慢性HBV感染及其相关肝病患者外周血T细胞亚群的变化

目的观察不同临床类型HBV感染者外周血T淋巴细胞亚群的差异,探讨HBV对人体T细胞免疫的影响及其可能机制,不同类型慢性HBV感染者免疫失衡的规律。方法用流式细胞仪技术检测患者外周血T细胞亚群。慢性HBV感染者318例,其中HBV携带者8例,慢性乙型肝炎231例,肝炎后肝硬化61例,原发性肝癌18例,观察患者的T淋巴细胞亚群、HBV DNA等。同时收集22名健康志愿者的新鲜血检测T淋巴细胞亚群。结果不同临床类型HBV感染者外周血CD3＋T、CD4＋T、CD8＋T细胞百分数低于正常对照组,差别均有统计学意义（P〈0.05或P〈0.01）,CD4＋/CD8＋比正常对照组低,但差异均无统计学意义（P〉0.05）。结论慢性HBV感染随着病情进展,由慢性肝炎→肝硬化→肝癌,直至细胞免疫功能逐渐衰退。慢性HBV感染的不同阶段的细胞免疫紊乱各具特点,就不同类型患者应采用不同的免疫调节治疗手段。

Differential profiles of T-cell subsets are present in peripheral blood of patients with various progressive forms of hepatitis B infection

Objective To determine whether various progressive forms of hepatitis B virus （HBV） infection, from HBV carriers to chronic hepatitis B （CHB） without complication or with cirrhosis or hepatoeellular carcinoma （HCC）, are associated with differential profiles of T lymphocyte subsets in peripheral blood. Methods Between 2009 and 2011,318 HBV infections presented for treatment at our hospital, in- cluding eight HBV carriers, 231 cases of CHB, 61 cases of CHB -related cirrhosis, and 18 cases of CHB -related HCC. Peripheral blood samples were collected from each patient, as well as from 22 non -HB~ infected individuals （to serve as healthy controls）. The various T lymphocyte subsets （ CD3 ＋ , CIM ＋ , and CD8 ＋ ） were detected by flow cytometry and expressed as percentages of the entire T lymphocyte cell population. HBV DNA presence and quantity was assessed by fluorescence real - time polymerase chain reaction. Differences between groups were assessed by the Kruskal - Wallis H test. Pairwise comparisons were made by Dunnett＇ s test and multiple comparisons were made by the least significant difference test. Results Compared to the healthy control group, all four of the HBV - infected groups showed signifi- cantly less peripheral blood T cell percentages of CD3 ＋ （ all, P 〈 0.01 ） and CD4 ＋ （ all, P 〈 0.01 ） ; however, only the HBV - infected groups of HBV - related cirrhosis and HCC showed significantly less percentages of CD8 ＋ （ P 〈 0.05 ）. None of the HBV - infected groups showed a significantly different CIM ＋/CD8 ＋ ratio from that detected in the healthy control group （ all, P 〉 0.05 ）. There was a general trend in decreasing percentages of the peripheral blood T cell subsets that followed increases in hepatitis disease progression （ HBV carriers 〉 CHB 〉 HBV - related cirrhosis 〉 HBV - related HCC）. Conclusion Progression of the HBV infection to more severe forms of liver disease is accompanied by ebbs in the CD3 ＋ , CD4＋ , and CD8 ＋ T cell subsets. Significantly differential profiles of immunomodulatory cell types may represent useful targets of novel therapeutic strategies tailored to the various progressive forms of CHB.