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目的探讨桂林地区不同基因分型慢性乙型肝炎(chronic hepatitis B,CHB)患者临床表现及肝内免疫活性细胞(CD4+、CD8+、CD20+、CD57+)与肝脏病理的关系。方法对70例2008年1月至2013年12月在桂林市第三人民医院肝病科住院CHB患者进行肝组织活检术,其中B基因型44例,C基因型26例,并运用免疫组织化学法分析肝组织内CD4+、CD8+、CD20+、CD57+淋巴细胞的表达,比较不同乙型肝炎病毒(HBV)基因分型患者CD4+、CD8+、CD20+、CD57+淋巴细胞与临床相关性。结果桂林地区CHB患者以B基因型为主,B、C两组基因型在年龄、白蛋白(albumin,ALB)、球蛋白(globulin,GLB)差异无统计学意义,而C基因型丙氨酸氨基转移酶(alanine aminotransferase,ALT)水平高于B基因型(P<0.05),B基因型HBeAg阳性率高于C基因型(P<0.05),C基因型肝脏组织病理损害程度比B基因型严重(P<0.05);B基因型CHB患者炎症程度到达G4组及C基因型到达G3组肝组织中CD4+、CD8+、CD20+的表达均比G1组明显增加,差异有统计学意义(P<0.05);C基因型组炎症程度到达G4肝组织中CD57+T细胞表达比G1明显增加,差异有统计学意义(P<0.05),B基因型ALT与CD4+、CD8+、CD20+T细胞水平呈直线相关(r值分别为0.554、0.678、0.740,P均<0.01),与CD57+无相关性,而C基因型ALT与CD8+、CD20+、CD57+T淋巴细胞水平呈直线相关关系(r值分别为0.517、0.626、0.737,P均<0.05),与CD4+无相关性。结论CHB患者以B基因型为主,B基因型患者HBeAg阳性率明显高于C基因型患者,C基因型肝脏组织病理损害程度比B基因型严重,B、C基因型患者肝组织内CD4+、CD8+、CD20+表达与肝组织内炎症分级均有明显相关性,不同基因型疾病严重程度与机体的免疫状况有关。
Objective To investigate the clinical manifestations and the relationship between intrahepatic immune cells (CD4 +, CD8 +, CD20 +, CD57 +) and liver pathology in different genotypes of chronic hepatitis B (CHB) patients in Guilin. Methods Seventy patients with CHB admitted to Department of Hepatology, Third People ’s Hospital of Guilin from January 2008 to December 2013 were enrolled in this study. Among them, 44 cases were genotype B and 26 cases were genotype C. Immunohistochemistry The expression of CD4 +, CD8 +, CD20 + and CD57 + lymphocytes in liver tissue was analyzed to compare the clinical features of CD4 +, CD8 +, CD20 + and CD57 + lymphocytes in different genotypes of hepatitis B virus (HBV). Results Genotype B was predominant in patients with CHB in Guilin. There was no significant difference in age, albumin (ALB) and globulin (GLB) genotypes between genotypes B and C, but C genotype alanine (P <0.05). The positive rate of HBeAg in B genotype was higher than that in C genotype (P <0.05). The pathological lesion degree of liver tissue of C genotype was higher than that of B genotype (P <0.05). The expression of CD4 +, CD8 + and CD20 + in liver tissue of CHB patients with genotype B was higher than that of G1 group (P <0.05) ). The expression of CD57 + T cells in G genotype group was significantly higher than that in G1 group (P <0.05), and the level of ALT and CD4 +, CD8 + and CD20 + T cells in B genotype was linear (R = 0.554,0.678,0.740, P <0.01), but no correlation with CD57 +, while there was a linear correlation between C genotype ALT and CD8 +, CD20 + and CD57 + T lymphocytes (r values were 0.517 , 0.626,0.737, P <0.05), but no correlation with CD4 +. Conclusions The genotype B is predominant in patients with CHB, the positive rate of HBeAg in patients with genotype B is significantly higher than those in patients with genotype C, the severity of liver damage in patients with genotype C is more severe than those with genotype B, The expression of CD8 + and CD20 + were significantly correlated with the grade of inflammation in liver tissues. The severity of different genotypes was related to the immune status of the body.