HBV前C区1896突变株感染慢性乙型肝炎患者外周血T淋巴细胞亚群的分析及意义

Analysis and significance of T lymphocyte subsets in peripheral blood of chronic hepatitis B patients with perC region 1896 mutation

目的探讨乙型肝炎病毒(HBV)前C区1896变异与感染宿主外周血T淋巴细胞亚群之间的关系。方法将196例乙型肝炎患者分为慢性乙型肝炎(CHB)组(146例)和乙型肝炎肝硬化(LC)组(50例),前者又分为含野生株CHB组(CHBⅠ组,80例)和前C区1896变异株CHB组(CHBⅡ组,66例);后者又分为含野生株LC组(LCⅠ组,19例)和前C区1896变异株LC组(LCⅡ组,31例)。采用特异性引物聚合酶链反应(PCR)检测196例乙型肝炎患者HBV前C区1896变异,并用流式细胞术检测外周血T淋巴细胞亚群的变化。以20名健康献血者作为正常对照组。结果 196例乙型肝炎患者中HBV前C区1896变异检出率为49.5%;LC组中HBV前C区1896变异检出率为62.0%,高于CHB组(45.2%)。CHB组CD4+T细胞绝对数明显低于正常对照组(P<0.01);LC组CD3+T细胞绝对数及百分率、CD8+T细胞绝对数、CD4+T细胞绝对数及百分率均明显低于正常对照组(P<0.01)。CHBⅡ组CD3+T细胞绝对数、CD4+T细胞绝对数均明显低于CHBⅠ组(P<0.05)。LCⅡ组CD3+T细胞绝对数、CD4+T细胞绝对数均明显低于CHBⅡ组(P<0.01)。结论 HBV前C区1896突变株感染的CHB患者较CHB野生株感染患者存在更为严重的T淋巴细胞亚群失衡,这种紊乱可能参与了HBV DNA前C区1896突变株感染导致的乙型肝炎慢性化过程。

Objective To investigate the relationship of hepatitis B virus （HBV） preC region 1896 mutation with peripheral blood T lymphocyte subsets. Methods A total of 196 patients with hepatitis B were classified into 146 cases of chronic hepatitis B （CHB） group and 50 cases of hepatitis B liver cirrhosis （LC） group. CHB group was classified into 80 cases of wild-type strain CHB group （CHB I group） and 66 cases of preC region 1896 mutation CHB group （CHB Ⅱ group）. LC group was classified into 19 cases of wild-type strain LC group （LC I group） and 31 cases of preC region 1896 mutation LC group （LC Ⅱ group）. In 196 patients with hepatitis B, the specific primers of polymerase chain reaction （PCR） was used to detect the HBV preC region 1896 mutation, and the T lymphocyte subsets in peripheral blood were detected by flow cytometry. A total of 20 healthy subjects were enrolled as healthy control group. Results In 196 hepatitis B patients, the rate of HBV preC 1896 mutation was 49.5%. The mutation rate in LC group （62.0%） was higher than that in CHB group （45.2%）. Compared with the healthy control group, the CD4 ＋ T cell absolute number of CHB group decreased significantly （P 〈 0.01 ）. In LC group, the absolute number and percentage of CD3 ＋ T cell, the absolute number of CD8 ＋ T cell and the absolute number and percentage of Cd4 ＋ T cell were significantly lower than those in the healthy control group （ P 〈 0.01 ）. Compared with CHB I group, the CD3 ＋ T cell absolute number and CD4 ＋ T cell absolute number of CHB Ⅱ group decreased significantly （P 〈 0.05）. Compared with CHB Ⅱ group, the absolute number of CD3 ＋ T cell and CD4 ＋ T cell in LC Ⅱ group had significant decrease （P 〈 0.01 ）. Conclusions In CHB patients with HBV preC 1896 mutation, the imbalance of T lymphocyte subsets is more serious than that of CHB patients with wild-type strain. The imbalance may participate in the pathogenesis of chronic hepatitis caused by the HBV preC region 1896 mutation.