阿德福韦酯治疗慢性乙肝后细胞免疫水平的临床研究

Cellular immune status in patients with chronic hepatitis B after treatment with Adefovir dipivoxil tablets

目的探讨阿德福韦酯治疗慢性乙肝(CHB)患者后免疫应答和细胞免疫状态。方法采用时间分辨法检测乙型肝炎病毒(HBV)血清标志物,酶联免疫吸附法检测白细胞介素-21(IL-21)水平,荧光定量聚合酶链反应检测血清HBV-DNA,流式细胞术检测HBV特异性细胞毒性T淋巴细胞(CTL)和滤泡辅助性T淋巴细胞(Tfh)的变化。结果阿德福韦酯治疗72周后HBV-DNA水平下降,血清IL-21水平、外周血HBV特异性CTL和Tfh水平高于治疗前(P<0.05),治疗后HBV-DNA转阴组和HBe Ag转阴组中血清IL-21水平、外周血HBV特异性CTL、Tfh水平高于未转阴组(P<0.05),而HBV-DNA转阴组和HBe Ag转阴组各检测指标比较,差异无统计学意义(P>0.05)。结论阿德福韦酯治疗CHB可提高血清IL-21、HBV特异性CTL及Tfh水平,该变化可能与CHB患者抗病毒治疗后病毒性应答有关。

Objective To investigate the dynamic variations of virological response and cellular immunity of patients with chronic hepatitis B （CHB） after Adefovir dipivoxil treatment. Methods Serum IL-21 level was analyzed by ELISA. HBV-DNA level was assayed by fluorescent quantitative polymerase chain reaction （FQ- PCR）. Peripheral T lymphocyte subsets of HBV special CTL and T follicular helper cells （Tfh） were examined by flow cytometry （FACS）. Results After treatment with Adefovir dipivoxil for 72 weeks, the serum HBV-DNA level was dramatically decreased, the levels of serum IL-21 and HBV special CTL and Tfh were significantly higher compared to those before treatment （P〈 0.05）. Moreover, the levels of serum IL-21 and HBV special CTL and Tfh in the HBV-DNA conversion and HBeAg conversion groups were significant higher than those in the HBV-DNA non-conversion and HBeAg non-conversion groups, respectively （P〈 0.05）. Conclusions The levels of serum IL-21, peripheral HBV special CTL and Tfh in CHB patients increase after thetreatment with Adefovir dipivoxil, which might be related with the cellular immune status of patients after antiviral treatment.