气阴两虚型HBV相关原发性肝癌患者外周血CD4^+、CD8^+ T细胞特征

Characteristics of CD4^+ and CD8^+ T cells in peripheral blood of patients with HBVrelated primary liver cancer of Qi-Yin deficiency type

目的观察中医证型在乙型肝炎病毒相关原发性肝癌患者(hepatitis B virus related primary liver cancer,HBV-PLC)发生和进展过程中的分布情况,比较不同中医证型外周血T淋巴细胞亚群、B细胞的变化.方法收集在首都医科大学附属北京地坛医院住院的67例HBV-PLC患者,55例乙型肝炎肝硬化患者(liver cirrhosis,LC),40例慢性乙型肝炎患者(chronic hepatitis B virus,CHB).收集3组患者一般资料、临床生化指标和中医辨证分型.采用流式方法检测3组患者外周血中CD3^+T淋巴细胞、CD4^+T、CD8^+T、CD3^-CD19^+B细胞的分布情况.结果从CHB、LC到HBV-PLC进展中气阴两虚型比例增加,肝郁脾虚型减少;在肝癌Child、Okuda、BCLC分期中早期以肝郁脾虚型为主,晚期以气阴两虚型为主.HBV-PLC中气阴两虚型患者与肝郁脾虚型比较:总胆红素、直接胆红素、凝血酶原时间、凝血酶原活动度、B细胞百分比明显升高(P<0.01),A/G、CHE、T淋巴细胞、CD8^+T细胞的计数和百分比、CD4^+T细胞计数均明显减少(P<0.05).气阴两虚型的LC和HBV-PLC与CHB患者比较,其T淋巴细胞、CD4^+、CD8^+T细胞存在不同程度的降低(P<0.05).结论随着肝癌的发生和进展,患者逐渐由肝郁脾虚型为主转为气阴两虚型为主,气阴两虚型患者肝脏功能更差,细胞免疫减弱,病情较重,预后较差.

AIM To observe the traditional Chinese medicine（TCM） syndrome distribution in the occurrence and progression of hepatitis B virus-related primary liver cancer（HBV-PLC） and compare the changes of T and B cells among different HBV-PLC syndromes. METHODS The laboratory characteristics and TCM syndromes of 67 HBV-PLV patients 55 liver cirrhosis（LC） patients and 40 chronic hepatitis B（CHB） patients were collected at Beijing Ditan Hospital Affiliated to Capital Medical University. The distributions of CD3＋ T,CD4＋T CD8＋ T and CD3-CD19＋ B cells in peripheral blood of all patients were detected by flow cytometry. RESULTS Compared with CHB and LC patients the percentage of HBV-PLC patients of Qi and Yin deficiency type increased but that of liver depression and spleen deficiency type declined.In terms of Child,Okuda,and BCLC stages of liver cancer the early stage was mostly associated with liver depression and spleen deficiency while the advanced stage was mainly associated with Qi and Yin deficiency. Compared with HBV-PLC patients with liver depression and spleen defi ciency type TBIL DBIL PT PTA and the percentage of B cells increased in patients with Qi and Yin defi ciency（P0.001） while A/G CHE the numbers and percentages of T and CD8＋ cells and the number of CD4＋ cells signifi cantly decreased（P〈0.05） in patients with Qi and Yin deficiency. The numbers of T CD4＋ T,CD8＋ T and B cells were less in the LC and HBV-PLC patients of Qi and Yin deficiency type than in CHB patients of the same type（P〈0.05）.CONCLUSION The TCM syndrome changes from liver depression and spleen defi ciency to Qi and Yin defi ciency in the occurrence and progression of HBV-PLC. HBV-PLC patients with Qi and Yin defi ciency have worse liver function lower antitumor immune response and poorer prognosis compared with patients with other types.