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目的比较慢性乙型肝炎患者、HBV 携带者、HBV 既往无症状感染者之间 T 细胞亚群和 HBV 特异性 CD_4~+ T 细胞应答强度的差异,分析宿主的细胞免疫状态对 HBV 感染后临床转归的影响,探讨乙型肝炎的发病机制,为慢性乙型肝炎的治疗提供新的线索。方法选取2004年2-10月在北京协和医院肝炎门诊就诊的慢性乙型肝炎患者30例、HBV 携带者22例、HBV 既往无症状感染者9例以及正常对照11例,使用流式细胞仪检测其 T 细胞亚群,使用酶联免疫斑点法检测病毒特异性 CD_4~+ T 细胞应答强度,分析其差异及临床意义。结果慢性乙型肝炎组 CD_4~+ T 细胞计数显著低于HBV 既往无症状感染组和正常对照组;慢性乙型肝炎组、HBV 携带者组、HBV 既往无症状感染组病毒特异性 CD_4~+ T 细胞应答强度分别为(156±105)、(56±68)、(229±114)SFC/10~6PBMC(每10~6个外周血单个核细胞中斑点形成细胞的个数);慢性乙型肝炎组明显高于 HBV 携带者组(P<0.01),而低于 HBV 既往无症状感染组(P<0.05)。结论慢性乙型肝炎患者、HBV 携带者、HBV 既往无症状感染者病毒特异性 T 细胞应答强度存在差异,这种差异可能是造成 HBV 感染后不同临床转归的主要因素之一。
Objective To compare the differences of T cell subsets and HBV-specific CD_4 ~ + T cell response in patients with chronic hepatitis B, HBV carriers and previously asymptomatic HBV carriers, and to analyze the influence of host immune status on the clinical outcome after HBV infection To study the pathogenesis of hepatitis B and provide new clues for the treatment of chronic hepatitis B. Methods Thirty cases of chronic hepatitis B, 22 cases of HBV carriers, 9 cases of previously asymptomatic HBV infection and 11 cases of normal control were selected from Union Hospital of Peking Union Medical Hospital from February to October in 2004. Flow cytometry The T cell subsets, the use of enzyme-linked immunosorbent assay to detect virus-specific CD_4 ~ + T cell response intensity, analysis of the difference and clinical significance. Results The counts of CD_4 ~ + T cells in chronic hepatitis B group were significantly lower than those in the asymptomatic HBV infection group and the normal control group. The HBV - specific CD_4 ~ + T The cell response intensities were (156 ± 105), (56 ± 68) and (229 ± 114) SFC / 10 ~ 6 PBMCs (the number of speckle forming cells per 10 ~ 6 peripheral blood mononuclear cells) Hepatitis group was significantly higher than the HBV carrier group (P <0.01), but lower than the previous HBV infection group (P <0.05). Conclusion There are differences in the intensity of virus-specific T cell responses among patients with chronic hepatitis B, HBV carriers, and previously asymptomatic HBV infection. This difference may be one of the main factors that lead to different clinical outcomes after HBV infection.