【摘要】 目的 探索乙型肝炎患者T淋巴细胞肿瘤坏死因子相关凋亡诱导配体（TRAIL）上调参与肝脏免疫病理一种新的发病机制。 方法 采用流式细胞技术及夹心酶联免疫吸附法分析58例慢性肝炎患者外周血CD₄⁺、CD₈⁺ T淋巴细胞膜TRAIL及血清可溶性TRAIL（sTRAIL）表达水平,同时检测血清γ干扰素（IFN-γ）水平变化并与肝功能相关指标进行相关性分析。 结果 各型慢性乙型肝炎患者外周血CD₄⁺、CD₈⁺ T淋巴细胞膜TRAIL表达水平,随疾病加重而明显增高;各型慢性乙型肝炎患者血清sTRAIL水平高于正常对照,随疾病加重而下降（F=3.776,P=0.009）。CD₄⁺ T淋巴细胞TRAIL表达与总胆红素（TBil）水平呈显著正相关（r=0.354,P=0.008）,与白蛋白（Alb）呈显著负相关（r=-0.276,P=0.044）;CD₈⁺ T淋巴细胞TRAIL表达与丙氨酸氨基转移酶（ALT）（r=0.393,P=0.003）,TBil（r=0.522,P=0.000）及凝血酶原时间（r=0.385,P=0.004）呈显著正相关。各型慢性乙型肝炎患者血清IFN-γ水平与外周血CD₄⁺ T淋巴细胞（r=0.302,P=0.011）,CD₈⁺ T（r=0.307,P=0.009）细胞膜TRAIL水平呈正相关;血清sTRAIL水平与乙型肝炎e抗原呈正相关（r=0.695,P=0.001）。 结论 慢性乙型肝炎患者外周血CD₄⁺、CD₈⁺ T淋巴细胞TRAIL表达上调,与TBil、ALT、凝血酶原时间呈正相关,提示TRAIL?更多还原

【Abstract】 Objective To describe a novel mechanism for TRAIL up-regulation of CD₄⁺, CD₈⁺ T cells to participate in the pathophysiological process in patients with chronic hepatitis B（CHB）. Methods The serum levels of soluble TRAIL（sTRAIL）, IFN-γ and membrane bound TRAIL expression on peripheral leucocytes from 58 CHB patients were examined by ELISA and flow cytometry respectively. The levels of TRAIL were compared with the baseline levels of 15 healthy controls, and correlation analysis were performed between ALT, TBil and PT, morphological change in hepatic tissues. Result The resuhs showed that TRAIL levels on membranes of CD₄⁺, CD₈⁺ T cells in CHB patients were much higher than the healthy controls（P<0.001）, which of CD₄⁺ T cells positively correlated with serum TBil（r=0.354, P=0.008）, Serum IFN-γ level（r=0.302, P=0.011） and which of CD₈⁺ T cells positively correlated with serum TBil（r=0.522, P=0.000）, ALT（r=0.393, P=0.003）, PT（r=0.385, P=0.004）, serum IFN-γ level（r=0.307, P=0.009）. The serum levels of soluble TRAIL only correlated with serum HBeAg expression（r=0.695, P=0.001）. Conclusion These findings suggest that the expression of TRAIL on the membranes of lymphocytes was up-regulated, which may take part in the immunopathogenesis in CHB patients. TRAIL expression can be induced either by virus-specific protein expression or by inflammation cytokine IFN-γ.更多还原