摘要
目的探讨乙肝病毒(HBV)感染后不同临床类型乙型肝炎患者及HBV DNA载量与外周血T细胞亚群的关系。方法选取确诊的共193例急性乙型肝炎、慢性乙型肝炎、慢性重型肝炎、亚急性重型肝炎、急性重型肝炎、乙肝肝硬化、乙肝肝癌、HBV携带者的外周血,流式细胞仪检测T细胞亚群,荧光定量PCR法检测HBV DNA水平。结果对照组CD3+、CD4+细胞百分率、CD4+/CD8+细胞比值明显高于各临床类型组,随病情加重CD3+、CD4+细胞百分率、CD4+/CD8+细胞比值下降明显,除急性乙型肝炎组和慢性肝炎组CD4+细胞百分率外与各组比较差异有统计学意义(P〈0.05及P〈0.01);对照组CD8+细胞百分率、CD4+/CD25+细胞比值明显低于各临床类型组,随病情加重CD8+细胞百分率、CD4+/CD25+细胞比值升高明显,各组比较差异有统计学意义(P〈0.05及P〈0.01)。低水平HBV DNA载量组(≤103 Copies/ml)CD3+、CD4+细胞百分率明显高于其他各病毒组,随病毒载量增加CD3+、CD4+细胞百分率逐渐减少,与各组比较差异有统计学意义(P〈0.05及P〈0.01);低水平HBV DNA载量组CD8+细胞百分率最低,随病毒载量增加CD8+细胞百分率升高明显,与各组比较差异有统计学意义(P〈0.05及P〈0.01);低水平HBV DNA载量组CD4+/CD8+及CD4+/CD25+细胞比值最高,其比值随病毒载量增加下降明显,低水平组CD4+/CD25+细胞比值与各组比较差异有统计学意义(P〈0.05及P〈0.01),低水平组CD4+/CD8+细胞比值与各组(103~105组除外)比较差异有统计学意义(P〈0.05及P〈0.01)。除乙肝肝硬化的CD4+细胞百分率外,同病种肝病的HBV DNA(+)组CD3+、CD4+、CD8+细胞百分率、CD4+/CD8+及CD4+/CD25+细胞比值与HBV DNA(-)组比较,差异有统计学意义(P〈0.05及P〈0.01)。结论细胞免疫功能紊乱是HBV感染后发病机制之一,高水平HBV DNA载量可能诱导和加重细胞免疫功能紊乱,CD4+/CD8+及CD4+/CD25+比值变化可为了解病情变化和指导治疗提供依据。
【Objective】 To investigate the relationship between peripheral blood T cell subsets and HBV DNA load in patients with different clinical types of hepatitis B virus(HBV) infection. 【Methods】 A total of193 cases diagnosed as acute hepatitis B, chronic hepatitis B, chronic severe hepatitis, subacute severe hepatitis, acute severe hepatitis, hepatitis B liver cirrhosis, hepatitis B liver cancer or HBV carriers were enrolled into this study. T cell subsets and HBV DNA load were detected in their peripheral blood using flow cytometry and fluorescence quantitative PCR, respectively. 【Results】 The percentages of CD3+and CD4+cells and CD4+/CD8+cell ratio in the control group were significantly higher than those in the clinical groups, which significantly decreased along with the increased severity of the diseases; the differences were statistically significant between the control group and the different clinical groups except CD4+T cell percentage in acute hepatitis B group and chronic hepatitis group(P 〈0.05 and P 〈0.01). The percentage of CD8+T cells and CD4+/CD25+cells ratio in the control group were lower than those in the clinical groups, which significantly increased as the disease severity increased; the differences were statistically significant between the control group and the different clinical groups(P 〈0.05 and P 〈0.01). The percentages of CD3+and CD4+cells in the low HBV DNA load group(≤103Copies/ml) were significantly higher than those in the groups with higher HBV DNA loads(P 〈0.05 and P 〈0.01), they gradually decreased with the increase of viral loads. The percentage of CD8+T cells was the lowest in the low HBV DNA load group and had significant differences compared to that in other groups(P 〈0.05 and P 〈0.01), it increased obviously with the increase of viral loads.The ratios of CD4+/CD8+and CD4+/CD25+cells were the highest in the low HBV DNA load group, the ratios significantly decreased with the increase of viral load. The CD4+/CD25+cell ratio in the low HBV DNA load group was statistically different from that in other groups(P 〈0.05 and P 〈0.01), the CD4+/CD8+cell ratio in the low HBV DNA load group was significantly different from that in other groups except the group with viral load of 103~105Copies/ml(P 〈0.05 and P 〈0.01). Except for the percentage of CD4+cells in the hepatitis B cirrhosis group, the percentages of CD3+, CD4+and CD8+cells and CD4+/ CD8+and CD4+/ CD25+cell ratios in the HBV DNA(+) subgroup were statistically different from those in the HBV DNA(-) subgroup of the same liver disease group(P 〈0.05 and P 〈0.05). 【Conclusions】 Cellular immune dysfunction is one of the pathogenic mechanisms of HBV infection. High level of HBV DNA load may induce and aggravate cellular immune dysfunction. The changes in CD4+/CD8+and CD4+/CD25+ratios can provide the basis for understanding the change of patient's condition and guiding the treatment.
出处
《中国现代医学杂志》
CAS
北大核心
2015年第17期35-41,共7页
China Journal of Modern Medicine