e抗原阳性乙肝患者细胞免疫状态对干扰素疗效的影响(1)
[摘要] 目的 探讨基线细胞免疫状态对干扰素(IFN)疗效的影响。 方法 选择e抗原阳性CHB患者67例，采用聚乙二醇IFNα-2a 180 μg皮下注射。基线时用流式细胞术(FCM)检测CD3+、CD4+、CD8+、CD4+/CD8+、自然杀伤(NK)细胞，按治疗结束时的完全应答(CR)或非完全应答(NCR)分为两组，比较两组基线时淋巴细胞亚群及ALT、HBV DNA定量、年龄等的差异。 结果 两组间基线时CD8+、ALT、年龄差异均无统计学意义(P > 0.05)；CR组基线HBV DNA定量低于NCR组，CD3+、CD4+、CD4+/CD8+、NK均高于NCR组，差异均有统计学意义(P < 0.05)。 结论 通过血淋巴细胞亚群的检测可以监控患者的免疫状态，从而为抗病毒治疗提供帮助。
[关键词] 慢性乙型肝炎；淋巴细胞亚群；聚乙二醇干扰素
[中图分类号] R512.6+2 [文献标识码] B [文章编号] 1673-9701(2012)16-0113-02
, http://www.100md.com
The influence of baseline cellular immunity to the therapeutic responses of interferon in HBeAg positive hepatitis B patients
XI Weixing
Department of Clinical Laboratory，Tongde Hospital in Zhejiang Province, Hangzhou 310012, China
[Abstract] Objective To explore the influence of baseline cellular immunity to the therapeutic responses of interferon. Methods Selected 67 cases of e antigen positive CHB patients and treated with subcutaneous injection of 180 μg polyethylene glycol IFNα-2a. Levels of CD3+, CD4+, CD8+, CD4+/CD8+, natural killer (NK) cells at baseline were determined by flow cytometry (FCM). The patients were divided into two groups according to complete response (CR) or non-complete response (NCR) at the end of treatment. The differences of lymphocyte subsets, ALT, HBV DNA quantitation and age at baseline of two groups were compared. Results There were no significant difference for CD8+, ALT, age at baseline of the two groups (P > 0.05); Baseline HBV DNA quantitation of CR group was lower than that of NCR group, and CD3+, CD4+, CD4+/CD8+, NK of the CR group were higher than the NCR group, and the differences were statistically significant (P < 0.05). Conclusion Through the blood lymphocyte subsets testing can monitor patients'' immune status, so as to provide help for antiviral treatment.
, 百拇医药
[Key words] Chronic hepatitis B; Lymphocyte subsets; PEG-interferon
乙型肝炎病毒(hepatitis B virus，HBV)是引起慢性肝炎、肝硬化、甚至肝细胞癌的主要病原体。乙型肝炎的发病机制复杂，至今尚未完全阐明。目前普遍认为宿主的免疫应答在乙型肝炎的发病机制中起主要作用，细胞免疫反应是HBV感染后引起肝细胞损害的主要机制。研究表明，机体感染HBV后，外周血淋巴细胞亚群间的平衡被打破，细胞亚群之间的调节紊乱是体内不能清除HBV及HBV在肝内持续复制的主要原因。干扰素抗病毒的作用机制有两个方面：①调节机体免疫，加强辅助T细胞1型(Th1)作用，分泌IL-2等细胞因子，促进HBV特异细胞毒T细胞(CTL)和自然杀伤(NK)细胞的活性，又刺激巨噬细胞产生细胞因子，增强细胞免疫。②IFN-α与细胞膜上干扰素受体1(IFN-R1)结合，诱导细胞内染色体产生抗病毒蛋白。因此聚乙二醇IFN-α作为慢性乙型肝炎抗病毒治疗的首选药物之一。影响IFN-α疗效的因素颇多，报道结果亦多有差异，总体来看可分为病毒因素和宿主因素两大类。在病毒因素方面，有病毒载量、基因型等；而宿主因素则较复杂，除性别、年龄、感染时间长短、ALT基线值的高低等外，宿主的细胞免疫状态也是决定疗效的重要因素，甚至可能是最重要的宿主因素，其他因素可能只是免疫因素的外在反映。抗病毒治疗前的细胞免疫状态对应答率的影响目前报道较少。外周血细胞亚群是反映慢性乙型肝炎患者免疫状态的重要指标[1]。本研究通过比较不同应答组之间淋巴细胞亚群、HBV DNA定量、ALT、年龄等的差异，探讨CHB患者IFN治疗前细胞免疫状态对抗病毒疗效的影响。, http://www.100md.com(奚伟星)
[关键词] 慢性乙型肝炎；淋巴细胞亚群；聚乙二醇干扰素
[中图分类号] R512.6+2 [文献标识码] B [文章编号] 1673-9701(2012)16-0113-02
, http://www.100md.com
The influence of baseline cellular immunity to the therapeutic responses of interferon in HBeAg positive hepatitis B patients
XI Weixing
Department of Clinical Laboratory，Tongde Hospital in Zhejiang Province, Hangzhou 310012, China
[Abstract] Objective To explore the influence of baseline cellular immunity to the therapeutic responses of interferon. Methods Selected 67 cases of e antigen positive CHB patients and treated with subcutaneous injection of 180 μg polyethylene glycol IFNα-2a. Levels of CD3+, CD4+, CD8+, CD4+/CD8+, natural killer (NK) cells at baseline were determined by flow cytometry (FCM). The patients were divided into two groups according to complete response (CR) or non-complete response (NCR) at the end of treatment. The differences of lymphocyte subsets, ALT, HBV DNA quantitation and age at baseline of two groups were compared. Results There were no significant difference for CD8+, ALT, age at baseline of the two groups (P > 0.05); Baseline HBV DNA quantitation of CR group was lower than that of NCR group, and CD3+, CD4+, CD4+/CD8+, NK of the CR group were higher than the NCR group, and the differences were statistically significant (P < 0.05). Conclusion Through the blood lymphocyte subsets testing can monitor patients'' immune status, so as to provide help for antiviral treatment.
, 百拇医药
[Key words] Chronic hepatitis B; Lymphocyte subsets; PEG-interferon
乙型肝炎病毒(hepatitis B virus，HBV)是引起慢性肝炎、肝硬化、甚至肝细胞癌的主要病原体。乙型肝炎的发病机制复杂，至今尚未完全阐明。目前普遍认为宿主的免疫应答在乙型肝炎的发病机制中起主要作用，细胞免疫反应是HBV感染后引起肝细胞损害的主要机制。研究表明，机体感染HBV后，外周血淋巴细胞亚群间的平衡被打破，细胞亚群之间的调节紊乱是体内不能清除HBV及HBV在肝内持续复制的主要原因。干扰素抗病毒的作用机制有两个方面：①调节机体免疫，加强辅助T细胞1型(Th1)作用，分泌IL-2等细胞因子，促进HBV特异细胞毒T细胞(CTL)和自然杀伤(NK)细胞的活性，又刺激巨噬细胞产生细胞因子，增强细胞免疫。②IFN-α与细胞膜上干扰素受体1(IFN-R1)结合，诱导细胞内染色体产生抗病毒蛋白。因此聚乙二醇IFN-α作为慢性乙型肝炎抗病毒治疗的首选药物之一。影响IFN-α疗效的因素颇多，报道结果亦多有差异，总体来看可分为病毒因素和宿主因素两大类。在病毒因素方面，有病毒载量、基因型等；而宿主因素则较复杂，除性别、年龄、感染时间长短、ALT基线值的高低等外，宿主的细胞免疫状态也是决定疗效的重要因素，甚至可能是最重要的宿主因素，其他因素可能只是免疫因素的外在反映。抗病毒治疗前的细胞免疫状态对应答率的影响目前报道较少。外周血细胞亚群是反映慢性乙型肝炎患者免疫状态的重要指标[1]。本研究通过比较不同应答组之间淋巴细胞亚群、HBV DNA定量、ALT、年龄等的差异，探讨CHB患者IFN治疗前细胞免疫状态对抗病毒疗效的影响。, http://www.100md.com(奚伟星)