补肾清毒法对慢性乙型肝炎患者外周血树突状细胞表型和功能的影响

Effect of nourishing the kidney and clearing toxicity decoction on phenotypes and functions of dendritic cells derived from peripheral blood monocytes of chronic hepatitis B patients

目的:观察研究慢性乙型肝炎(CHB)患者外周血树突状细胞(DC)表型及功能的变化,探讨补肾清毒法治疗CHB的作用机制。方法:筛选血清HBV DNA>105拷贝/mL且无其他肝脏疾病及自身免疫性疾病的CHB患者49例。其中补肾清毒法治疗组28例,核苷类似物治疗组21例,疗程均为24周。治疗前后均从患者外周血分离单个核细胞,体外诱导培养DC。用流式细胞仪检测DC表型HLA-DR、CD80、CD83、CD86的表达,MTT法检测DC的自体淋巴细胞反应,ELISA法测定IL-12、IL-10的水平。结果:CHB患者DC的扩增数量、速度低于正常人。CHB患者治疗后HLA-DR、CD80、CD83、CD86的表达均高于治疗前,补肾清毒法组HLA-DR、CD80、CD86表达率高于核苷类似物组,差异有统计学意义(P<0.05)。两组患者经治疗后,DC自体混合淋巴反应中刺激能力较治疗前升高,但仍低于健康人水平,差异有统计学意义(P<0.05)。CHB患者和正常人DC上清液中IL-10的量,各组间差异无统计学意义。混合淋巴细胞反应上清液中IL-l2的量两组经治疗后,较治疗前升高,差异有统计学意义(P<0.05)。结论:补肾清毒法能改善DC的表型表达率和抗原递呈能力及其分泌功能,部分恢复CHB患者免疫功能。

Objective： To investigate the phenotypes and functions of peripheral blood monocytes derived dendritic cells （DC） of chronic hepatitis B （CHB） patients, and to explore the mechanism of nourishing the kidney and clearing toxicity decoc- tion. Methods： Forty-nine CHB patients were divided into two groups and took medicine for 6 months. One was treated with nour- ishing the kidney and clearing toxicity decoction, and the other was treated with lamivudine. Peripheral blood DC of each subject was enriched. The phenotypes of DC were subjected to flow cytometric analysis. The lymphocyte allo-stimulatory capacity of DC was evaluated through MTY assay. IL-10 and IL-12 production were quantitied by ELISA. Results： DC of the CHB patients pro- liferated much slower than those of the healhty controls. After 6 month＇s treatment, the expression of DC＇s surface markers of CHB patients such as HLA-DR, CDS0, CD83, CD86 were higher than those before treated. Especially the expression of HLA- DR, CDSO, CD86 in the TCM decoction group were significant higher than those in western pharmaceuticals group. The stimu- latory capacity of the DC in autologous mixed lymphocyte reaction were increased after trerapy, but still beth lower than that of the healthy controls. The production of IL-12 and IL-10 also decreased significantly in the patients. However IL-12 showed the high level after treatment. Conclusion： Nourishing the kidney and clearing toxicity decoction could promote DC＇s mature, elevate the expression of DC＇s surface markers, advance the capability of antigen presentation and recover parts of immunologic functions in CHB patients.