恩替卡韦对HBeAg阳性慢性乙型肝炎患者的免疫调节作用

Immunoregulation of entecavir for patients with HBeAg-positive chronic hepatitis B

目的探讨恩替卡韦对HBeAg阳性的慢性乙型肝炎患者的免疫调节作用及其机制。方法 30例HBeAg阳性慢性乙型肝炎患者每日给予0.5mg恩替卡韦治疗,于治疗0、12、24、48周分别检测血清HBV DNA、IFN-γ及IL-4水平,并检测外周血单个核细胞(PBMCs)中B7-H1mRNA水平。结果 1应答组患者PBMCs中B7-H1mRNA水平在治疗过程中呈进行性下降,且有统计学差异(P=0.005),而无应答组该指标在治疗过程中无显著变化(P=0.466);2应答组患者的血清IFN-γ水平在治疗过程中呈上升趋势(P<0.05),无应答患者的血清IFN-γ水平在治疗过程中虽也呈上升趋势,但均无统计学意义(P>0.05);3应答组患者的血清IL-4水平在治疗过程中表现为持续下降,并具有统计学意义(P<0.05),无应答组患者的血清IL-4水平在治疗过程中虽然有下降趋势,但均无统计学意义(P>0.05)。结论恩替卡韦治疗HBeAg阳性的慢性乙肝患者不仅具有抑制病毒作用,而且具有促进免疫恢复和调节的功能,其机制可能是通过降低患者体内的病毒载量、减少抑制性共刺激分子B7-H1的表达而发挥作用。

Objective To study the immunoregulation and mechanism of entecavir for patients with HBeAgpositive chronic hepatitis B.Methods Thirty patients with HBeAg-positive chronic hepatitis B took 0.5 mg entecavir every day.Then we detected the levels of serum HBVDNA,IFN-γ,IL-4 and B7-H1 mRNA of PBMCs in baseline at12,24,48 and weeks,respectively.Results ① The level of B7-H1 mRNA of PBMCs after treatment decreased progressively in responding group,with a significant difference （P =0.005）.It decreased slowly in nonresponding group,without significant difference （P =0.466）.② The level of serum IFN-γ after treatment increased progressively in responding group,with a significant difference （P ＜ 0.05）.But it increased slowly in nonresponding group,with no significant difference （P＞0.05）.③ The level of serum IL-4 after treatment decreased progressively in responding group,with a significant difference （P＜0.05）,but decreased slowly in non-responding group with no significant difference （P＞0.05）.Conclusion Entecavir used to treat patients with HBeAg-positive chronic hepatitis B not only suppressed HBVDNA replication but also promoted the recovery and regulation of the immune system.The mechanisms may be related to reducing HBVDNA loads and decreasing B7-H1 expression.