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目的探讨核苷类药物替比夫定对慢性乙肝患者(CHB)外周血中CD4+CD25+CD127lowT细胞和CD8+CD25+T细胞比例的影响,并结合临床指标分析其临床意义。方法替比夫定抗病毒治疗22例CHB患者,在治疗前及治疗后3,6个月时,分别以流式细胞仪检测外周血中CD4+CD25+CD127lowT细胞和CD8+CD25+T细胞比例,实时荧光定量RT-PCR检测Foxp3 mRNA的表达水平,荧光定量PCR检测血清HBV DNA水平,酶联免疫吸附法检测HBV标志物,全自动生化分析仪检测ALT水平。结果 CHB患者外周血中CD4+CD25+CD127lowT细胞和CD8+CD25+T细胞比例显著高于对照组。替比夫定治疗3个月时,这两群细胞比例显著下降,Foxp3 mRNA的表达也显著下降;HBV DNA水平降至检测水平以下的CHB患者,其CD4+CD25+CD127lowT细胞也降至正常水平。治疗3、6个月时,HBeAg阴转率分别为9.1%和18.2%,发生HBeAg血清学转换者的CD4+CD25+CD127lowT细胞和CD8+CD25+T细胞比例均降至正常水平。结论替比夫定能快速有效抑制CHB患者的病毒复制,同时CD4+CD25+CD127lowT细胞和CD8+CD25+T细胞比例显著下调,可能降低了Treg对HBV特异性T淋巴细胞的抑制作用,改善了机体的免疫应答。
Objective To investigate the effect of telbivudine nucleoside on the proportion of CD4 + CD25 + CD127lowT cells and CD8 + CD25 + T cells in peripheral blood of patients with chronic hepatitis B (CHB) and to analyze their clinical significance. Methods 22 patients with chronic hepatitis B were treated with telbivudine antiviral therapy. The proportion of CD4 + CD25 + CD127low T cells and CD8 + CD25 + T cells in peripheral blood were measured by flow cytometry before treatment and at 3 and 6 months after treatment Real-time fluorescent quantitative RT-PCR was used to detect the expression of Foxp3 mRNA, serum HBV DNA level was detected by fluorescence quantitative PCR, HBV markers were detected by enzyme linked immunosorbent assay, and ALT level was detected by automatic biochemical analyzer. Results The proportion of CD4 + CD25 + CD127lowT cells and CD8 + CD25 + T cells in peripheral blood of patients with CHB was significantly higher than that of the control group. After 3 weeks of telbivudine treatment, the ratio of these two groups of cells decreased significantly, and the expression of Foxp3 mRNA also decreased significantly. The level of CD4 + CD25 + CD127lowT cells in CHB patients with HBV DNA levels below the detection level also dropped to normal levels . HBeAg negative conversion rates were 9.1% and 18.2% at 3 and 6 months of treatment, respectively, and the proportion of CD4 + CD25 + CD127lowT cells and CD8 + CD25 + T cells in HBeAg seroconverters were both reduced to normal levels. Conclusion Telbivudine can rapidly and effectively inhibit virus replication in patients with CHB, meanwhile, the proportion of CD4 + CD25 + CD127low T cells and CD8 + CD25 + T cells decreased significantly, which may reduce the inhibitory effect of Treg on HBV specific T lymphocytes and improve The body’s immune response.