摘要
目的探讨慢性乙型肝炎（乙肝）病毒（HBV）感染者外周血CD4＋、CD8＋T细胞的表达与乙肝表面抗原（HBsAg）定量水平的变化及两指标间的相关性。方法回顾性分析天津市第二人民医院2012年1月至2014年12月收治的27例乙肝病毒携带者（乙肝携带组）、98例慢性乙肝患者（慢乙肝组）、84例乙肝肝硬化患者（肝硬化组）、35例原发性肝癌患者（肝癌组）的一般情况及外周血CD4＋、CD8＋T细胞的表达、HBsAg定量指标。比较4组患者CD4＋、CD8＋T细胞表达水平及其与HBsAg的相关性。结果外周血CD4＋、CD8＋T细胞的表达和HBsAg定量在乙肝携带组、慢乙肝组、肝硬化组、肝癌组呈现逐渐下降的趋势[CD4＋（个／肛L）：829．0（672．0，890．0）、733．0（529．3，923．5）、520．0（329．0，717．5）、438．0（318．0，565．0），CD8＋（个／¨L）：415．0（407．0，935．O）、570．0（436．8，764．3）、298．0（211．5，510．3）、309．0（223．0，483．0）]，差异有统计学意义（日值分别为37．250、53．056，均P=0．000），两两比较的结果显示乙肝携带组CD4＋、CD8＋T细胞水平高于肝硬化组、肝癌组，慢乙肝组高于肝硬化组、肝癌组，差异有统计学意义（CD4＋：H值分别为3．804、4．580、3．928、4．650，CD8＋：H值分别为4．246、3．778、6．189、4．816，均P〈0．01），而乙肝携带组与慢乙肝组比较差异无统计学意义（均P〉0．05），肝硬化组与肝癌组比较差异无统计学意义（均P〉0．05）。乙肝携带组HBsAg水平高于慢乙肝组、肝硬化组、肝癌组[U／L：9．898（7．565，12．708）、5．257（3．428，8．216）、0．459（0．282，0．791）、0．221（0．125，0．324）]，慢乙肝组高于肝硬化组、肝癌组，差异有统计学意义（／t值分别为2．628、9．037、9．828、9．604、9．883，均P〈0．叭），而肝硬化与肝癌组比较差异无统计学意义（P〉0．05）。Spearman相关性分析显示在慢乙肝组中CD4＋与HBsAg呈负相关（r=-0．300，P=0．003），在肝硬化组中CD8＋与HBsAg呈正相关（r=0．283，P=0．009）。结论慢性HBV感染者随着疾病的进展，外周血CD4＋、CD8＋T细胞的表达呈下降趋势，且CD8＋T细胞表达与HBsAg定量在慢乙肝组中呈负相关，在肝硬化组中呈正相关。
Objective To investigate the changes of expressions of peripheral blood CD4＋ and CD8＋ T lymphocytes and the quantitative level of hepatitis B virus surface antigen （HBsAg） in patients with chronic hepatitis B virus （HBV） infection, and the correlations between the above two indexes. Methods A retrospective analysis was conducted. Twenty-seven carriers with hepatitis B virus （HBV carriers group）, 98 patients with chronic hepatitis B （chronic hepatitis B group）, 84 patients with hepatitis B virus liver cirrhosis （liver cirrhosis group） and 35 patients with primary liver cancer （hepatic carcinoma group） admitted to Tianjin Second People＇s Hospital from January 2012 to December 2014 were enrolled, and their general conditions, expressions of peripheral blood CD4＋ and CD8＋ T lymphocytes and quantitative level of HBsAg were collected in the four groups. The expression levels of peripheral blood CD4＋ and CD8＋ T lymphocytes in the four groups were compared, and the correlations between the expression levels of CD4＋ and CD8＋ T lymphocytes and quantitative levels of HBsAg among the four groups were determined. Results The expression levels of peripheral blood CD4＋ and CD8＋ T lymphocytes and quantitative levels of HBsAg among the HBV carriers group, chronic Hepatitis B group, liver cirrhosis group and hepatic carcinoma group showed a gradually downward tendency [CD4＋ （cells/μL）： 829.0 （672.0,890.0）, 733.0 （529.3,923.5）, 520.0 （329.0, 717.5）. 438.0 （318.0, 565.0）, CD8＋ （cells/μ L）： 415.0 （407.0, 935.0）, 570.0 （436.8, 764.3）, 298.0 （211.5, 510.3）, 309.0 （223.0, 483.0）], and the differences were statistically significant （H value was 37.250, 53.056, both P = 0.000）; the results of pairwise comparisons showed the expression levels of CD4＋ and CD8＋ T lymphoeytes in HBV carriers group were higher than those in liver cirrhosis group and hepatic carcinoma group, and in chronic hepatitis B group, they were higher than those of liver cirrhosis group and hepatic carcinoma group, the differences being statistically significant （CD4＋：H value was 3.804, 4.580, 3.928, 4.650, CD8＋： H value was 4.246, 3.778, 6.189, 4.816, all P 〈 0.01）, but there were no statistically significant differences between HBV carriers group and chronic hepatitis B group （all P 〉 0.05）, and there were no statistically significant differences between liver cirrhosis group and hepatic carcinoma group （all P 〉 0.05）. The level of HBsAg in HBV carriers group was higher than that in chronic hepatitis B group, liver cirrhosis group and hepatic carcinoma group [U/L： 9.898 （7.565, 12.708）, 5.257 （3.428, 8.216）, 0.459 （0.282, 0.791）, 0.221 （0.125, 0.324）], while in chronic hepatitis B group, the HBsAg was higher than that in liver cirrhosis group and hepatic carcinoma group, the differences being statistieally significant （H value was 2.628, 9.037, 9.828, 9.604, 9.883, all P 〈 0.01）, but the comparison of HBsAg between liver cirrhosis group and hepatic carcinoma group showed the difference was not statistically significant （P 〉 0.05）. Spearman correlation analysis revealed in chronic hepatitis B group, CD8＋ was negatively correlated with HBsAg （r = -0.300, P = 0.003）, and in liver cirrhosis group, CD8＋ was positively correlated with HBsAg （r = 0.283, P = 0.009）. Conclusions Along with the disease progress of patients with chronic HBV infection, the expressions of peripheral blood CD4＋ and CD8＋ T cells show a certain degree of downtrend, and in the chronic hepatitis B group, the correlation between the expression of CD8＋ and quantitative level of HBsAg is negative, while in the liver cirrhosis group, the correlation between the above two indexes is positive.
出处
《中国中西医结合急救杂志》
CAS
北大核心
2016年第4期399-403,共5页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
国家科技重大专项课题（2012ZX10005-005）
