慢性乙型肝炎病毒感染者外周血T细胞亚群及NK细胞的特点及意义

目的探讨慢性乙型肝炎病毒（hepatitis B virus，HBV）感染者外周血T细胞亚群及NK细胞的特点及临床意义。方法采用流式细胞术检测各研究组，包括慢性乙型肝炎（chronic hepatitis B，CHB）组33例、乙型肝炎失代偿期肝硬化（1iver cirrhosis，LC）组20例、慢性乙型重型肝炎（chronic severe hepatitis B，CSH）组17例及健康对照组（Control）20例的外周血T细胞亚群及NK细胞相对计数，并检测肝功能、HBVDNA含量及HBV血清标志物。结果按Control、CHB、LC、CSH顺序，CD3^＋T细胞、CD8^＋T细胞百分比依次升高，而CIM^＋T细胞、CD4^＋／CD8^＋比值及NK细胞百分比依次降低，且CHB、LC、CSH组与Control组及CHB组与CSH组相比，差异均有统计学意义（P〈0．05或P〈0．008）。CHB患者的CD3^＋T细胞与血清总胆红素（total bilirubin，TB）、HBVDNA含量（log_10）呈正相关（P〈0．001；P〈0．001）；CD8^＋T细胞与HBVDNA含量（log_10）呈正相关（P=0．007），NK细胞与HBVDNA含量（log_10）（P=0．001）呈负相关。CHB组乙型肝炎e抗原（HBeAg）阳性者的CD4^＋T细胞及CD4^＋／CD8^＋比值低于HBeAg阴性者（P=0．018；P〈0．001），而HBVDNA含量（log_10）和CD8^＋T细胞高于HBeAg阴性者（P=0．012；P=0．019）。结论慢性HBV感染者外周血T细胞亚群及NK细胞相对值紊乱，且与临床类型、病情、血清HBVDNA水平及HBeAg相关。

Characteristic and clinical significance of peripheral blood T cells subsets and NK cells In patients with chronic hepatitis B

Objective To study the characteristic and clinical significance of peripheral blood T ceils subsets and NK cells in patients with chronic hepatitis B. Methods Thirty-three patients with chronic hepatitis B （CHB）, twenty hepatitis B patients with decompensated liver cirrhosis （LC）, seventeen patients with chronic severe hepatitis B （CSH） and 20 healthy controls （Control） were enrolled for observation. The peripheral blood T cells subsets and NK cells were determined by flow cytometry, liver functions were assayed on automatic biochemistry analyzer, serum HBV DNA was amplified by real-time fluorescent quantitative PCR and serum HBV markers were examined by ELISA. Results The percentage of CD3^＋T and CD8^＋T cells in Control, CHB, LC and CSH groups increased gradually,while the percentage of CD4^＋T and NK ceils and the ratio of CD4^＋/CD8^＋ reduced gradually. The differences between CHB and control, LC and control, CSH and control, CHB and CSH were statistically significant （P 〈 0.05 or P 〈 0. 008） in percentages of CD3^＋ T cells, CD4^＋ T cells, CD8^＋ T cells,NK cells and the ratio of CD4^＋/CD8^＋. In the patients with chronic hepatitis B, the correlations between CD3^＋T cells and serum total bilirubin （TB）, CD3^＋T cells and HBV DNA, CD8^＋ T cells and HBV DNA showed positive trend （ P 〈 0. 001 ; P 〈 0. 001 ; P = 0. 007）, while the correlation between NK cells and HBV DNA was negative （ P = 0. 001 ）. Meanwhile, in chronic hepatitis B patients with positive hepatitis B e antigen （HBeAg）, the percentage of CD4^＋T cells and the ratio of CD4^＋ ＋/CD8^＋ were significantly lower （P =0.018 ;P 〈0.001 ）, but HBV DNA and the percentage of CD8 ^＋ T cells were considerably higher （P = 0.012 ;P = 0.019） than those with negative HBeAg. Conclusions Aberrant T cells subsets and NK cells exist in chronic hepatitis B patients which correlate with clinical types, pathogenetic conditions, serum HBV DNA load and HBeAg.