不同抗病毒方案治疗慢性乙型肝炎对患者T细胞亚群的影响

Changes of T-cell subsets in different antiviral treatment options for chronic hepatitis B patients

目的探讨干扰素及核苷(酸)类似物治疗慢性乙型肝炎(CHB)患者乙肝病毒(HBV)DNA转阴时的T细胞亚群的变化及差异。方法收集CHB患者60例,分为两组,干扰素组30例,核苷(酸)类似物30例。分别于治疗前后HBV DNA转阴时,检测外周血T细胞亚群。治疗后HBV DNA未转阴者,于治疗48周时测外周血T细胞亚群。同时收集30例正常人外周血测T细胞亚群作为正常对照。结果 CHB患者T细胞亚群中CD4+细胞百分数及CD4+/CD8+比值均低于正常对照组(P<0.05),而CD8+细胞百分数高于正常对照组(P<0.05)。治疗前,干扰素组及核苷(酸)类似组的HBV DNA转阴组与未转阴组相比较,CD8+细胞百分数差异均无统计学意义(P>0.05),CD4+细胞前者高于后者,差异均有统计学意义(P<0.05)。CD4+/CD8+比值在干扰素治疗组中差异有统计学意义(P<0.05),前者高于后者;在核苷(酸)类似物组中,虽前者高于后者,但差异无统计学意义(P>0.05)。治疗后,干扰素组及核苷(酸)类似物组的HBV DNA转阴患者,其CD4+细胞百分数及CD4+/CD8+比值均较治疗前明显升高(P<0.05),而CD8+T细胞百分数虽下降,但在干扰素组差异无统计学意义(P>0.05),在核苷(酸)类似物组有统计学意义(P<0.05)。两治疗组中HBV DNA未转阴患者,其CD4+、CD8+细胞百分数及CD4+/CD8+比值在治疗前后均无统计学意义(P>0.05)。结论 CHB患者治疗前的免疫状态对抗病毒效果有预示作用,抗病毒前患者免疫状态较好的,其抗病毒疗效可能也较好。两类抗病毒药物均可明显改善患者免疫状态。CHB患者检测T细胞亚群有助于判断其预后。

[Objective] To investigate the changes and differences of T cell subsets in chronic hepatitis B （CHB） patients treated with interferon or nucleoside （acid） when their HBV DNA was negative. [Methods] 60 CHB patients including 30 interferon treatment patients and 30 nucleoside （acid） treatment patients were collected for the study. For patients with HBV DNA negative conversion, the peripheral blood T cell subsets were detected by flow cytometry before treatment and when HBV DNA negative conversion. For patients without HBV DNA negative conversion, the detection of T cell subsets were carried before treatment and the 48th w of anti-virus treatment. Meanwhile, 30 patients with non-B hepatitis and no disease effect on the measured T cell subsets were collected as a healthy control group. [Results] The percentages of CD4^＋ cells and the ratio of CD4^＋/CD8^＋ of CHB patients were lower than the normal control group respectively （P 〈0.05）, and the CD8^＋ percentage is higher than the normal control group （P〈0.05）. Before treatment, as to interferon and nucleoside group, the percentage of CD8^＋ cells in patients with HBV DNA negative conversion were comparative to patients without HBVDNA negative conversion （P〈0.05）, the percentage of CD4^＋ cells in patients with HBV DNA negative conversion were higher statistically higher than those without HBV DNA negative conversion （P〈0.05）; as to interferon group, the ratio of CD4^＋/CD8^＋ in patients with HBV DNA negative conversion were higher statistically higher than those without HBV DNA negative conversion （P 〈0.05）, as to nucleoside group, there were no significant differences between patients with HBV DNA negative conversion and those without HBV DNA negative conversion （P 〈0.05）. after treatment, as to interferon and nucleoside group, the percentage of CD4^＋ and the ratio of CD4^＋/CD8^＋ in patients with HBV DNA negative conversion were significantly higher than before treatment （P 〈0.05）. However, for patients without HBV DNA negative conversion, the percentage of CD4^＋ and CD8^＋, and CD4^＋/CD8^＋ ratio were similar to before treatment （P〈 0.05）. [Conclusion] The immune status before treatment indicates antiviral effect. The better immune status before treatment mean better antiviral efficacy. The two types of antiviral drugs can significantly improve immune function in patients with CHB. For patients with CHB, the detection of T cell subsets before antiviral treatment is beneficial to judgment of curative effect.