阿德福韦酯抗病毒治疗对慢性乙肝患者免疫功能的影响

目的探讨阿德福韦酯抗病毒治疗对慢性乙型肝炎患者外周血淋巴细胞各亚群的影响。方法对41例慢性乙型肝炎患者采用流式细胞术检测阿德福韦酯(ADV-dpv)治疗前、治疗12周和24周后与11例对照者外周血T淋巴细胞亚群进行比较,并结合血清丙氨酸氨基转移酶(ALT)和总胆红素(TbiL)水平及乙肝病毒DNA(HBV-DNA)载量水平进行统计学分析。结果治疗前各组患者外周血T淋巴细胞CD3+、CD4+、CD8+绝对计数值明显低于对照组,差异有统计学意义(P<0.05)。各组患者血清中ALT、TBiL水平及HBV-DNA载量水平与T淋巴细胞亚群失衡存在一致性,表现为慢性乙型肝炎(CHB)组和慢性重型肝炎(SH)组的ALT高于肝炎肝硬化(LC)组,差异有统计学意义(P<0.05),LC组和SH组患者外周血T淋巴细胞CD3+、CD4+、CD8+绝对计数值明显低于CHB组患者,差异有统计学意义(P<0.05)。ADV-dpv治疗12周和24周患者外周血T淋巴细胞CD3+、CD4+、CD8+绝对计数值明显高于治疗前,差异有统计学意义(P<0.05);各组患者ALT和TBiL水平及HBV-DNA载量较治疗前明显好转。结论慢性乙型肝炎在发展为重度和肝硬化的过程中外周血T淋巴细胞随病情的进展显著减少,经ADV-dpv抗病毒治疗后,肝功能明显改善,HBV-DNA复制明显减少,外周血淋巴细胞亚群绝对细胞数CD3+、CD4+、和CD8+进行性升高,T细胞亚群的状态呈逐渐改善的趋势。

The influence of adefovir dipivoxil on peripheral blood lymphocyte subsets in treatment of patients with chronic hepatitis B

Objective To study the influence of adefovir dipivoxil on peripheral blood lymphocyte subsets in treatment of patients withchronic hepatitis B.Methods The flow cytometry was used to detect peripheral T-cell subsets from 41 patients with chronic hepatitis B beforeand 12 weeks and 24 weeks after treatment,and 11 normal persons were used as negative controls.The data of serum levels of alanine transaminase（ALT） and total bilirubin（TBiL） and serum level of HBV-DNA load were statistically analyzed.Results Before treatment,the peripheralblood T lymphocytes CD3,CD4 and CD8 absolute counts in each group of patients with hepatitis B were significantly lower than those of controlgroup（NC group）,the difference was statistically significant（P 0.05）.The liver function tests as serum levels of ALT and TBiL and serumlevel of HBV-DNA load were in consistence with the imbalance of T cell subsets.The serum level of ALT in chronic hepatitis B patients（CHB）group was higher than that of severe hepatitis B patients（SH） group,the serum level of TBiL in SH group was higher than that of CHB group,theserum level of TBiL in liver cirrhosis（LC） group was the lowest.The peripheral blood T lymphocytes CD3,CD4 and CD8 absolute counts in LCgroup and SH group were significantly lower than those of CHB group.The peripheral blood T lymphocytes CD3,CD4 and CD8 absolute counts,serum levels of ALT and TBiL,and HBV-DNA loads in patients with ADV-dpv treatment for 12 weeks and 24 weeks were much lower thanthose before treatment.The difference was statistically significant（P 0.05）.Conclusion The absolute amount of peripheral blood T lympho-cyte subsets in patients with chronic HBV infection decreased significantly following the progress of disease.While the peripheral blood T cell sub-sets gradually improved after ADV-dpv antiviral treatment,serum levels of ALT and TBiL,and HBV-DNA loads in ADV-dpv treatment for12weeks and 24 weeks groups were much lower than those before treatment.The treatment with adfovir dipivoxil can increase the absolute amount oflymphocytes CD3 ＋,CD4 ＋,and CD8 ＋ lymphocytes in peripheral blood in a certain extent in patients with chronic hepatitis B.