乙型病毒性肝炎并原发性肝癌患者外周血中T淋巴细胞的表达研究

Study on the expression of T lymphocytes in peripheral blood of patients with hepatitis B and primary liver cancer

目的观察乙型病毒性肝炎(乙肝)并原发性肝癌(肝癌)患者外周血中T淋巴细胞亚群表达水平的变化,为临床肝癌的诊断及治疗提供理论依据。方法收集2017年1月—2018年3月石家庄市第五医院诊治的167例乙肝患者、151例乙肝并肝癌患者以及30例健康者抗凝血;根据病程将乙型肝炎病毒(HBV)感染者进一步分为慢性乙肝组103例、乙肝肝硬化组64例、肝癌组151例;根据BCLC分期将乙肝并肝癌组患者分为A期45例、B期62例、C期34例、D期10例;根据HBV载量将乙肝并肝癌组患者分为低复制组33例、中复制组38例、高复制组32例。采用流式细胞术对以上各组研究对象外周血中CD3^+、CD4^+、CD8^+T淋巴细胞表达量进行检测。结果乙肝组和乙肝并肝癌组患者CD3^+、CD4^+、CD8^+T淋巴细胞表达量均明显低于正常水平(P均<0.05);HBV感染者中,乙肝并肝癌组CD8^+表达量明显低于慢性乙肝组、肝硬化组(P均<0.05);肝癌D期患者CD3^+、CD8^+表达量较A、B、C期者明显降低(P均<0.05);在肝癌患者中,HBV载量高复制组CD4^+表达量较低复制组明显降低(P<0.05)。结论乙肝并肝癌患者CD8^+T淋巴细胞亚群表达水平明显降低;HBV感染导致的CD8^+T淋巴细胞功能受损可能是HBV感染患者易诱发肝癌的机制之一;治疗乙肝并肝癌的适宜时期为A、B、C期;在临床上,当乙肝并肝癌患者体内HBV开始复制时,应及早采取措施进行抗病毒治疗。

Objective It is to observe the changes in the expression levels of T lymphocyte subsets in the peripheral blood of patients with hepatitis B and primary liver cancer,so as to provide a theoretical basis for the diagnosis and treatment of liver cancer in clinic.Methods The anticoagulant blood of 167 patients with hepatitis B,151 patients with hepatitis B and primary liver cancer and 30 healthy persons treated in the Fifth Hospital of Shijiazhuang was collected.According to the course of disease,the patients with hepatitis B virus(HBV)were further divided into chronic hepatitis B group(n=103),liver cirrhosis group(n=64),and liver cancer group(n=15).According to the BCLC staging,the patients with hepatitis B and liver cancer were divided into stage A group(n=45),stage B group(n=62),stage C group(n=34),and stage D group(n=10).According to the HBV load,the patients with hepatitis B and liver cancer were divided into low replication group(n=33),medium replication group(n=38),and high replication group(n=32).The expression levels of CD3^+,CD4^+,and CD8^+T lymphocytes in the peripheral blood of the above groups of subjects were detected by flow cytometry.Results The expression of CD3^+,CD4^+,and CD8^+T lymphocytes in the liver cancer group and hepatitis B group was significantly lower than the normal level(P<0.05);among the patients with hepatitis B virus infection,the CD8^+expression in the liver cancer group was significantly lower than that in the hepatitis B group and cirrhosis group(P<0.05).The expression levels of CD3^+and CD8^+in stage D patients were significantly lower than those in stages A,B,and C(P<0.05).In the patients with liver cancer,the expression of CD4^+expression in the high replication groups was significantly was lower than that in the low replication group(P<0.05).Conclusion The expression level of CD8^+T lymphocyte subsets in patients with hepatitis B and liver cancer is significantly reduced;the impairment of CD8^+T lymphocyte function caused by hepatitis B virus infection may be one of the mechanisms by which patients with HBV virus infection is likely to induce liver cancer;the suitable period for treatment of hepatitis B with liver cancer is stage A,B,and C.When the hepatitis B virus in patients with hepatitis B and liver cancer begins to replicate,early measures should be taken for antiviral treatment in clinic.