不同病毒载量HBV感染者外周血T淋巴细胞亚群和转化生长因子β的变化及意义

Changes in peripheral blood T cell subsets and TGFβ and their clinical significance among HBV infection patients with different viral loads

目的通过检测不同病毒载量慢性乙型肝炎(CHB)患者和HBV携带者(ASC)外周血T淋巴细胞各亚群变化的规律,探讨T淋巴细胞与人转化生长因子(TGF)β、ALT及TBil相关性。方法选择2012年7月至2012年12月兰州市第二人民医院收治的175例HBV感染者作为研究对象,分为ASC组(112例)、CHB组(63例),以同期健康体检者84例作为对照组。运用流式细胞术检测3组血清中T淋巴细胞亚群水平,同时检测肝功能指标等。正态分布的计量资料多组间比较采用方差分析,偏态分布的计量资料组间比较采Kruskal-Wallis H秩和检验。结果与健康对照组相比,ASC和CHB组TGFβ表达水平显著升高(P均<0.05),CD3+、CD4+T淋巴细胞百分数显著降低(P<0.05或P<0.01),CD4+与CD8+T淋巴细胞比值显著降低(P<0.01),CD8+T淋巴细胞百分数显著升高(P<0.05或P<0.01)。ASC与CHB组HBeAg阳性组和HBeAg阴性组患者CD3+、CD4+T淋巴细胞百分数均降低,CD8+T淋巴细胞百分数升高,CD4+与CD8+T淋巴细胞百分数降低。结论 TGFβ可能参与了CHB的发病过程,其免疫抑制作用可能是通过对T淋巴细胞、抗原递呈细胞成熟分化的抑制等多个环节发挥作用。

Objective To study the changes in peripheral blood T cell subsets among chronic hepatitis B（ CHB） patients and asymptomatic hepatitis B virus（ HBV） carriers（ ASC）,who have different viral loads,and to investigate the correlation of T cell subsets with transforming growth factor beta（ TGFβ）,alanine aminotransferase,and total bilirubin. Methods A total of 175 HBV infection patients admitted to our hospital from July to December,2012 were recruited and divided into ASC group（ n = 112） and CHB group（ n = 63）; 84 healthy controls who underwent physical examination in the same period were selected as control group. The percentages of T cell subsets in serum were determined by flow cytometry,and liver function parameters were measured. For normally distributed continuous data,comparison between groups was made by analysis of variance; for non- normally distributed continuous data,comparison between groups was made by Kruskal- Wallis H rank sum test. Results Among the 175 HBV infection patients,the percentages of CD3＋,CD4＋,and CD8＋T cells and CD4＋/CD8＋ratio were72. 14%- 74. 07%,38. 43%- 39. 47%,30. 74%- 31. 42%,and 1. 31- 1. 34,respectively. Compared with the control group,the ASC group and CHB group had significantly increased TGFβ levels（ P〈0. 05 for both）,significantly reduced percentages of CD3＋and CD4＋T cells（ P〈0. 05 or P〈0. 01）,significantly reduced CD4＋/CD8＋ratios（ P〈0. 01）,and significantly increased percentages of CD8＋T cells（ P〈0.05 or P〈0.01）. In the ASC and CHB groups,both HBeAg- positive and HBeAg- negative patients had reduced percentages of CD3＋and CD4＋T cells,increased percentages of CD8＋T cells,and reduced CD4＋/CD8＋ratios. In addition,no correlation was found between HBV DNA loads and T cell subsets in the two groups（ P〈0. 05）. Conclusion TGFβ may be involved in the pathogenesis of CHB,and its immunosuppressive effect may be exerted by inhibiting T cells and antigen- presenting cell maturation.