慢性乙型肝炎患者和乙型肝炎病毒携带者外周血T细胞亚群的变化和意义

目的分析慢性乙型肝炎患者、乙型肝炎病毒携带者和正常人外周血T细胞亚群的差异,探讨乙型肝炎的发病机制与宿主细胞免疫功能的关系。方法收集2004年2月至7月在中国医学科学院中国协和医科大学北京协和医院肝炎门诊就诊的的慢性乙型肝炎患者29例、HBV携带者25例及健康献血员35例的外周血,使用流式细胞仪检测T细胞亚群,分析其差异及临床意义。结果慢性乙肝患者、HBV携带者和正常对照外周血CD4+T细胞计数分别为565±192、672±148和816±259;CD8+T细胞计数分别为491±225、445±157和609±177。与正常对照组比较,慢性乙肝患者和HBV携带者外周血白细胞、淋巴细胞、T细胞、CD4+T细胞、CD8+T细胞、CD4+CD28+T细胞、CD8+CD28+T细胞计数均减少,慢性乙肝患者NK细胞计数减少;与正常对照和HBV携带者相比,慢性乙肝患者CD8+CD38+T细胞和CD4+CD45RA-记忆/效应T细胞比例显著升高,CD4+CD45RA+62L+初始T细胞比例及计数均显著减少。结论慢性乙肝患者和HBV携带者体内存在T淋巴细胞亚群失衡和细胞免疫功能紊乱,这可能与乙肝病毒感染后慢性化相关。

Difference and significance of peripheral blood T-lymphocyte subsets in patients with chronic hepatitis B and asymptomatic HBV carriers

OBJECTIVE: To investigate the difference of peripheral blood T-lymphocyte subsets in patients with chronic hepatitis B and asymptomatic HBV carriers, and to analyze the relationship between the pathogenesis of hepatitis B and the hosts' cellular immunity. METHODS: Flow cytometry was used to detect the peripheral blood T-lymphocyte subsets in 29 patients of chronic hepatitis B, 25 asymptomatic HBV carriers and 35 healthy blood donors. RESULTS: Compared with normal controls, the numbers of leucocytes, lymphocytes, T-lymphocytes, CD4+ T cells, CD8+ T cells, CD4+CD28+ T cells and CD8+CD28+ T cells decreased in both the patients with chronic hepatitis B and asymptomatic HBV carriers, the number of NK cells of the patients with chronic hepatitis B decreased as well. Compared with normal controls and asymptomatic HBV carriers, the proportions of CD8+CD38+ T cells and CD4+CD45RA-memory T cells markedly increased and the proportion and number of CD4+CD45RA+62L+ T cells decreased in patients with chronic hepatitis B. CONCLUSION: There is an imbalance in peripheral blood T-lymphocyte subsets and turbulence in cellular immunity in the patients with chronic hepatitis B and asymptomatic HBV carriers, which may be associated with HBV persistent infection.