慢性乙型肝炎患者肝组织穿孔素表达的临床意义

目的:探讨慢性乙肝患者肝组织穿孔素表达的临床意义．方法:慢性乙肝患者47例,进行肝穿刺活组织病理学检查,其中的35例患者随后接受了α-2b干扰素抗病毒治疗．用免疫组织化学技术检测肝组织穿孔素的表达,同时检测外周血HBV DNA载量、乙肝病毒血清免疫学标志物和肝功能等．结果:慢性乙肝患者中有37例肝组织穿孔素表达阳性,其中强阳性13例．穿孔素表达强度与血清ALT水平、肝组织炎症程度具有显著的一致性关系(分别为x2=8．004,P=0．018;x2 =8．532,P=0．014);与肝组织纤维化程度无关(x2=0．865,P=0．649);与外周血乙肝病毒载量呈显著的负向关系(x2=7．902,P=0．019),与HBeAg水平也几乎呈显著的负向关系(x2= 5．283,P=0．071)．35例接受干扰素抗病毒的患者治疗结束时完全应答为12例,部分应答14例,无应答9例,分析显示治疗前穿孔素表达的强度与干扰素应答具有显著的一致性关系(x2 =7．533,P=0．023)．结论:慢性乙肝患者肝组织穿孔素的表达介导了肝细胞的损害,有利于乙肝病毒的清除,可能会促进干扰素的抗病毒效果,并具有预测干扰素抗病毒疗效的价值．

Clinical significance of intrahepatic perforin expression in patients with chronic hepatitis B

AIM: To investigate the clinical significance of intrahepatic perforin expression in patients with chronic hepatitis B virus (HBV) infection. METHODS: The hepatic biopsies were performed in 47 patients with chronic hepatitis B, and out of them, 35 patients subsequently received interferon a-2b antiviral therapy. The expression of perforin in liver tissues was detected by immunohistochemistry, and the HBV DNA loads, the serum HBV immunologic markers and transaminases were also determined in peripheral blood samples. RESULTS: The expression of intrahepatic perforin was positive in 37 patients (13 cases strongly positive). The intensity of perforin showed a significant accordance with serum alanine ami-notransferase (ALT) level (x2 = 8.004, P = 0.018) and histological inflammation grades (x2 = 8.532, P = 0.014), but did not correlate with the degrees of liver fibrosis (x2= 0.865, P = 0.649). The data showed a significantly negative correlation between perforin and the HBV DNA loads (x2 = 7.902, P = 0.019), and there was almost significantly correlation between perforin and the level of HBeAg (x2 = 5.283, P = 0.071). Among the 35 patients accepted interferon antiviral therapy, there were 12 cases with complete responses, 14 cases with partial responses and 9 without responses at the end of treatment. The intensity of perforin expression was positively correlated with the interferon responses (x2 = 7.533, P = 0.023). CONCLUSION: The expression of intrahepatic perforin can mediate the liver cell injury, contribute to the clearance of hepatitis B virus, and enhance the antiviral efficacy of interferon, and it may be a predictor to interferon antiviral therapy.