慢性乙型肝炎患者外周血CD8+CD28+T淋巴细胞百分比的变化及其临床意义探讨

目的 探讨不同病程阶段的慢性乙型肝炎患者外周血CD8⁺CD28⁺T淋巴细胞百分比的变化,以及CD8⁺CD28⁺T淋巴细胞百分比变化与血清HBsAg水平的关系。方法 2018年4月~2018年8月我院诊治的慢性乙型肝炎患者88例,其中免疫耐受期20例,免疫清除期28例,非活动期20例,再活动期20例,另选择健康人20例。使用流式细胞术检测外周血CD8⁺CD28⁺T淋巴细胞百分比。结果 健康人与免疫耐受期患者外周血CD8⁺CD28⁺T淋巴细胞百分比分别为（26.1±3.5）%和（26.3±3.4）%,差异无统计学意义（P>0.05）;免疫清除期患者CD8⁺CD28⁺T淋巴细胞百分比为（40.1±4.7）%,显著高于健康人（P<0.05）;非活动期和再活动期患者外周血CD8⁺CD28⁺T淋巴细胞百分比分别为（20.3±2.2）%和（26.1±2.2）%,显著低于健康人（P<0.05）;外周血HBsAg低、中、高三组人群外周血CD8⁺CD28⁺T淋巴细胞百分比分别为（24.0±7.5）%、（28.4±8.9）%和（33.2±8.5）%,各组间差异有统计学意义（P<0.05）。结论 不同病程阶段的慢性乙型肝炎患者外周血CD8⁺CD28⁺T淋巴细胞百分比存在明显差异,可能与病毒长期刺激机体免疫系统,导致免疫系统功能失调有关,而这种失调可能参与了慢性乙型肝炎的发病过程。

Changes of peripheral blood CD8+CD28+T lymphocyte percentages in patients with hepatitis B

Objective To investigate the changes of peripheral blood CD8⁺CD28⁺T lymphocyte percentages in patients with hepatitis B. Methods A total of 88 patients with hepatitis B and 20 healthy individuals were recruited in 902nd hospital of PLA between April 2018 and August 2018,and the patients with hepatitis B included patients in immune tolerance phase（n=20）,immune clearance phase（n=28）,low replication phase （n=20）,and re-activation phase（n=20）. The percentages of CD8⁺CD28⁺T lymphocytes in peripheral blood were measured by flow cytometry. Results The percentages of CD8⁺CD28⁺T lymphocytes in patients in immune tolerance phase were（26.3±3.4）%,not significantly different as compared to（26.1±3.5）% in healthy persons（P>0.05）;the percentages of CD8⁺CD28⁺T lymphocytes in patients in immune clearance were（40.1±4.7）%,significantly higher than that in healthy control（P<0.05）;the percentages of CD8⁺CD28⁺T lymphocytes in patients inactive phase and reactive stage were （20.3±2.2）% and （26.1±2.2）%,respectively,significantly lower than that in healthy control （P<0.05）;the CD8⁺CD28⁺T lymphocytes in patients with high,moderate and low serum HBsAg level were（24.0±7.5）%,（28.4±8.9）% and （33.2±8.5）%,respectively,with statistically significant differences among them （P<0.05）. Conclusion s There are significant differences in the percentages of peripheral blood CD8⁺CD28⁺T lymphocytes in patients with hepatitis B at different immune phases,which might be related to the dysfunctions of immune system activated by the viral infection.