粒细胞-巨噬细胞集落刺激因子对HBV宫内感染婴儿的免疫调节作用

Regulation of granulocyte-macrophage colony-stimulating factor on immunization of intrauterine hepatitis B virus infection newborns

目的观察粒细胞-巨噬细胞集落刺激因子（GM—CSF）对HBV宫内感染免疫失败婴儿的免疫调节作用。方法官内感染婴儿分为治疗组和对照组（均为20例），都给予乙肝疫苗10斗g免疫用量，同一部位三角肌注射（疫苗注射时间按0、1、6方案），乙肝免疫球蛋白200IU臀部肌肉注射，20天1次，共3次。治疗组注射乙肝疫苗3天后，同一部位皮内注射GM-CSF10μg／Kg。1岁时抽外周静脉血检测T淋巴细胞亚群的水平、血清干扰素-γ（IFN-γ）和白细胞介素4（IL4）的水平。结果（1）治疗组CD4^＋T细胞百分数及CD4^＋／CD8^＋比值高于对照组（t=11．67，P〈0．05；t=13．06，P〈0．05），CD8^＋百分数低于对照组（t=6．25，P〈0．05），两组比较差异均有显著意义。（2）患者外周血IFN．1水平治疗组高于对照组（t=13．92，P〈0．05）；IL-4水平与对照组相比，差异无统计学意义（t=1．30，P〉0．05）。结论GM-CSF可提高HBV宫内HBV感染免疫失败婴儿CD4^＋／CD8^＋比值，并且调节Th1／Th2细胞因子比例平衡。

Objective To study the immunization regulation of the granulocyte-macrophage colony- stimulating factor （GM-CSF） on the intrauterine infection HBV neonates. Methods Forty intrauterine in- fected infants entered the study. They were assigned randomly into two groups. Twenty babies were assigned to GM-CSF group and twenty babies were assigned to control group. They were received combined therapy with 10txg of recombinant hepatitis B vaccine （rHBvac） and 200IU hepatitis B immunoglobulin （HBIG）in- jected intramuscularly at different sites after birth, 10μg/kg of GM-CSF intradermally after three days at receiving rHBvac the same point. One year after birth, interleukin-4 and interferon-γ level of the post-treatment serum sample was measured by using enzyme linked immunosorbent assay （ELISA）. Flow cytometry was used to show the levels of T lymphocyte subsets（ CD4^＋ ,CD8 ^＋ ） and to calculate the ratio of CD4^ ＋/CD8^＋ in the peripheral blood . Results The percentage of CD4^＋ T cells and the ratio of CD4 ^＋/CD8 ^＋ T ceils in the GM-CSF group were higher than that in the control group （ t = 11.67, P 〈 0. 05 ; t = 13.06 , P 〈 0. 05 ）. The percentage of CD8 ^＋ T cells in the therapy group were lower than that in the control group （ t = 6.25, P 〈 0.05 ）, the difference between two groups was significant ; The IFN-γ levels of GM-CSF group were signifi- cantly higher than those of control group （t = 13.92 ,P 〈 0. 05）. There was no significant difference in IL-4 levels between the two groups （ t = 1.30, P 〉 0. 05 ）. Conclusions GM-CSF can increase the ratio of CD4 ^＋/CD8 ^＋ T cells and regulate the Thl/Th2 balance of intrauterine HBV infection infant.