慢性乙型肝炎患者的乙型肝炎病毒基因型与细胞免疫功能的关系

目的探讨慢性乙型肝炎（cHB）患者的乙型肝炎病毒（HBV）基因型与细胞免疫功能的关系及其临床意义。方法对108例CHB患者用聚合酶链反应（PCR）微板核酸杂交-酶联免疫吸附测定（ELISA）技术进行HBV基因分型，用流式细胞仪检测T细胞亚群、非特异性细胞毒性T淋巴细胞（CTL）、辅助性T细胞（Th）1、Th2、自然杀伤（NK）细胞，对其中55例人白细胞抗原（HLA）-A2阳性CHB患者检测HBV特异性CTL。结果108例CHB患者中，B基因型59例（54．6％），C基因型48例（44．4％），B、C混合型1例（0．9％），HLA—A2阳性55例（51．4％）中，C基因型感染者27例，B基因型感染者28例；乙型肝炎病毒e抗原（HBeAg）阳性率高于B基因型感染者（75．0％VS49．2％）（P〈0．01），C基因型的HBVDNA水平高于B基因型感染者（6．12±0．81）log10copies／mlvs（5．02±0．61）log10 copies／ml（P〈0．01），HBV特异性CTL低于B基因型感染者（0．21±0．06）％vs（0．39士o．12）％（P〈0．01）。非特异性CTL高于B基因型感染者（19．84±6．17）％vs（16．81±3．56）％（P〈0．01），丙氨酸转氨酶（ATL）高于B基因型感染者（505．12±312．91）U／Lvs（222．11±205．16）U／L（P〈0．01），血清总胆红素（TBIL）高于B基因型感染者（45．71±41．12）μmol／Lvs（28．18±15．12）μmol／L（P〈0．05）。结论与CHBB基因型感染者相比，C基因型感染者的HBV特异性CTL较低，导致HBVDNA水平高于B基因型感染者，HBeAg阳性率也高于B基因型感染者，因此C基因型感染者的肝功能损害比B基因型感染者重，C基因型感染者的肝功能损害比B基因型感染者重，可能也与C基因型感染者的非特异性CTL比B基因型感染者高有关。

Relation between HBV genotypes and cellular immunity of patients with chronic hepatitis B

Objective To explore relation between genotype of HBV and cellular immunity of patients with chronic hepatitis B and its clinical significance. Methods HBV genotypes of 108 CHB patients were determined by PCR microplate nuclear acid hybridization-ELISA, T cell subgroups （CD3^＋ , CD4^＋ ,CD8^＋ , CD4^＋/CD8^＋ ratio）, nonspecific CTL, helper T cells （Th）1, Th2 and natural killer（NK） cells were examined by flow eytometry,of whom 55 CHB patients with positive human leukocyte antigen（HLA） A2 were tested for HBV specific CTL. Results In 107 CHB patients,59 cases had genotype B（54.6%） ,48 cases had genotype C （44.4%） and 1 case had mixed type of B and C （0.9%）. In 55 cases with HLA A2 positive（51.4%）, 27 were genotype C,28 were genotype B, HBeAg positive rate was higher than that with genotype B （75.0% vs 49.2 % ）（ P 〈0.01）. HBV DNA titer was higher than those with genotype B （6.12±0.81） log10 copies/ml vs （5.02±0.61） log10 copies/ml（ P 〈0.01）. HBV specific CTL of genotype C was lower than that of genotype B （0.21±0.06） % vs （0.39±0.12） %（P 〈0.01）. For patients infected with genotype C, non-specific CTL was higher than those with genotype B （19.84±6.17） % vs （16.81±3.56） %（ P〈 0.01）. ALT was higher than that with genotype B （505.12±312.91） U/L vs （222. 11±205.16） U/L（ P 〈0.01）, TBIL was higher than that with genotype B （45.71 ± 41.21） μmol/L vs （28.18 ± 15.12） μmol/L（ P 〈0.05）. Conclusion Compared with CHB patients infected with genotype B, HBV specific CTL was lower in patients infected with genotype C, resulting in higher HBV DNA level, HBeAg positive rate was also higher than that in patients with genotype B. So,liver function damage of patients with genotype C was more serious. In addition,the reason for that was probably related to higher non-specific CTL in patients with genotype C than that in patients with genotype B.