拉米夫定治疗慢性乙型肝炎患者后外周血T淋巴细胞亚群的变化研究

Analysis of the variations of T-lymphocyte subsets in peripheral blood in chronic hepatitis B patients after the therapy of Lamivudine

目的探讨拉米夫定治疗慢性乙型肝炎患者后外周血T淋巴细胞亚群状态的变化情况。方法 154例慢性乙型肝炎患者按照HBeAg表达不同分为HBeAg阳性组(83例)和HBeAg阴性组(71例),采用流式细胞技术检测研究对象外周血的CD4+和CD8+T细胞的表达情况;并观察两组患者均给予拉米夫定治疗24周后,患者的HBV-DNA、HBeAg、肝功能、CD4+和CD8+T细胞的变化情况。结果两组的CD4+T细胞均呈现不同程度的降低,而CD8+T细胞则相对较高,与对照组相比差异有统计学意义(P<0.05);拉米夫定抗病毒治疗24周后,HBeAg阳性组患者已有60.2%的患者HBV-DNA低于检测下限并有HBeAg阴转,且丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)均有明显降低,同时CD4+和CD8+T细胞较治疗前均有明显上升趋势(P<0.05);HBeAg阴性组患者的HBV-DNA、ALT、AST等指标也呈明显降低,临床症状亦明显改善,CD4+T细胞的表达较治疗前明显提高(P<0.05),另有5例患者的病情未能得到有效控制,分析其外周血CD4+T和CD8+T细胞均有不同程度的表达下调。结论 T淋巴细胞在慢性乙型肝炎的发病及转归中起到非常重要的作用,且核苷(酸)类似物抗病毒药物可以增强患者的细胞免疫,提高CD4+和CD8+T细胞的表达。

Objective To investigate the variations of T-lymphocyte subsets in peripheral blood in chronic hepatitis B patients after the therapy of Lamivudine. Methods Flow cytometry was used to detect the peripheral blood T-lymphocyte subsets in 154 patients of chronic hepatitis B who were divided into two groups according to the expression of HBeAg - the positive group and the negative group. The variations of HBV-DNA, HBeAg,liver function,CD4＋ and CD8＋ T cells in the patients were detected after a 24 weeks therapy of Lamivudine. Results Either in positive group or negative group, the percentage of CD4＋ T cells was lower, but higher in CD8＋T cells, and both of the two groups had statistical differences compared with controls （P〈0.05）. After the antiviral therapy hy Lamivudine for 24 weeks, 60.2% patients＇ HBV-DNA and HBeAg became negative and the expressions of ALT and AST also obviously degraded in HBeAg positive group,meanwhile the expressions of CD4＋ and CD8＋ T cells were increasing and had significant differences compared with pre-therapy （P〈0.05） and in the HBeAg negative group,the expression of HBV-DNA, ALT and AST significantly degraded and the clinical symptoms also improved, furthermore the expression of CD4＋T cells obviously increased （P〈0.05）. In addition,the analysis result of T-lymphocyte subsets in peripheral blood showed that the expressions of CD4＋ T cells and CD8＋ T cells degraded in the 5 patients whose conditions were not effectively controlled. Conclusion T lymphocyte played extremely important role in the course of disease with hepatitis B virus and Lamivudine could enhance cellular immunity of the patients,and improve the expression of CD4＋ T cells and CD8＋ T cells.