不同乙肝病毒DNA载量的慢性乙型肝炎患者外周血中Th17/Treg表达及意义

Expression and clinical significance of Th17/Treg in peripheral blood of patients with chronic hepatitis B in different virus DNA loads

目的探讨不同乙肝病毒(HBV)-DNA载量的慢性乙型肝炎(CHB)患者外周血中辅助性T细胞17/调节性T细胞(Th17/Treg)表达及临床意义。方法前瞻纳入乐山市人民医院检验科检测的217例CHB患者为研究对象,检测患者HBV-DNA载量并分组;调查并记录患者基线资料,重点观察外周血Th17、Treg、Th17/Treg表达,同时检测患者外周血肝纤维化相关指标[谷氨酸氨基转移酶(ALT)、天门冬氨酸基转移酶(AST)],分析外周血Th17/Treg表达与CHB患者HBV-DNA载量及主要肝纤维化指标的关系。结果217例CHB患者中低HBV-DNA载量64例,占29.49%,中HBV-DNA载量118例,占54.38%,高HBV-DNA载量35例,占16.13%;高HBV-DNA载量组ALT、AST、Th17、Treg、Th17/Treg水平均高于中HBV-DNA载量组、低HBV-DNA载量组,且中HBV-DNA载量组ALT、AST、Th17、Treg、Th17/Treg水平高于低HBV-DNA载量组,差异有统计学意义(P<0.05);3组间其他基线资料比较差异无统计学意义(P>0.05);经Spearman相关性分析检验,结果显示,CHB患者HBV-DNA载量分别与Th17/Treg、ALT、AST呈正相关(r>0,P<0.05),且Th17/Treg分别与ALT、AST呈正相关(r>0,P<0.05)。结论CHB患者HBV-DNA载量与外周血Th17/Treg呈正相关,且肝纤维化的发展也可能与Th17/Treg失衡有关,考虑未来可检测患者入院时Th17/Treg,辅助评估HBV-DNA载量与肝纤维化风险。

Objective To investigate the expression and its clinical significance of Th17/Treg in peripheral blood of patients with chronic hepatitis B(CHB)in different hepatitis B virus(HBV)-DNA loads.Methods A total of 217 patients with CHB who were detected in our hospital were enrolled in the study.The HBV-DNA load was detected and divided into groups.The baseline data of patients were investigated,and the expression levels of Th17,Treg and Th17/Treg in peripheral blood were detected,moreover,the related indexes of liver fibrosis in peripheral blood[glutamic acid aminotransferase(ALT),aspartate aminotransferase(AST)]were detected,and the correlation between Th17/Treg expression and HBV-DNA load as well as main liver fibrosis indexes was analyzed.Results Of 217 patients with CHB,64 cases had low HBV-DNA load,accounting for 29.49%;118 cases had medium HBV-DNA load,accounting for 54.38%;35 cases had high HBV-DNA load,accounting for 16.13%.The levels of ALT,AST,Th17,Treg and Th17/Treg in high HBV-DNA load group were higher than those in medium HBV-DNA load group and low HBV-DNA load group,and the levels of ALT,AST,Th17,Treg and Th17/Treg in medium HBV-DNA load group were higher than those in low HBV-DNA load group,with statistical significance(P<0.05).There were no significant differences in the baseline data among the three groups(P>0.05).Spearman correlation analysis showed that HBV-DNA load was positively correlated with Th17/Treg,ALT and AST(P<0.05),and Th17/Treg was positively correlated with ALT and AST(P<0.05).Conclusion HBV-DNA load is positively correlated with Th17/Treg in peripheral blood of patients with CHB,and the development of liver fibrosis may be related to the imbalance of Th17/Treg,it is suggested that the levels Th17/Treg should be detected in patients on admission to assistantly assess the risk of HBV-DNA load for liver fibrosis.