慢性乙型肝炎抗病毒治疗后病毒学应答与特异性细胞免疫的关系

Relationship between virological response and specific cellular immunity after antiviral treatment of chronic hepatitis B

目的探讨阿德福韦酯治疗慢性乙型肝炎（CHB）患者病毒学应答与HBV特异性细胞毒性T淋巴细胞（CTL）的关系。方法51例CHB患者，HBVDNA阳性（HBVDNA≥I×10^4拷贝／ml，HBeAg阳性32例（62．75％）、丙氨酸转氨酶（ALT）〉2×正常值上限（ULN）、人白细胞抗原（HLA）-A2阳性，用阿德福韦酯10mg，口服，每日1次。观察治疗72周后HBVDNA转阴和HBeAg血清学转换与HBV特异性CTL的关系。结果阿德福韦酯治疗72周后，HBVDNA转阴（〈500拷贝／m1）39例（76．47％），其HBV特异性CTL（0．81％±0．06％），高于12例（23．53％）的HBVDNA未转阴者（0．66％±0．06％），t=7．93，P〈0．01，IqBeAg血清学转换8例（25％），其HBV特异性CTL（0．97％±0．07％），高于24例（75％）的无HBeAg血清学转换者（0．67％±0．07％），t=7．61，P〈0．01。结论阿德福韦酯治疗CHB患者病毒学应答和血清学应答与HBV特异性CTL水平升高有关。

Objective To explore the relationship between virological response and HBV specific cytotoxic T lymphocyte in patients with chronic hepatitis B （CHB） treated by adefovir dipivoxil. Methods 51 cases of CHB,HBV DNA positive（HBV DNA≥1 x 104 copies/ml） , 32 cases （62.75%） with positive HBeAg, alanine amino-transferase （ALT） 〉 2 × upper limit of normal value （ ULN）, human leukocyte antigen（HLA）-A2 positive, 10 mg adefovir dipivoxil was used orally, once a day. After treatment for 72 weeks, observe relationship between HBV DNA turning negative, HBeAg seroconversion and HBV specific CTL. Results After treatment with adefovir dipivoxil for 72 weeks, HBV DNA turned negative （ 〈 500 copies/ml） in 39 cases（76.47% ）, their HBV specific CTL（0.81% ± 0.06% ）was higher than that of 12 cases（23.53% ） whose HBV DNA failed to turn negative （0.66% ± 0.06% ）, t = 7.93, P 〈 0. 01, HBeAg seroconversion occurred in 8 cases（25% ） ,their HBV specific CTL（0. 97%±0. 07% ）was higher than that of 24 cases （75 % ） who had no HBeAg seroconversion （ 0. 67 %± 0. 07% ） , t = 7.61, P 〈 0. 01. Conclusion When adefovir dipivoxil was used to treat CHB patients, virological response and serological response was related to increase of HBV specific CTL level.