合并乙肝病毒感染对弥漫大B细胞淋巴瘤患者细胞免疫功能的影响

背景与目的：乙型肝炎病毒(hepatitis virus B，HBV)感染与弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma，DLBCL)密切相关，前期研究发现在接受联合免疫化疗的DLBCL患者中，HBsAg阳性者生存较差，但具体机制有待进一步证实。本研究通过分析HBV感染对DLBCL患者细胞免疫的影响，为阐明这一机制寻找细胞免疫方面的证据。方法：2004年3月-2013年6月共294例住院初治的DLBCL患者纳入本研究。采用四色流式分析患者外周血CD3+、CD4+、CD8+细胞计数及CD4+/CD8+细胞比例，比较HBsAg阳性及阴性的DLBCL患者发病时、化疗后2～4个月、化疗后4～6个月及化疗后6～12个月上述参数的时序改变及2组间的差异。结果：与HBsAg阴性患者相比，HBsAg阳性DLBCL患者化疗前各淋巴细胞亚群差异无统计学意义(P>0.05)；外周血CD4+细胞计数在化疗后2～4个月显著低于HBsAg阴性患者；HBsAg阳性患者CD4+/CD8+比例降低，在化疗后4～12个月显著低于HBsAg阴性患者。结论：合并HBV感染对DLBCL患者化疗前细胞免疫状态无明显影响；HBsAg阳性的DLBCL患者化疗后出现更为明显和持续的细胞免疫抑制。

The impact of hepatitis B virus concurrent infection on peripheral T cells in diffuse large B cell lymphoma patients

Background and purpose: The clinical relevance of HBV infection with respect to diffuse large B cell lymphoma(DLBCL) patients and immune patterns of T lymphocyte subsets during chemotherapy remains unclear. This study aimed to identify the characteristics of T-cell mediated immunity in DLBCL patients with HBV infection, thereafter, to explore the possible cell-mediated immune mechanisms of HBsAg positive HBV infection on the survival of DLBCL. Methods: A total of 294 newly diagnosed DLBCL patients were enrolled in this cohort study. Four-color flow cytometric method was used to enumerate the absolute number of CD3+, CD4+, CD8+ T lymphocytes and the CD4+/CD8+ ratio in peripheral blood samples, at the onset of disease, 2-4, 4-6 and 6-12 months after the initiation of chemotherapy, individually. Results: The absolute number of CD3+, CD4+, CD8+ T lymphocytes in both groups were similar at the onset of disease; the count of CD4+ lymphocytes was lower in HBsAg positive group during 2 to 4 months after the initiation of chemotherapy, compared with that in the HBsAg negative group. During 4 to 12 months after chemotherapy, the CD4+/CD8+ ratio in peripheral blood samples was significantly lower in HBsAg positive group. Conclusion: For newly diagnosed DLBCL patients who received chemotherapy, the dynamic nature of cell mediated immune response was characterized as a low counts of CD4+ T lymphocyte during the first several cycles of chemotherapy followed by a decreased circulating CD4+/CD8+ ratio. Depressions of cell immunity after chemotherapy in HBsAg positive DLBCL patients were greater and prolonged.