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目的研究替比夫定与恩替卡韦治疗e抗原(HBe Ag)阳性慢性乙型肝炎(CHB)患者Treg/Th17比率变化及与HBe Ag消失的关系及其对比。方法收集2013年1月至2014年12月在沈阳医学院附属中心医院感染科接受治疗的HBe Ag阳性CHB患者,将其随机分为替比夫定及恩替卡韦组,其中替比夫定组34例,恩替卡韦组27例,在治疗前及治疗4周、12周、24周、36周、48周,分别检测乙肝标志物、肝功能、HBV DNA,Treg细胞频数、Th17细胞频数。同时选取20名健康人作为对照组。结果 Treg/Th17比率在第4周开始下降,至第12周达到最低值。CHB患者在各时间点Treg/Th17比率均低于健康对照组。在治疗12周时Treg/Th17比率与HBe Ag消失有显著相关性,替比夫定组12周时Treg/Th17比率低于恩替卡韦组。48周时替比夫定组HBe Ag消失率(64.7%,22/34)高于恩替卡韦组(37.0%,10/27)。结论 12周时Treg/Th17比率水平低的患者更容易发生HBe Ag消失,12周时Treg/Th17比率可能作为48周HBe Ag消失的预测因子。替比夫定组的Treg/Th17比率(12周)水平低于恩替卡韦组,替比夫定的免疫调节作用强于恩替卡韦。
Objective To study the changes of Treg / Th17 ratio in patients with telbivudine and entecavir for HBeAg-positive chronic hepatitis B (CHB) and its relationship with the disappearance of HBeAg. Methods HBeAg-positive patients with CHB who were treated at Department of Infectious Diseases, Shenyang Medical College Hospital from January 2013 to December 2014 were randomly divided into telbivudine and entecavir group, 34 patients in telbivudine group , Entecavir group (n = 27). Hepatitis B markers, liver function, HBV DNA, Treg cell number and Th17 cell number were detected before treatment, 4 weeks, 12 weeks, 24 weeks, 36 weeks and 48 weeks after treatment. At the same time, 20 healthy people were selected as the control group. Results The Treg / Th17 ratio started to decrease from the 4th week and reached the lowest value at the 12th week. CHB patients at each time point Treg / Th17 ratio were lower than the healthy control group. The Treg / Th17 ratio was significantly associated with the disappearance of HBe Ag at 12 weeks of treatment, and the Treg / Th17 ratio at telbivudine 12 weeks was lower than that of entecavir. HBeAg disappearance rate (64.7%, 22/34) in telbivudine group was higher than that in entecavir group (37.0%, 10/27) at 48 weeks. Conclusions Patients with low Treg / Th17 rates at 12 weeks are more likely to have HBe Ag disappearance, and the Treg / Th17 ratio at 12 weeks may serve as a predictor of HBe Ag disappearance at 48 weeks. Telbivudine group Treg / Th17 ratio (12 weeks) lower than the entecavir group, telbivudine immunomodulatory effect stronger than entecavir.