乙型肝炎病毒基因型不同的患者肝功能相关指标及免疫功能变化分析

目的 探讨基因型不同的乙肝患者肝功能、病毒载量和免疫功能的差异及临床意义.方法 145例乙肝患者划分两个年龄段:小于35岁和大于35岁,全部应用实时荧光PCR法进行乙型肝炎病毒(HBV)基因分型检测;同时采用实时荧光PCR法检测血清HBV-DNA载量;用全自动生化分析仪和流式细胞仪检测各组肝功能相关指标及淋巴细胞亚群含量.结果 145例HBV患者仅为两种基因型,B基因型62例(42.76％),C基因型83例(57.24％).B型患者谷丙转氨酶(ALT)、谷草转氨酶(AST)和HBV-DNA均稍高于C型,分别是(263.6±36.13) U/L比(243.1±37.69) U/L]、(128.1±15.84) U/L比(123.6±19.1)U/L]和(6.131±0.2133)比(5.875±0.1725)],进行统计学分析后差异均无统计学意义(P＞0.05),但划分年龄段后,大于35岁的患者,B型ALT、AST和HBV-DNA均显著高于C型(P＜0.05),分别是(227.6±34.52) U/L比(144.8±19.92) U/L]、(124.5±19.4) U/L比(79.79±12)U/L]和(6.166±0.2582)比(5.228±0.2644)].淋巴细胞亚群分析可见,所有年龄段或大于35岁患者均是B型的CD4+T细胞比例显著低于C型(32.97±0.95)％比(35.81±0.85)％](P＜0.05),CD8+T细胞显著高于C型(30.19 ±0.97)％比(27.44±0.92)％](P＜0.05),而CD3+T细胞、B细胞、NK细胞在B型和C型患者中则差异无统计学意义(P＞0.05).结论 145例HBV患者B、C型的分布未见显著差异;肝功能、病毒载量及T细胞亚群在年龄较大的B、C两组患者中存在显著差异.

Analysis of liver function and immune function changes in patients with different HBV genotypes

Objective To investigate the differences and clinical significance of liver function,viral contern and immune function in patients with different hepatitis B virus (HBV)genotypes.Methods 145 patients with hepatitis B were divided into two age groups:less than 35 years old and more than 35 years old.HBV genotypes of the patients were determined by real-time quantitative PCR (RT-qPCR).Meanwhile,the serum HBV-DNA content was detected by RT-qPCR.The indexes of liver function and lymphocyte subsets in each group were detected by automatic biochemical analyzer and flow cytometry.Results 145 patients with HBV infection only have two genotypes,B genotype in 62 patients (42.76％) and C genotype in 83 patients (57.24％).ALT,AST,and HBV-DNA of the patients with genotype B were slightly higher than that of the patients with genotype C (263.6 ± 36.13) U/L versus (243.1 ± 37.69) U/L for ALT;(128.1 ± 15.84) U/L versus (123.6 ± 19.1) U/L for AST;and (6.131 ± 0.2133) versus (5.875 ± 0.1725) for HBV DNA content)].However,there is no significant difference (P ＞ 0.05).However,significant difference was obtained between patients sorted according to their ages (35 year old as the boundary line).For patients older than 35 years,ALT,AST and HBV-DNA of patients with genotype B were significantly higher than that of patients with genotype C (P＜0.05) (227.6 + 34.52) U/L versus (144.8 ±19.92)U/L for ALT;(124.5 ±19.4)U/L versus 79.79 ± 12) U/L for AST,and(6.166 ± 0.2582) versus (5.228 ± 0.2644) for HBV DNA content].The analysis of lymphocyte subsets showed that the ratio of CD4 + T cell in all patients with genotype B was significantly lower than that of patients with genotype C(32.97 ±0.95)％ versus (35.81 ±0.85)％)P ＜ 0.05)],while the ratio of CD8 + T cells was significantly higher in patients with genotype B than that of the patients with genotype C (30.19 ±0.97)％ versus (27.44 ±0.92)％] (P＜0.05).No obvious difference was found for CD3 + T cells,B cells,NK cells between patients with genotype B and genotype C.Conclusion There was no significant difference for the distribution of viral genotype B and genotype C in 145 patients with HBV.However,liver function,viral content and T cell subsets were significantly different in patients with either genotype B or C at the age above 35 years old compared with patients below 35 years old.