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目的观察替比夫定治疗HBeAg阳性慢性乙肝患者对HBV特异性T细胞细胞亚群的影响。方法选取2013年12月至2015年1月在我院接受替比夫定治疗的HBeAg阳性慢性乙型肝炎患者10例,其中完全应答(CR)组3例,部分应答(PR)组4例,无应答(NR)组3例,观察治疗后HBV特异性细胞毒T淋巴细胞(CTL)水平及HBV DNA、干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)等的变化。结果三组患者HBV DNA水平随着治疗时间的延长而下降,CR组和PR组差异有统计学意义(F=17.21,P<0.05)。患者HBV特异性CTL水平随着治疗时间的延长而增加,对于CR组,强烈的增殖反应在12周时达到最高,持续反应到36周(t=28.27,P<0.05),对于PR组,强烈的增殖反应出现在12周(t=15.57,P<0.05),而NR组则无明显的增殖反应(P=0.286)。患者治疗后第3个月IFN-γ和TNF-α含量较治疗开始时高,差异有统计学意义(F_(IFN-γ)=23.43,F_(TNF-α)=18.27,P<0.05),第6个月、第12个月IFN-γ和TNF-α含量均高于治疗第3个月,差异有统计学意义(F_(IFN-γ)=27.35,F_(TNF-α)=16.17,P<0.05);第6个月和第12个月IFN-γ、TNF-α含量比较,差异无统计学意义(P>0.05)。结论替比夫定治疗HBeAg阳性慢性乙型肝炎患者能有效抑制HBV的复制,降低HBeAg水平,HBV特异性细胞毒T淋巴细胞功能随着治疗的延长而增强,治疗后HBeAg血清学转换的发生与HBV特异性细胞毒T淋巴细胞水平升高有关。
Objective To observe the effect of telbivudine on HBV-specific T cell subsets in HBeAg-positive chronic hepatitis B patients. Methods Ten patients with HBeAg-positive chronic hepatitis B treated with telbivudine in our hospital from December 2013 to January 2015 were selected, including 3 cases of complete response (CR) group and 4 cases of partial response (PR) No response (NR) was observed in 3 cases. The level of HBV specific cytotoxic T lymphocytes (CTL) and the levels of HBV DNA, interferon-γ (IFN-γ) and tumor necrosis factor-α Variety. Results HBV DNA levels in three groups decreased with the prolongation of treatment time. There was significant difference between CR group and PR group (F = 17.21, P <0.05). Patients with HBV-specific CTL levels increased with the extension of treatment time, CR group, the strong proliferative response reached the highest at 12 weeks, sustained response to 36 weeks (t = 28.27, P <0.05), for the PR group, Proliferative response was observed at 12 weeks (t = 15.57, P <0.05), while there was no significant proliferative response in NR group (P = 0.286). The levels of IFN-γ and TNF-α in the third month after treatment were significantly higher than those at the beginning of treatment (F_ (IFN-γ) = 23.43, F_ (TNF_α) = 18.27, P < The levels of IFN-γ and TNF-α in the 6th month and the 12th month were higher than the 3rd month of treatment, the difference was statistically significant (F_ (IFN-γ) = 27.35, F_ (TNF_α) = 16.17, P <0.05). There was no significant difference in the levels of IFN-γ and TNF-α between the 6th month and the 12th month (P> 0.05). Conclusion Telbivudine treatment of HBeAg-positive chronic hepatitis B patients can effectively inhibit HBV replication and reduce the level of HBeAg, HBV-specific cytotoxic T lymphocyte function with the extension of treatment, the treatment of HBeAg seroconversion and HBV-specific cytotoxic T-lymphocyte levels.