替比夫定对慢性乙型肝炎患者外周血CD4+CD25+调节性T细胞动态变化的影响及其临床意义

目的 探讨替比夫定抗病毒治疗过程中慢性乙型肝炎(CHB)患者外周血CD4+CD25+调节性T细胞(Tregs)比例的变化及其临床意义.方法 选取给予替比夫定抗病毒治疗的CHB患者36例,在治疗前及治疗后3、6、9个月时,分别以流式细胞仪检测外周血Tregs比例(以CD4+CD25<'high>T细胞作为Tregs),荧光定量PCR检测血清HBV DNA水平,酶联免疫吸附法检测HBV标志物,全自动生化分析仪检测ALT水平.结果 CHB患者外周血Tregs比例明显高于对照组(P<0.01).替比夫定抗病毒治疗过程中,CHB患者外周血Tregs比例逐步下降,治疗6、9个月时基本恢复正常水平;HBV DNA水平降至检测水平以下的CHB患者(30例)在Tregs比例明显下降的CHB患者中所占比例(7/7,100.0%)高于Tregs比例无明显下降的CHB患者(23/29,79.3%),但两者差异无统计学意义(P>0.05).治疗3、6、9个月时,HBeAg阴转率分别为11.1%、19.4%、25.0%,其中7例(19.4%)发生HBeAg血清学转换者在治疗3、6个月时Tregs比例均已降至正常人水平.结论 替比夫定抗病毒治疗过程中,能降低CHB患者外周血Tregs比例,治疗早期Tregs比例下降的患者HBeAg血清学转换率更高.

The effect of telbivudine on peripheral blood CD4+CD25+ regulatory T cells and its significance in pa-tients with chronic hepatitis B

Objective To investigate the effect of telbivudine on peripheral blood regulatory T cells and its significance in patients with chronic hepatitis B (CHB). Methods Thirty-six HbeAg positive chronic hepatitis B patients were recruited and received telbivudine treatment for 9 months. Before and during the 3, 6, 9 months of treatment, flow cytometry was used to detect the proportion of peripheral blood Tregs; real-time PCR was used to detect the levels of HBV DNA in the serum. Markers of hepatitis B virus infection were detected by ELISA assay and levels ofalanine aminotransferase in the serum were measured. Results The proportion of peripheral blood Tregs in patients with CHB was significantly higher than that in healthy con-trois and decreased over 6 or 9 months of telbivudine treatment to a level comparable to that of the healthy controls. After 3 months of telbivudine treatment, the rate of tmdetectable HBV DNA in patients whose proportion of peripheral blood Tregs was decreased was higher than those whose Tregs had been reduced, but the difference was not statistically significant (P > 0.05). Three, 6 or 9 months of telbivudine treatment resulted in HbcAg negativity in 4 (11.1%) patients, 7 (19.4%) patients or 9 (25.0%) patients respectively. In 7 (19.4%) patients who had seroeonvertion from HBeAg to anti-HBeAg, after 3 or 6 months of telbivudine treatment, their proportion of peripheral blood Tregs had decreased to a level comparable to that of the healthy controls. Conclusion Telbivudine treaunent reduces HBV replication and the proportion of peripheral blood Tregs. In addition, patients who have their proportion of peripheral blood Tregs decreased quickly at the early phase of telbivudine treatment are prone to have HBeAg to anti-HBeAg seroconversion.