HBeAg阳性慢性乙型病毒性肝炎患者外周血中分泌IL-21的CD4^(+)T细胞频数的检测及临床意义

Clinical significance of IL-21-secreting by CD4^(+)T lymphocyte frequency in peripheral blood of HBeAg-positive chronic hepatitis B patients

目的分析HBeAg阳性慢性乙型病毒性肝炎(慢乙肝)患者外周血中分泌白细胞介素21(IL-21)的CD4^(+)T细胞(CD4^(+)IL-21+T细胞)频数,了解其对慢乙肝患者抗病毒治疗结局的影响及意义。方法收集67例HBeAg阳性慢乙肝患者的一般资料、基线时ALT、HBV DNA定量、HBsAg定量、IL-21和CD4^(+)IL-21+T细胞频数,并进行检测分析。结果67例HBeAg阳性慢乙肝患者中,接受核苷(酸)类似物治疗后出现HBeAg阴转或血清转换慢乙肝患者39例,HBeAg持续阳性者28例。HBeAg阴转或血清转换组与HBeAg持续阳性组间的年龄(P=0.963)、基线ALT(P=0.071)、基线HBV DNA(P=0.716)和用药疗程(P=0.589)的差异无统计学意义。分析结果显示,HBeAg阴转或血清转换组的IL-21、CD4^(+)IL-21+T细胞频数和HBsAg定量较HBeAg持续阳性组差异有统计学意义,P值分别为0.004、<0.001、0.028。logistic多因素分析显示CD4^(+)IL-21+T细胞频数和HBsAg定量在两组间差异有统计学意义,P值分别为0.001和0.026。结论多因素分析结果显示CD4^(+)IL-21+T细胞频数和HBsAg定量可用于预测HBeAg阳性慢乙肝患者抗病毒治疗后发生HBeAg阴转或血清学转换。

Objective To analyze the frequency of IL-21 expression on CD4^(+)T lymphocytes in peripheral blood of patients with HBeAg-positive chronic hepatitis B,and to understand its effect on the outcome of antiviral treatment.Methods The general biological data,alanine aminotransferase(ALT)at baseline,HBV DNA,HBsAg,IL-21 and CD4^(+)IL-21+T cell frequency were collected and analyzed for 67 HBeAg-positive chronic hepatitis B patients.Results Of the 67 patients with HBeAg,39 achieved HBeAg negative or serum conversion after treatment with nucleoside(acid)analogue,and 28 remained persistent HBeAg positive.No significant difference was found in age(P=0.963),baseline ALT(P=0.071),baseline HBV DNA(P=0.716),and treatment course(P=0.589)between HBeAg negative or serum conversion group and HBeAg persistent positive group.IL-21,CD4^(+)IL-21 T cell frequency and HBsAg quantity showed significant difference between HBeAg negative or serum conversion group and HBeAg persistent positive group(P=0.004,<0.001,and=0.028,respectively).Logistic regression analysis showed that CD4^(+)IL-21+T cell frequency and the quantity of HBsAg were different significantly between the two groups(P=0.001 and 0.026,respectively).Conclusions CD4^(+)lL-21+T cell frequency and HBsAg can be used to predict the HBeAg negative or serum conversion outcome of antiviral therapy in patients with chronic B hepatitis.