不同基因型HBV感染患者临床表现及肝组织内免疫活性细胞表达的研究

Clinical characteristics and immunocompetent cell populations in liver tissues of hepatitis B patients with different HBV genotype

目的探讨桂林地区不同基因分型慢性乙型肝炎(chronic hepatitis B,CHB)患者临床表现及肝内免疫活性细胞(CD4+、CD8+、CD20+、CD57+)与肝脏病理的关系。方法对70例2008年1月至2013年12月在桂林市第三人民医院肝病科住院CHB患者进行肝组织活检术,其中B基因型44例,C基因型26例,并运用免疫组织化学法分析肝组织内CD4+、CD8+、CD20+、CD57+淋巴细胞的表达,比较不同乙型肝炎病毒(HBV)基因分型患者CD4+、CD8+、CD20+、CD57+淋巴细胞与临床相关性。结果桂林地区CHB患者以B基因型为主,B、C两组基因型在年龄、白蛋白(albumin,ALB)、球蛋白(globulin,GLB)差异无统计学意义,而C基因型丙氨酸氨基转移酶(alanine aminotransferase,ALT)水平高于B基因型(P<0.05),B基因型HBeAg阳性率高于C基因型(P<0.05),C基因型肝脏组织病理损害程度比B基因型严重(P<0.05);B基因型CHB患者炎症程度到达G4组及C基因型到达G3组肝组织中CD4+、CD8+、CD20+的表达均比G1组明显增加,差异有统计学意义(P<0.05);C基因型组炎症程度到达G4肝组织中CD57+T细胞表达比G1明显增加,差异有统计学意义(P<0.05),B基因型ALT与CD4+、CD8+、CD20+T细胞水平呈直线相关(r值分别为0.554、0.678、0.740,P均<0.01),与CD57+无相关性,而C基因型ALT与CD8+、CD20+、CD57+T淋巴细胞水平呈直线相关关系(r值分别为0.517、0.626、0.737,P均<0.05),与CD4+无相关性。结论CHB患者以B基因型为主,B基因型患者HBeAg阳性率明显高于C基因型患者,C基因型肝脏组织病理损害程度比B基因型严重,B、C基因型患者肝组织内CD4+、CD8+、CD20+表达与肝组织内炎症分级均有明显相关性,不同基因型疾病严重程度与机体的免疫状况有关。

Objective To study hepatitis B virus（HBV）genotypes and the clinical characteristics,immunocompetent cell populations in liver tissues chronic hepatitis B（CHB）patients. Methods CHB patients were recruited for needle biopsy of liver at the Department of Hepatitis in the Third People′s Hospital of Guilin from January 2008 to December 2013.HBV genotypes were determined and immunocompetent cell types of CD4＋,CD8＋,CD20＋,CD57＋were detected by immunochemistry. Results A total of 70 chronic hepatitis B patients were recruited for needle liver biopsy;44HBV strains were genotype B and 26 genotype C but without significant difference in age,ALB and GLB.The positive rate of HBeAg in genotype B patients is higher than that in genotype C patients（P〈0.05）;however,the level of ALT in genotype C is higher than that in genotype B（P〈0.05）.The injury degree of liver in genotype C group is higher than that in genotype B group;the.The expression of CD4＋,CD8＋,CD20＋in liver tissues of genotype B（above G4stage）and genotype C（above G3stage）is obviously increased than that in G1stage（P〈0.05）.The expression of CD57＋T in liver tissue of genotype C（G4stage）was markedly higher that that of G1stage（P〈0.05）.ALT levels in genotype B was linearly correlated with CD4＋,CD8＋,CD20＋T levels（r values were 0.554,0.678,0.740,P〈0.01）but not with CD57＋;ALT levels in genotype C were linearly correlated with CD8＋,CD20＋,CD57＋T lymphocyte levels（r values were 0.517,0.626,0.737,P〈0.05）but not with CD4＋. Conclusions Most chronic hepatitis B patients recruited in this hospital were infected with genotype B HBV;the positive rate of HBeAg at genotype C HBV-infected patients was higher than that in genotype C HBV-infected patients.Liver injury degree in genotype C HBV-infected patients was higher than that of genotype B.The expression of CD4＋,CD8＋,CD20＋in genotype B and C liver tissues were correlated with the grade of liver damage.