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目的 通过检测慢性乙型肝炎患者急性发作后体液免疫和细胞免疫的相关指标,探讨慢性乙型肝炎急性发作后宿主免疫功能变化及其与肝功能损伤之间的关系,为阐明慢性乙型肝炎的发病机制和特异性免疫治疗提供理论基础。方法 25例随机入组的慢性乙型肝炎患者,根据 HBc-IgM定性结果分为两组(HBc-IgM阳性组为实验组;HBc-IgM阴性组为对照组),分别以赖氏法检测血清丙氨酸氨基转移酶(alanine aminotransferaseALT)、比色法检测天冬氨酸氨基转移酶(aspartate aminotransferase AST)、核酸扩增(PCR)荧光定量检测乙型肝炎病毒(HBV) DNA、激光散射比浊法测定血清免疫球蛋白G(IgG)和荧光素双标记 FCM(flow cytometry)技术检测外周血CD3+、CD4+、CD8+ T淋巴细胞相对含量,统计学分析用 t检验与秩和检验。结果 HBc-IgM阳性组ALT、AST和HBVDNA平均值高于 HBc-IgM阴性组,有统计学差异(P<0.05);两组血清 IgG含量和外周血CD3+、CD4+、CD8+ T细胞亚群间无统计学差异(P>0.05)。结论 慢性乙型肝炎急性发作后,HBV清除延迟;HBV激活的宿主免疫应答主要通过特异性免疫导致肝组织损伤和病毒清除,宿主体内多克隆免疫应答的激活不明显。
Objective To investigate the relationship between humoral immunity and cellular immunity after acute attack in patients with chronic hepatitis B and to explore the relationship between the changes of host immune function and liver dysfunction after acute exacerbation of chronic hepatitis B. To elucidate the relationship between chronic hepatitis B Pathogenesis and specific immunotherapy provide a theoretical basis. Methods Twenty-five patients with chronic hepatitis B were randomized into two groups according to the qualitative results of HBc-IgM (HBc-IgM positive group was the experimental group; HBc-IgM negative group was the control group) Alanine aminotransferase ALT, aspartate aminotransferase AST by colorimetric assay, hepatitis B virus (HBV) DNA by fluorescence quantitative PCR, The serum relative levels of CD3 +, CD4 + and CD8 + T lymphocytes in peripheral blood were detected by serum immunoglobulin G (IgG) and flow cytometry (FCM). The statistical analysis was performed by t-test and rank sum test. Results The mean levels of ALT, AST and HBVDNA in HBc-IgM positive group were significantly higher than those in HBc-IgM negative group (P <0.05). There was no significant difference between the two groups in the serum IgG levels and in peripheral blood CD3 +, CD4 +, CD8 + T cell subsets Statistical difference (P> 0.05). Conclusions After acute exacerbation of chronic hepatitis B, the clearance of HBV is delayed. The host immune response activated by HBV mainly results in the liver tissue damage and virus clearance by specific immunization. The activation of polyclonal immune response in the host is not obvious.