HBV慢性感染者不同阶段的特异性CTLs水平分析

The expression of HBV-specific cytotoxic T lymphocytes during different disease phases in patients with chronic HBV infection

目的探讨乙肝病毒(HBV)慢性感染者疾病不同阶段的特异性细胞毒性T淋巴细胞(CTLs)水平及其临床意义。方法本研究共收集乙肝病毒慢性感染患者81例,表面抗体和核心抗体阳性的正常对照20例,依据HBV感染后的自然史将慢性HBV感染者分为免疫耐受期患者(耐受组)、免疫清除期患者(活动组)和非活动期患者(非活动组),采用酶联免疫斑点试验(ELISPOT)检测患者外周血中分泌IFN-γ的特异性CTLs数量,并分析其与临床指标的相关性。结果慢性HBV感染者的特异性CTLs反应较弱,其反应强度和阳性率均明显低于正常对照组(P<0.05)。对于不同疾病分期的慢性HBV感染者,CTLs数量在免疫耐受组<非活动组<活动组,差异有统计学意义(P<0.05)。相关性分析显示,免疫清除期患者的表面抗原和核心抗原特异性CTLs数量与血清ALT之间呈显著正相关(P<0.05)。结论慢性HBV感染者不同阶段的特异性免疫反应存在明显差异,对于免疫清除期患者,血清ALT在一定程度上反应了HBV特异性CTLs反应的强度。

To explore the changing of peripheral blood HBV-specific cytotoxic T lymphocytes （CTLs） during different disease phases in patients with chronic hepatitis B virus （HBV） infection, 81 patients with chronic HBV infection and 20 healthy adults with HBsAb-HBeAb-positive were enrolled in this study. The 81 patients were divided into immune tolerant phase patients （tolerant group）, immune reactive phase patients （reactive group） and inactive phase patients （inactive group） according to the natural history of chronic HBV infection. The numbers of HBV-specific CTLs were detected by interferon-gamma enzyme-linked immunospot （ELISPOT） assay. Data shown that the HBV-specific CTLs in the patients with chronic HBV infection were significantly weaker than those in the healthy adults （P〈 0.05）. In addition, the number of CTLs in tolerant group was less than that in inactive group （P〈 0.05）, and the number of CTLs in inactive group were less than that in reactive group （P 〈 0.05）. Furthermore, the number of CTLs in reactive group was positively correlated with the levels of ALT （P〈 0.05）. All this results suggest that the expression of HBV-specific CTLs is obviously different among the patients during different disease phases. And in immune reactive phase patients, the level of ALT represents the strength of the HBV-specific CTLs responses to some extent.