自体树突状细胞联合抗病毒药治疗HBeAg阳性慢性乙型肝炎临床效果研究

目的探讨体外诱导自体树突状细胞（DC）对 HBeAg阳性慢性乙型肝炎的治疗效果。方法选择 HBeAg阳性的慢性乙型肝炎病例126例，随机分成治疗组（75例）和对照组（51例），治疗组采用自体 DC联合恩替卡韦治疗，对照组仅采用恩替卡韦治疗。抽取患者静脉血50 ml，密度梯度离心法获得单个核细胞，加入含 GM-CSF和 rhIL-4的培养基，隔日换液，培养至第6天加入 HBsAg，4 h后加入 TNF，继续培养1 d收获 DC。取 DC 2 ml，皮下注射和静脉输注各1 ml，连续3个月。两组患者于治疗前和治疗后6个月检测肝功、HBV-DNA 定量及血清乙型肝炎标志物，并将两组各项检测指标进行对比。结果治疗6个月后检测患者 HBeAg/抗-HBe血清转换率，治疗组和对照组分别为30.62%（23/75）和21.4%（11/51），自体 DC联合恩替卡韦治疗 HBeAg阳性的慢性乙型肝炎的效果优于单纯恩替卡韦的治疗。HBV-DNA 滴度检测治疗组为500拷贝/ml，对照组为1400拷贝/ml。两组差异有统计学意义。结论自体 DC联合恩替卡韦治疗 HBeAg阳性的慢性乙型肝炎的效果优于单纯恩替卡韦的治疗。

Effects of autologous dendritic cells combined with antiviral treatment on HBeAg-positive chronic hepatitis B

Objective To investigate the clinical effects of autologous dendritic cells combined with antiviral treatment on HBeAg-positive chronic hepatitis B. MethodsA total of 126 patients with hepatitis Be antigen （HBeAg） positive chronic hepatitis B were assigned to receive autologous Dendritic cells （DCs） and entecavir （ETV） treatment （experiment group including 75 patients） or only ETV group （control group including 51 patients）. Mononuclear cells in venous blood of 50 ml extracted from patients were obtained by density gradient centrifugation. DCs were obtanined after the mononuclear cells were cultured with medium containing GM-CSF and rhIL-4, and then added HBsAg and TNF on the sixth day, and lastly continued to cultivate one more day. The treatment of subcutaneous and intravenous injection of 1ml of DCs respectively lasted for 3 months. Liver function and the level of HBV-DNA and serum markers of hepatitis B were examined and compared after the treatment of the two groups. Results The rate of HBeAg seroconversion were 30.62% （23/75） and 21.4% （11/51） in experiment and control group after treatment for six months. The level of HBV-DNA were 500 copies/ml and 1400 copies/ml in experiment and control group, respectively. There existed statistical significance in both of the differences between the two groups. Conclusion In terms of improving HBeAg serological conversion rate,autologous DCs combined with ETV treatment exerts more potent effects on HBeAg-positive chronic hepatitis B as compared to ETV treatment.