乙型肝炎患者外周血T细胞亚群、IL-32、IL-6水平的变化及其临床意义

Changes and Clinical Significance of Peripheral Blood T Cell Subsets,IL-32 and IL-6 in Patients with Hepatitis B

HBV感染人体后的不同转归受病毒和宿主两方面因素的影响，T细胞介导的细胞免疫应答在其中起重要作用，而细胞因子在免疫应答的调节中具有关键意义。目的：研究乙型肝炎患者外周血T细胞亚群、IL-32、IL-6水平的变化及其临床意义。方法：纳入112例乙型肝炎患者和30例健康志愿者，流式细胞术检测外周血T细胞亚群，ELISA方法检测血清IL-32、IL-6水平。结果：与健康对照组相比，乙型肝炎患者外周血CD4＋ T细胞比例降低，CD8＋ T细胞比例升高，血清IL-32、IL-6水平升高，差异均有统计学意义。IL-32水平为急性乙型肝炎组最高，重、中、轻度慢性乙型肝炎组依次降低；IL-6水平为重、中、轻度慢性乙型肝炎组依次降低，急性乙型肝炎组最低。HBV DNA（＋）与HBV DNA（-）组间外周血T细胞亚群、血清IL-32、IL-6水平和肝功能指标均无明显差异。乙型肝炎患者的血清IL-32、IL-6水平与ALT和总胆红素水平呈正相关，与Alb水平呈负相关。结论：乙型肝炎患者存在T细胞亚群比例异常。其血清IL-32、IL-6水平升高与病毒复制无关，而与机体免疫异常有关，两者可能参与了乙型肝炎的肝脏炎性损伤过程。

The outcomes of HBV infection are affected by virus and host factors. Cellular immunologic response mediated by T cells, which is critically regulated by some cytokines, might be involved in these processes. Aims： To investigate the changes and clinical significance of peripheral blood T cell subsets, IL-32 and IL-6 in patients with hepatitis B. Methods： One hundred and twelve patients with hepatitis B and 30 healthy volunteers were recruited. Peripheral blood T cell subsets were analyzed by flow cytometry, and the serum levels of IL-32 and IL-6 were determined by ELISA. Results： The percentage of CD4＋ T cells was significantly lower, while the percentage of CD8＋ T cells and the levels of IL-32 and IL-6 were significantly higher in peripheral blood of hepatitis B patients than those in healthy controls. Serum level of IL-32 was the highest in acute hepatitis B, and decreased gradually from severe, moderate to mild chronic hepatitis B. Serum level of IL-6 also decreased gradually from severe, moderate to mild chronic hepatitis B, yet was the lowest in acute hepatitis B. No significant differences were found in peripheral blood T cell subsets, serum levels of IL-32 and IL-6, as well as the liver function parameters between HBV DNA-positive and HBV DNA-negative groups. Serum levels of IL-32 and IL-6 were positively correlated with the serum levels of ALT and total bilirubin, but negatively correlated with the level of serum albumin in hepatitis B patients. Conclusions： The percentages of T cell subsets are aberrant in hepatitis B patients. It seems that the upregulations of serum IL-32 and IL-6 are not correlated with the viral replication but with the immunologic abnormality. These two cytokines might be involved in the liver inflammatory injury occurred in hepatitis B.