拉米夫定对慢性乙型肝炎的抗病毒疗效与Th1/Th2变化的关系

目的观察拉米夫定（LAM）治疗前后患者血清Th1/Th2比值的动态变化。方法用酶联免疫吸附（ELISA）方法分别检测60例慢性乙型肝炎患者在拉米夫定治疗前,治疗后第3、6、9、12月时的血清IFN-γ和IL-4水平。选取20名健康献血员作为正常对照。结果LAM治疗前ALT高水平组IFN-γ水平及IFN-γ/IL-4比值较高,完全应答率较高,无应答率较低;治疗后完全应答组IFN-γ/IL-4水平接近或高于对照组,部分应答组和无应答组IFN-γ/IL-4水平低于对照组。结论拉米夫定治疗慢性乙型肝炎可增加Th1类细胞因子IFN-γ分泌,抑制Th2类细胞因子IL-4分泌,治疗后Th1/Th2平衡的恢复与抗病毒疗效有关。T细胞免疫功能的恢复是抗病毒治疗的关键之一。

Relationship between the Antiviral Effect and Changes of Th1/Th2 during the Treatment of Chronic Hepatitis B Using Lamivudine.

Objective To investigate changes in serum Th1/Th2 ratios of patients with chronic hepatitis B during Lamivudine treatment.Methods Serum INF-γ and IL-4 levels were determined by ELISA in 60 patients with chronic hepatitis B at baseline and 3, 6, 9 and 12 months during treatment. At the same time, and 20 healthy volunteers were served as normal control.Results The patients with high ALT levels showed higher IFN-γ levels and IFN-γ/IL-4 ratios than those with low ALT levels,and they showed higher rate of complete response and lower rate of non-response to LAM treatment. After treatment, the ratios of IFN-γ to IL-4 in complete response patients were approximate to those of control group, sometimes even higher than them. The ratios of IFN-γ to IL-4 in partial response and non response patients were lower than those of control group.Conclusion LAM can increase the release of IFN-γ(cytokines of Th1 type ), whereas inhibit IL-4(cytokines of Th2 type ) levels. The antiviral effect is related to the recovery of Th1/Th2 balance. The reconstruction of the T lymphocyte function in vivo is an important aspect in antiviral treatment.