慢性乙型肝炎中医虚实辨证与机体特异性细胞免疫及病毒复制的关系探讨

Exploration on Relationship between TCM Syndrome Differentiation of Deficiency-Excess in Chronic Hepatitis B,Organism-specific Cellular Immunity and Viral Replication

目的:通过对虚实不同证型的慢性乙型肝炎患者体内HBV特异性的细胞毒性T淋巴细胞(CTL)及T淋巴细胞亚群及病毒复制水平的检测,探讨慢性乙型肝炎中医虚实辨证分型与机体特异性细胞免疫及病毒复制的关系。方法:抗原特异性CTL及T淋巴细胞亚群采用流式细胞仪检测;HBV病毒学指标由ABBOTT I2000检测;HBVDNA由ABI荧光定量PCR仪完成。结果 (:1)虚实两组患者特异性CTL细胞的阳性率存在差异(P<0.05),实证组患者特异性CTL细胞阳性率较虚证组患者高,差异有统计学意义(P<0.05)。(2)虚实两组CD3+、CD4+以及CD4+/CD8+值均较正常对照有所下降,其中虚证组患者CD4+、CD4+/CD8+水平下降较正常组明显,有统计学意义(P<0.05),虚实两组之间CD4+水平有显著性差异(P<0.05),但实证组与正常对照组相比,二者无显著性差异(P>0.05),虚实两组患者CD8+水平均高于正常组,虚证组升高更明显,差异有统计学意义(P<0.05)。(3)虚实两组患者病毒复制程度不同,实证组中高病毒载量患者所占比例较大,约为62.2%,虚证组高病毒载量患者所占比例仅为40%,较前者明显减少,虚证组患者病毒复制处于低复制水平,二者有统计学意义(P<0.05)。结论:虚实两组患者的外周血特异性CTL细胞阳性率、T淋巴细胞亚群及病毒复制水平存在有统计学差异,可以为指导临床辨证分型提供一定的客观参考价值。

Objective ： To explore the relationship between TCM syndrome differentiation of deficiency- excess in chronic hepatitis B, organism-specific cellular immunity and viral replication through detecting the levels of HBV specific cytotoxic T lymphocytes, T lymphocyte subsets and viral replication in chronic hepatitis B patients with different syndromes of deficiency and excess. Methods ： The specific cytotoxic T lymphocytes （ CTL ） and T lymphocyte subsets were detected by MHC pentamers in chronic hepatitis B patients.HBV virology index was detected by ABBOTT 12000; HBVDNA by ABI fluorescence quantitative PCR instrument. Result： （ 1 ）The positive rate of specific CTL cell in excess syndrome group was higher than that in deficiency syndrome group significantly. （ 2 ） The levels of CD3＋, CD4~ and CD4~/CD8~ in excess syndrome group and deficiency syndrome group were lower than those in control group.The levels of CD4~ and CD4~/CD8＋ in deficiency syndrome group were significantly lower than those in excess syndrome group.The levels of CD8＋ in deficiency syndrome group were significantly lower than those in control group and excess syndrome group. （ 3 ）There were some differences between deficency syndrome group and excess syndrome group in space of hepatitis B virus replication for patients with chronic hepatitis B.The proportion of higher hepatitis B virus replication in excess syndrome group was statistically significant then those in deficiency syndrome group （ 62.2% VS 40% ） .Conclusion ： This study showed that there was an obvious statistical difference between deficiency-excess syndrome differentiation of chronic virus hepatitis B in space of the immune function of the specific cytotoxic T lymphocytes （ CTL ）, T lymphocyte and the level of hepatitis B virus replication.Their indexes could be considered as some objective evidences for deficiency- excess syndrome differentiation.