18 patients with HBsAg negative but HBcAb positive. The Platclets （PLT） were counted and the ALT and AST were measured, meanwhile, AST/PLT values were calculated. Results The CD4^＋ cell counts of the three types patients were lower than those of healthy controls significantly, and those of HBcAb positive patients without CHB were higher than those of HBeAg negative patients with CHB which were higher than those of HBeAg positive patients significantly（P 〈 0.05）. And the ALT,AST and AST/PLT levels of both HBeAg negative and positive patients were much higher than the three indicators of both HBcAb positive patients without CHB and healthy controls significantly（P 〈 0.02） ,meanwhile, the three indicators of HBeAg negative patients were much lower than those of HBeAg positive ones. In addition, the CD4^＋ cell counts of the two types patients were negatively correlative with the three indicators（P 〈 0.05）. Conclusion Decreased CD4^＋ cell count can be used as the indicator to predicate the progress of liver damage in patients with CHB, and it is also useful for HBeAg to evaluate the development degree of liver damage and fibrosis in CHB patients.