乙肝患者外周血HBV抗原抗体表达及病毒载量与T细胞亚群检测分析

Relationship among Hepatitis B Patients Peripheral Blood Antigen-Antibody Expression and HBV-DNA Load and T cell Subsets, and Its Clinical Significance

目的 探讨乙型肝炎患者外周血抗原抗体表达及乙肝病毒载量与T细胞亚群关系及其临床意义.方法 2010年5月～10月苏州市第五人民医院住院乙肝患者70例（实验组）、正常对照40例,分别采用流式细胞术检测外周血T细胞亚群、微粒子酶免分析法获取HBV抗原抗体结果、实时荧光定量法检测HBV-DNA.按HBV抗原抗体检测结果分为HBeAg阳性乙肝组与HBeAg阴性乙肝组.按HBV-DNA载量分为三组（〈104,104～106,107～108） IU/ml.结果 ①HBeAg阳性乙肝与HBeAg阴性乙肝T细胞亚群检测值（%）分别为CD3＋：69.81±1.1,68.76±3.03;CD4^＋：32.84±2.55,35.32±3.45;CD8^＋：31.66±1.67,29.68±2.58,与正常人T细胞亚群结果（CD3＋：75.17±1.31;CD4^＋：42.29±2.13;CD8^＋：24.73±0.83）差异具有统计学显著性意义（t=3.637~7.468,P〈0.001）.两检测组间T细胞亚群差异无统计学显著性意义,但CD4^＋与CD8^＋比值后者高于前者.②HBV-DNA定量结果小于104 IU/ml时,只有CD3＋（69.59%±3.73%）与正常人组间差异具有统计学显著性意义（t=3.574,P=0.000 8）.当病毒量大于104 IU/ml而小于106 IU/ml时,CD3＋（71.89%±2.21%）与正常人组间差异具有统计学显著性意义（t=2.665,P=0.010 1）,CD8^＋（31.29%±2.03%）与正常人组间差异具有统计学显著性意义（t=7.183,P〈0.000 1）.当病毒量大于107 IU/ml而小于108 IU/ml时,CD3＋,CD4^＋,CD8^＋（66.71%±1.99%,33.79%±2.22%,32.84%±1.52%）与正常人组差异具有统计学显著性意义（t=5.514～9.567,P〈0.000 1）;且该组与上一组CD4^＋（38.38%±3.20%）间差异有统计学显著性意义（t=2.297,P=0.025）.结论 临床上乙肝患者HBV抗原抗体的不同表达,其T细胞亚群、DNA含量与正常人组存在显著性差异,通过它们的协同检测可以监控患者的免疫功能状况,适时调节患者的免疫功能水平,为乙肝患者的抗病毒治疗提供帮助.

Objective To investigate the relationship among hepatitis B patients peripheral blood antigen-an.tibody expression and HBV-DNA load and T cell subsets, and its clinical significance. Methods Hepatitis B patients in hospital from May 2010 to October 70 eases（experimental group）,40 normal controls, respectively, using flow cytometry test peripheral blood T cell subsets;using microparticle enzyme immunoassay to analyse viral antigens phenotype;by real time-quantitative method to detect HBV-DNA. According to HBV antigen antibody test results in HBeAg positive hepatitis B groups and HBeAg neg- ative chronic hepatitis B group. Divided into three groups by HBV-DNA loads （〈 10^4 , 10^4- 10^8 , 10^7- 10^8 ）. Results O Compared with normal T cell subsets （CD3＋ ..75.17%±1.31% ;CD4^＋ ;42. 29%±2.13% ;CD8^＋ ：24.73%±0.83%） ,both the HBsAg, HBeAg,anti-HBe positive group （CD3＋ ：69.81%±1.1% ,CD4^＋ ：32.84%±2.55% ,CD8^＋ ：31.66%!1.67%） and HBsAg, anti-HBe, anti-HBc positive group T cell subsets （CD3＋ ： 68. 76 ± 3.03%, CD4^＋ ： 35.32 ± 3.45%, CD8^＋ ： 29.68% ±2.58%） showed statistically significant differences 0=3. 637±7. 468（P〈0. 001）. There was no significant difference between HBsAg, HBeAg, anti-HBc positive group and HBsAg, anti-HBe, anti-HBc positive group, but the ratio of CD4^＋/CD8^＋ was HBsAg, anti-HBe, anti-HBc positive group higher than HBsAg, HBeAg, Anti-HBc positive group. ② When HBV DNA load was less than 104 IU/ml,only the CD3＋ T cell subset （CD3＋ .. 69.59 % ±3.73 %） showed significant- ly difference 0=3. 574,P=0. 000 8）. When HBV-DNA load was greater than 104 IU/ml and less than 10s IU/ml. Com- pared to normal group＇s T cell subsets,the CD3＋ T cell subset （71.89 %±2.21%） had significant difference （t= 2. 665, P =0. 0101）, and the CD85＋ subset （31.29% ± 2.03%） was significantly different （t= 7. 183, P〈0. 000 1）. When HBV-DNA load was greater than 10^4 IU/ml and less than 108 IU/ml,all the CD3＋ ,CD4^＋ and CD8^＋ subsets （66.71% ± 1.99, 33. 79 % ± 2.22 %, 32.84% ±1.52%） were significantly different （t = 5.514 ±9. 567, P〈0. 0001）. And CD4^＋ （38. 380%±3.20%） of thisgroup with last one was statistical differences （t ： 2. 297, P = 0. 025）. Conclusion Compared to normal group＇s T cell subsets,It found that both the different hepatitis B phenotypes patients and the higher virus DNA carriers showed significantly different. So,It could monitor the status of the patient＇s immune function through these collaborative detection, and timely ad]ust the immune function of patients. It provide the basis of antiviral treatment＇ s follow-up for hepatitis B patients.