阿德福韦治疗对慢性乙型肝炎患者Th细胞相关细胞因子水平及HBV DNA的影响

The effect of adefovir dipivoxil therapy on T helper cell cytokines and HBV DNA loads in patients with hepatitis B

目的观察乙型肝炎e抗原（HBeAg）阳性慢性乙型肝炎患者阿德福韦治疗前后不同时相点血清干扰素（IFN）-γ和白细胞介素（IL）-4的水平，以及其与乙型肝炎病毒（HBV）DNA定量的关系，以探讨阿德福韦治疗对机体免疫状态的影响。方法采集30例阿德福韦治疗前及治疗16周、52周和132周患者的血清，其中完全应答组14例，部分应答组16例；另设健康对照组10例。采用酶联免疫吸附试验（ELISA）检测IFN-γ和IL-4水平；HBV DNA定量检测，采用罗氏COBAS AMPLICOR HBV MONITOR检测，下限为10^3拷贝／mL，由美国MDS公司北京临床实验室给予检测。结果完全应答组在治疗前及治疗16周，IFN-γ水平均显著高于部分应答组（P〈0．05）及对照组（P〈0．05），部分应答组与对照组之差异无显著性（P〉0．05）；完全应答组IL4水平在治疗后逐渐下降，部分应答组变化不大。各组在治疗前，HBV DNA水平与IFNW及IL-4水平均无明显相关性；在治疗16周，HBV DNA水平均明显下降，此时完全应答组IFN-γ升高程度显著高于部分应答组（P〈0．05）；完全应答组IL-4水平逐渐下降，部分应答组下降不明显。结论经阿德福韦治疗后，慢性乙型肝炎患者细胞免疫应答有一定程度恢复，其恢复程度与治疗后HBV DNA定量下降幅度呈正相关。

Objective To explore the influence of adefovir dipivoxil （ADV） therapy on the cellular immunity by observing the levels of interferon γ（IFN -γ）, interleukin-4 （IL-4） and their relationship with HBV DNA loads in patients with HBeAg-positive chronic hepatitis B at different time before and after treatment. Methods Sera of 30 patients before ADV therapy and 16 weeks ,52 weeks and 132 weeks after ADV therapy respectively were collected in this study. There were 14 complete response cases（group A）, 16 incomplete response cases（group B）. Sera of 10 healthy people were chosen as control group（group C）. Levels of IFN-γ and IL-4 were detected with enzymedinked immunosorbent assay; HBV DNA loads were detected by ROCHE COBAS AMPLICOR HBV MONITOR, lower limit was 10^3 copy/mL. Results The average IFN-γ level in group A was significantly higher than that of group B （P〈0. 05）and C（P〈0. 05）, there was no significant difference between group B and C（P〉0. 05） ;The level of IL- 4 of group A decreased after treatment while group B didn＇t. HBV DNA loads of all groups had no significant cot relation with IFN-γ and IL-4 levels before treatment, but dropped obviously at 16th week after treatment; and the increased level of IFN -γ in group A was significantly higher than that of group B（P〈0. 05） ; IL-4 levels in group A decreased gradually, but didn＇t decreased obviously in group B. Conclusion Cellular immune response of patients with hepatitis B was resumed to some extent after ADV treatment. The resumption level was positively related with the decreased level of HBV DNA load.