小儿慢性乙型肝炎外周血T细胞亚群和临床病理关系的研究

目的　探讨小儿慢性乙型肝炎细胞免疫功能与临床、病理的关系 ,了解其间的相关性。方法　研究对象为确诊的 94例 12岁以内慢性乙型肝炎住院患儿。常规检测血T细胞亚群等、血丙氨酸转氨酶 (ALT)水平、病毒学指标 ,并进行腹部B超、肝脏病理学检查。结果　有活动性肝脏病理炎症者CD4 CD8 升高 (P <0 0 5 ) ;女性比男性CD4 降低差异有非常显著意义 (P <0 0 1)、CD8 升高差异有显著意义 (P <0 0 5 )、CD4 CD8 降低差异有非常显著意义 (P <0 0 1) ;T淋巴细胞的异常改变与HBVDNA、PTA以及脾脏大小关系不明显。而各项观察的临床、病理指标与CD3 T淋巴细胞、B淋巴细胞均无明显相关性。结论　小儿慢性乙型肝炎患者机体存在细胞免疫功能失衡 ,其相关性表现在肝脏炎症损伤严重程度与T淋巴细胞功能的损伤有明显的相关性 ,女性对HBV的T淋巴细胞反应比男性更有利于清除HBV ,其预后及对抗病毒和免疫调节治疗反应较好。

Association of T cell subsets with clinical status and hepatic pathology in children with chronic hepatitis B virus infection

BACKGROUND: To study characteristics of peripheral T cell subsets in 94 children with chronic hepatitis B and to elucidate its relationships with clinical status and hepatic pathology. METHODS: Peripheral T cell subsets were detected using flow cytometric analysis with specific monoclonal antibodies staining in 94 patients with HBV infection. The authors simultaneously detected their serum ALT, markers of HBV infection and examined liver biopsy material for pathological changes. RESULTS: In patients with serious liver lesion, the ratio of CD4+/CD8+ cells was significantly higher than those with mild lesion (1.41+/-0.54 vs 1.08+/-0.35, P less than 0.05), which seemed to be associated with the various liver lesions among the patients. In female cases, the levels of CD4+ T cells and the ratio of CD4+/CD8+ T cells were higher than their counterpart in male cases (33.1+/-5.39 vs 28.8+/-6.28, 1.28+/-0.32 vs 1.02+/-0.36, P less than 0.05), but the level of CD8+ T cells was lower than those in males (26.79+/-4.66 vs 30.51+/-7.17, P less than 0.05). There was no obvious correlation between T cell subsets and circulating HBV viral load, the size of spleen among the HBV-infected children. CONCLUSION: The characteristics of peripheral T cell subsets probably suggests the immune disorder occurred in these children with hepatitis B compared with healthy controls and its mechanism needs further investigation.