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目的:研究HBV携带者的细胞免疫功能变化及其与血清HBVDNA,HBeAg的关系,并对T细胞亚群与肝组织病理学改变进行对比分析,探讨HBV携带及其所导致肝组织病理改变的机制.方法:应用流式细胞仪检测109例HBV携带者和40例健康对照外周血T细胞亚群百分率,并对其中28例行肝组织病理学检查,ELISA法检测HBV标志物,PCR法检测HBVDNA.结果:HBV携带者外周血CD3+、CD4+细胞百分率及CD4+/CD8+比值较正常对照组显著降低(67.2±9.0%vs71.0±3.5%,P<0.05;33.1%±6.6vs40.3±2.8%,P<0.001;1.10±0.36vs2.01±0.19,P<0.001),CD8+细胞百分率明显升高(33.8±8.4%vs20.2±1.9%,P<0.001).HBVDNA(+)组及HBeAg(+)组分别与HBVDNA(-)组及HBeAg(-)组比较,CD3+细胞无统计学差异,CD4+细胞显著降低(31.2±6.3%vs37.2±5.4%,P<0.001;31.0±6.0%vs35.8±6.5%,P<0.001),CD8+细胞明显升高(36.7±8.4%vs27.9±4.2%,P<0.001;37.3±8.4%vs29.5±6.0%,P<0.001),CD4+/CD8+比值明显降低(0.91±0.32vs1.35±0.26,P<0.001;0.89±0.30vs1.26±0.33,P<0.001).HBVDNA(+)组肝病理组织学改变68.8%达到G1S1及以上程度,而HBVDNA(-)组仅为16.7%,二组间差异显著(c2=5.57,P<0.01).G1S1组CD3+细胞较G1S0组明显降低(F=2.919,P=0.047),CD4+细胞降低(P>0.05).G2S1组与G1S0组相比,CD3+细胞及CD4+细胞百分率有降低趋势,CD8+细胞百分率有升高趋势,CD4+/CD8+比值有明显降低趋势.结论:HBV感染可导致HBV携带者细胞免疫功能改变,HBVDNA复制增加可进一步加重HBV携带者的细胞免疫功能紊乱,并加重肝组织损害.
OBJECTIVE: To investigate the changes of cellular immune function in HBV carriers and its relationship with serum HBVDNA and HBeAg, and to analyze the relationship between T cell subsets and pathological changes of liver tissue to explore the mechanism of HBV carriers and the pathological changes of liver tissue Methods: Flow cytometry was used to detect the percentages of T lymphocyte subsets in peripheral blood of 109 cases of HBV carriers and 40 healthy controls, 28 cases of them were examined by histopathology, HBV markers were detected by ELISA and HBVDNA by PCR Results: The percentage of CD3 +, CD4 + cells and CD4 + / CD8 + in peripheral blood of HBV carriers were significantly lower than those in normal controls (67.2 ± 9.0% vs 71.0 ± 3.5%, P <0.05; 33.1% ± 6.6 vs 40.3 ± 2.8% , P <0.001; 1.10 ± 0.36vs2.01 ± 0.19, P <0.001), the percentage of CD8 + cells increased significantly (33.8 ± 8.4% vs20.2 ± 1.9%, P <0.001) (31.2 ± 6.3% vs 37.2 ± 5.4%, P <0.001; 31.0 ± 6.0% vs35, respectively), but there was no significant difference in CD3 + cells between HBVDNA (-) group and HBeAg (P <0.001, P <0.001); CD4 + / CD8 + cells significantly increased (P <0.001) CD8 + ratio was significantly lower (0.91 ± 0.32vs1.35 ± 0.26, P <0.001; 89 ± 0.30vs1.26 ± 0.33, P <0.001) .HBVDNA (+) group histological changes of 68.8% reached G1S1 and above, while HBVDNA (-) group was only 16.7%, significant difference between the two groups (c2 = 5.57, P <0.01) .Compared with G1S0 group, the percentage of CD3 + cells and CD4 + cells in G1S1 group was significantly lower than that in G1S0 group (F = 2.919, P = 0.047) The percentage of CD8 + cells increased and the ratio of CD4 + / CD8 + decreased significantly.Conclusion: HBV infection can lead to the change of cellular immunity in HBV carriers, and the increase of HBVDNA replication may further aggravate the cellular immune dysfunction in HBV carriers, And increase liver damage.