阿德福韦酯治疗前后慢性乙型肝炎患者血清中Th1/2型细胞因子水平的变化及其意义

目的：观察阿德福韦酯治疗前后慢性乙型肝炎患者血清中Th1/2型细胞因子水平的变化,探讨阿德福韦酯抗乙型肝炎病毒(HBV) 的免疫效应机制。方法：22例乙型肝炎患者每日服用阿德福韦酯10 mg，于治疗前及治疗12、24周通过三色法流式细胞术检测细胞因子水平、HBV DNA和肝功生化指标。结果：应用阿德福韦酯治疗后，各时相点Th1分泌的细胞因子IL-2、IFN、TNF与Th2细胞分泌的细胞因子IL-4、IL-6、IL-10水平均明显高于治疗前（P<0.05）。治疗前，Th1分泌的细胞因子TNF水平明显高于Th2细胞分泌的细胞因子IL-6及IL-10水平（P<0.05）。治疗后（12及24周末），Th1分泌的细胞因子水平仍高于Th2分泌的细胞因子水平，但两者比较差异无显著性（P>0.05）。治疗12周时与对照组比较，阿德福韦酯组患者Th1/Th2细胞分泌的细胞因子水平无明显变化；24周时，与对照组比较，IFN、IL-4和IL-6水平明显增加（P<0.05）。结论：阿 德福韦酯在抗乙型肝炎病毒治疗过程中，可调动机体的免疫反应，打破机体的免疫耐受，恢复T细胞的功能。

Changes of Th1/Th2 cytokine levels in serum in patients with chronic hepatitis B before and after treatment of adefovir dipivoxil

Objective To study the dynamic changes of the levels of Th1/Th2 cytokines in serum of the patients with chronic hepatitis B(CHB)treated with adefovir dipivoxil,and explore the immune response mechanism of adefovir dipivoxil against hepatitis B virus(HBV).Methods 22 CHB patients were enrolled and given adefovir dipivoxil 10 mg·d-1.The cytokine level,HBV-DNA level and liver function were assessed by three-color flow cytometry before treatment and 12,24 weeks after treatment.Results After treatment of adefovir dipivoxil,the average levels of the cytokines secreted by Th1 and Th2 were higher than before trentment(P<0.05).Before treatment,the level of TNF secreted by Th1 was significantly higher than those of IL-4,IL-6,and IL-10 secreted by Th2(P<0.05).12 and 24 weeks after treatment,the levels of the cytokines secreted by Th1 were still higher than those of the cytokines secreted by Th2,but there was no significant difference(P>0.05).12 weeks after treatment,compared with control group,the levels of cytokines secreted by Th1/Th2 had no significant change;24 weeks after treatment,the levels of IFN,IL-4 and IL-6 were higher than those in control group(P<0.05).Conclusion Adefovir dipivoxil is effective in inhibiting HBV replication,promoting the immunologic mechanism of the body.Adefovir dipivoxil can break down the immune tolerance and help to recover T cell function.