慢性肝病患者免疫状态对HBV血清学标志物表达模式的影响

目的探讨慢性肝病患者免疫状态对乙肝病毒血清学标志物（HBVM）表达模式的影响。方法以确诊的慢性肝病患者包括慢性病毒性乙型肝炎轻、中、重度、慢性重型乙型肝炎、肝炎肝硬化和原发性肝细胞癌患者作为研究对象,采用ELISA法对研究对象的乙肝病毒血清学标志物（HBsAg、HBsAb、HBeAg、HBeAb和HBcAb）、IL-2、IL-10进行检测,采用流式细胞仪进行CD4＋、CD8＋T细胞分析,应用两样本均数比较的统计学方法进行统计学分析。结果慢性肝病患者共有3种HBVM表达模式：大三阳（HBsAg、HBeAg和HBcAb阳性）、小三阳（HBsAg、HBeAb和HBcAb阳性）和小二阳（HBsAg和HBcAb阳性）模式。大三阳、小三阳和小二阳表达模式的阳性率分别为31.09%、57.14%和11.77%;小三阳表达模式组的CD8＋细胞显著低于大三阳表达模式组（P〈0.05）,其余各组间的IL-2、IL-10、CD4＋、CD8＋T细胞水平虽有差别但差异无统计学意义（P〉0.05）。结论慢性肝病患者小三阳表达模式多见;患者血中CD8＋细胞水平低可能有助于慢性肝病患者HBVM小三阳模式的表达,反之可能有助于HBVM大三阳模式的表达。

The Influence of Immune Status on the Expression Patterns of Hepatitis B Virus Markers in Patients with Chronic Hepatic Diseases

Objective To investigate the influence of immune status on the expression patterns of hepatitis B virus serological markers（HBVM）in patients with chronic hepatic diseases related to hepatitis B virus infection（CHB）.Methods Peripheral blood was collected from the patients with chronic hepatic diseases due to hepatitis B virus infection（including clinical types of mild,moderate and heavy degree）,chronic severe hepatitis,cirrhosis and hepatocellular carcinoma.IL-2,IL-10 and HBVM（HBsAg,HBsAb,HBeAg,HBeAb,HBcAb） were determined by ELISA,and the levels of CD4＋ and CD8＋ T-lymphocytes were tested by flow cytometry（model EPICS XL）.Results The expression of HBVM in the patients with hepatitis B virus infection was large three positive patterns（HBsAg,HBeAg,HBcAb;L3PP）,small three positive patterns（HBsAg,HBeAb,HBcAb;S3PP）,small two positive patterns（HBsAg,HBcAb;S2PP）.The rates of the three patterns were 31.09%,57.14% and 11.77% respectively.The level of CD8＋ T-lymphocytes in the S3PP group was significantly lower than that in the L3PP group（P0.05）.There were no significant（P0.05）difference in the levels of IL-2,IL-10,CD4＋,CD8＋,T-lymphocytes in the other groups.Conclusions Small three positive patterns（HBsAg,HBeAb,HBcAb;S3PP）might be the most commonly encountered in the patients with chronic hepatic diseases（due） to hepatitis B virus infection.Lower level of CD8＋ T-lymphocytes might be inclined to HBVMdevelop the expression of small three positive patterns,on the contrary,might develop the expression of large three positive patterns.