恩替卡韦对慢性乙型肝炎患者细胞免疫功能的影响

目的 探讨慢性乙型肝炎患者接受恩替卡韦抗病毒治疗前后细胞免疫学功能的变化.方法 纳入对象为慢性乙型肝炎患者（CHB）50例,分为治疗组30例,对照组20例,治疗组接受恩替卡韦抗病毒治疗12个月,对照组未接受核苷类似物或干扰素抗病毒治疗.通过流式细胞术动态分析两组患者外周T细胞亚群和CD4＋ CD25＋ Foxp3＋调节性T细胞的表型和频率变化.结果 接受恩替卡韦治疗的患者,与治疗前比较,治疗后3个月、6个月和12个月其CD4 T细胞、CD4/CD8逐渐增高和CD4＋ CD25＋ Foxp3＋调节性T细胞比例逐渐显著性降低,差异有统计学意义（P＜0.05）;而对照组观察前后差异无统计学意义（P＞0.05）.治疗组治疗后12个月,其调节性T细胞的下降幅度与血清HBV DNA的下降水平呈显著正相关（r=0.65,P＜0.01）.结论 恩替卡韦在有效抗病毒治疗同时具有改善患者的细胞免疫功能.

The effect of Entecavir on cell mediated immunity of patients with chronic hepatitis B during its antiviral treatment period

Objective To explore the role of Entecavir in CD4 ＊ T cells and CD4 ＋ CD25 ＋ Foxp3 ＋ regulatory T cells of patients with chronic hepatitis B.Methods Patients with chronic active hepatitis B （CAH,n =50） were divided into Entecavir treatment group （n =30） and controls （n =20）.The entecavir treatment group and the controls were followed up for 12 months.The frequency and phenotype of peripheral CD4 ＋ and CD4 ＋ CD25 ＋ Foxp3 ＋ T cells were detected by flow cytometry.Results Patients with CHB receiving entecavir treatment for 3 months,6 months and 12months exhibited significantly higher frequency of CD4 ＋ T cells and CD4/CD8 ratio as opposed to those of baseline levels（P 〈0.05）.The frequency of CD4 ＋CD25 ＋ Foxp3 ＋ T cells from the patients receiving entecavir treatment for 3 months,6 months and 12 months was significantly decreased compared with that of basline level（P 〈 0.05）.However,the frequency of CD4 T cells and CD4 ＋ CD25 ＋ Foxp3 ＋ T cells,as well as CD4/CD8 ratio of the control group following up for 12 months displayed no significant differences compared with its baseline levels.The serum HBV DNA level from the baseline to Entecavir treatment for 12 months was correlated with the frequency of CD4 ＋ CD25 ＋Foxp3 ＊ T cells from the baseline to Entecavir treatment for 12 months.Conclusions Entecavir not only can effectively suppress HBV replication,but also simultaneously improve the cellular immune function of chronic hepatitis B.