慢性乙型肝炎炎症反应中Th17／Treg的变化及恩替卡韦对其的影响

目的 观察外周血Th17/Treg在慢性乙型肝炎(CHB)不同ALT水平中的变化及恩替卡韦对其的影响。 方法 选择杭州市红十字会医院肝病科2012年6月-2012年10月CHB患者85例,分为ALT轻度、中度、重度异常组,同时选取健康对照组30名,观察Th17/Treg在不同ALT水平中的变化;从以上病例中选择符合抗病毒指征的CHB患者30例,予恩替卡韦片抗病毒治疗24周后测定外周血Th17细胞、Treg细胞等指标。 结果 CHB组与健康对照组Th17和Treg细胞频数、Th17/Treg细胞比值差异均有统计学意义(均P<0.05);ALT水平不同的3组CHB患者之间Th17/Treg比值差异有统计学意义(P<0.05);Th17与ALT呈正相关,Treg与ALT呈负相关。恩替卡韦抗病毒治疗前后ALT水平、HBV-DNA载量、Th17/Treg比较差异有统计学意义(均P<0.05)。ALT及HBV-DNA均正常患者(22例)、ALT和(或)HBV-DNA异常患者(8例)Th17/Treg比率较基线时降低,差异均有统计学意义(均P<0.05);2组基线Th17/Treg比率比较及治疗后比较差异均无统计学意义(均P>0.05)。 结论 外周血Th17/Treg在CHB患者中存在失衡,与ALT水平密切相关,恩替卡韦抗病毒治疗有助于Th17/Treg平衡。 

Variation of T helper cell 17/regular T cell balance in inflammatory process of hepatitis B virus infection and effect of entecavir

Objective To observe the variation of Th17/Treg balance in different ALT levels of chronic hepatitis B and effect of entecavir. Methods Eighty-five CHB patients in Hangzhou Red Cross hospital during June, 2012 to October, 2012 were divided into three groups; mildly, moderately, significantly elevated ALT and 30 healthy volunteers were enrolled as healthy controls. The peripheral blood Th17, Treg of 30 patients from the above cases were measured after entecavir antiviral treatment for 24 weeks. Results Th17 cell levels, Treg cell levels and Th17/Treg ratio of CHB patients were significantly different than those of healthy volunteers (P<0.05). The difference in Th17/Treg ratio between 3 groups of CHB patients with different ALT levels was statistically significant (P<0.05). Th17 was positively correlated with ALT, and Treg was negatively correlated with ALT. At 24 weeks after entecavir antiviral treatment, the differences of ALT level, HBV-DNA load and Th17/Treg were statistically significant (P<0.05). The ratio of Th17/Treg in patients with Normal ALT and HBV-DNA (22 cases), ALT and/or HBV-DNA abnormality (8 cases) was significantly lower than that of baseline (P<0.05). There was no statistical difference in the comparison of the baseline Th17/Treg ratio and the comparison of the two groups after the treatment (P>0.05). Conclusion Th17/Treg was unbalanced in CHB patients and correlated with the ALT levels. Entecavir treatments was beneficial to the balance of Th17/Treg.