【摘要】 目的探讨乙型病毒性肝炎患者外周血T淋巴细胞亚群、血清干扰素-γ(IFN-γ)和肿瘤坏死因子-α(TNF-α)的变化与疾病临床转归的关系。方法收集2009年1~12月益阳市中心医院诊治的352例乙肝病毒性肝炎患者,并选择同期健康人82例作为对照。采用流式细胞仪检测外周血T淋巴细胞亚群(CD3+、CD4+、CD8+),ELISA法检测细胞外血清IFN-γ和TNF-α,比较乙肝病毒性肝炎患者与健康人外周血T淋巴细胞亚群及IFN-γ和TNF-α水平。结果不同HBV-DNA载量的患者CD3+、CD4+、CD8+、CD4+/CD8+、IFN-γ和TNF-α水平与健康人比较,差异均有统计学意义(P<0.05)。急性或亚急性肝衰竭、慢性HBV感染、隐匿性HBV感染患者CD3+、CD4+、CD8+、CD4+/CD8+、IFN-γ和TNF-α水平与健康人比较,差异均有统计学意义(P<0.05)。212例HBc-Ig M阳性HBV患者经保肝护肝基础治疗(106例)和IFN-α治疗(106例)6个月后,患者的CD3+、CD4+、IFN-γ和TNF-α水平仍较健康人显著升高,差异有统计学意义(P<0.05),但CD4+/CD8+的比较差异无统计学意义(P>0.05)。IFN-α治疗患者治疗6个月和随访1、3、5年时,HBV-DNA阴转率均高于保肝护肝基础治疗患者(P<0.05)。结论乙型病毒性肝炎患者存在细胞免疫功能紊乱,其功能状态直接影响临床转归,动态监测患者T淋巴细胞亚群和血清IFN-γ、TNF-α对乙型病毒性肝炎的诊断、治疗、预后评估及个体化治疗都有重要的意义。更多还原

【Abstract】 Objective To explore the correlation between the change of T cell subgroups, serum IFN-γ, TNF-α in patients with hepatitis B and clinical prognosis. Methods From January to December 2009, in the Center Hospital of Yiyang City, 352 patients with hepatitis B were selected, and 82 healthy people were selected as control at the same time. Flow cytometer was used to detect the T cell subgroups(CD3+, CD4+, CD8+), and the level of serum IFN-γ and TNF-α were detected by ELISA, the results were compared. Results The levels of CD3+, CD4+, CD8+, CD4+/CD8+, IFN-γand TNF-α in different HBV-DNA capacity patients were compared with those in healthy people, the differences were statistically significant(P < 0.05) The levels of CD3+, CD4+, CD8+,CD4+/CD8+, IFN-γ and TNF-α in acute or subacute liver failure, chronic HBV infection, delitescence HBV infection patients were compared with those in healthy people,the differences were statistically significant(P < 0.05). 212 patients with HBc-Ig M positive HBV were given liver protection basic treatment(106 cases) and IFN-α treatment(106 cases) for 6 months, the CD3+,CD4+,IFN-γ and TNF-αlevels were significantly higher than those in healthy people, the differences were statistically significant(P < 0.05), but the difference of CD4+/CD8+was not statistically significant(P > 0.05). HBV-DNA negative rates of patients given IFN-α treatment at 6 months finished, follow-up 1, 3, 5 years were higher than those patients given liver protection basic treatment(P < 0.05). Conclusion The disorder of cellular immunity in patients with hepatitis B was confirmative.The functional status may to directly affect the hepatitis B prognosis. Dynamic monitoring of the T cell subgroups and serum IFN-γ, TNF-α on hepatitis B patients, which has important clinical significance to diagnosis, treatment,prognosis and individual therapy.更多还原