急慢性乙型肝炎患者外周血调节性T细胞鉴定与临床意义

Identification and Clinical Significance of Regulatory T Cells in Peripheral Blood of Patients with Acute or Chronic Hepatitis B

目的探讨急慢性乙型肝炎患者外周血调节性T细胞的鉴定与临床意义。方法选择本院收治的急慢性乙型肝炎患者82例,其中急性乙肝患者(AHB)40例,慢性乙肝患者(CHB)42例,同期入选体检健康者40例为对照组。应用流式细胞仪分析Treg细胞表面及细胞内分子表达、Treg频率,应用实时荧光定量RT-PCR检测血清HBV DNA载量;评估三组外周血调节性T细胞表面、细胞内分子表达、Treg频率水平,评估急慢性乙型肝炎患者的血清HBV DNA载量指标。结果慢性乙型肝炎患者的Treg占CD4^+T细胞频率显著高于急性乙型肝炎组,差异有统计学意义(P<0.05);慢性乙型肝炎组与健康对照组比较差异无统计学意义(P>0.05);急性乙型肝炎组与健康对照组比较差异有统计学意义(P<0.05)。慢性乙型肝炎组在高病毒载量患者的Treg频率为(4.6±1.8)%,显著高于低病毒载量患者的(3.2±0.7)%,差异有统计学意义(t=5.22,P<0.05);急性乙型肝炎患者恢复期的Treg频率为(6.1±1.6)%,显著高于急性期的(3.0±0.8)%,差异有统计学意义(t=10.25,P<0.05)。结论慢性乙型肝炎患者高病毒载量组的CD4^+Treg频率显著增高,说明Treg可通过抑制细胞免疫反应影响病毒清除;急性乙型肝炎早期患者的Treg较低,随后增高,可能与急性乙型肝炎不同发病阶段的Treg所起作用密切相关。

Objective To explore the identification and clinical significance of regulatory T cells in peripheral blood of patients with acute or chronic hepatitis B. Methods Treg in peripheral blood from 42 chronic hepatitis B （CHB） patients, 40 acute hepatitis B （AHB） patients and 40 healthy subjects were quantitatively analyzed using flow cytometry. HBV DNA levels of patients with acute or chronic hepatitis B were measured using real-time RT-PCR. Results CHB patients presented a higher fraction of circulating Treg than AHB patients （P〈0.05）, but were similar to healthy controls （P〉0.05）; AHB patients presented a lower fraction of circulating Treg than healthy controls （P 〈0.05）. CHB patients with high viral load had a higher frequency （4.6% ± 1.8%） of circulating Treg than CHB patients with low viral load （3.2% ±0.7%）, with statistical difference （t = 5.22, P〈0.05）. Treg was more frequent in convalescent phase （6.1% ±1.6%） than in early acute phase （3.0% ± 0.8%） of AHB patients, with statistical difference （t = 10.25, P〈0.05）. Conclusions Increased peripheral Treg is found to be associated with HBV replication in chronic hepatitis B, suggests that Treg can affect viral clearance by inhibiting cellular immune response. In acute HBV infection, Treg is less frequent in early phase, and increases later, which may be closely related to the role of Treg in different stages of acute hepatitis.