论文部分内容阅读
目的:分析孕晚期应用替比夫定(Ld T)对乙肝孕妇细胞免疫功能的影响,为降低乙肝高病毒血症孕产妇死亡率提供临床依据。方法:收集2013年3月至12月我院收治的乙肝表面抗原阳性(HBs Ag)阳性、乙肝e抗原(HBe Ag)阳性、HBV DNA≥106IU/ml的59例孕妇,根据孕晚期是否服用Ld T,分为Ld T治疗组和未治疗组。同时收集同期HBs Ag(+)、HBe Ag(-)、HBV DNA<106IU/ml的孕妇30例为低病毒组,HBs Ag(-)的孕妇30例为正常对照组。运用流式细胞术分析Ld T对乙肝孕妇外周血CD3~+T细胞、CD4~+T细胞、CD8~+T细胞及CD4+CD25+Treg细胞(Tregs)的影响。结果:正常组、低病毒组、高病毒未治疗组和高病毒Ld T治疗组的CD3~+T细胞比例无明显差异;与正常组比较,高病毒和低病毒组中CD4~+T细胞比例升高、CD8~+T细胞降低、CD4~+/CD8~+比值进一步升高,Tregs比例显著升高。经Ld T治疗后,T细胞亚群基本处于正常水平。与高病毒未治疗组相比,Ld T治疗组的CD4~+T细胞比例下降,CD8~+T细胞比例也有上升趋势,CD4~+/CD8~+比值显著下降,Tregs比例显著降低。结论:乙肝高病毒血症孕妇体内细胞免疫功能紊乱。Ld T治疗可能解除Tregs对乙肝孕妇机体细胞免疫功能的抑制作用,恢复CD4~+T细胞与CD8~+T细胞之间的平衡状态。Ld T治疗可能通过免疫调节在有效阻断母婴垂直传播的同时,还有可能降低重型肝炎发生率,从而降低孕产妇死亡率。
Objective: To analyze the influence of telbivudine (Ld T) on the cellular immune function of pregnant women in the third trimester of pregnancy and provide a clinical basis for reducing the maternal mortality rate of hepatitis B viraemia. Methods: 59 pregnant women with HBsAg positive, HBeAg positive and HBV DNA≥106IU / ml were collected from March 2013 to December 2013 in our hospital. According to whether Ld T, divided into Ld T treatment group and untreated group. Meanwhile, 30 pregnant women with HBsAg (+), HBeAg (-) and HBV DNA <106IU / ml were also collected as low virus group and 30 pregnant women with HBs Ag (-) as normal control group. The effect of Ld T on CD3 + T cells, CD4 + T cells, CD8 + T cells and CD4 + CD25 + Treg cells (Tregs) in peripheral blood of pregnant women with HBV was analyzed by flow cytometry. Results: There was no significant difference in the proportion of CD3 ~ + T cells between normal group, low virus group, high virus untreated group and high virus Ld T treatment group. Compared with normal group, the ratio of CD4 ~ + T cells in high virus and low virus group Increased, CD8 ~ + T cells decreased, CD4 ~ + / CD8 ~ + ratio increased further, the proportion of Tregs increased significantly. After Ld T treatment, T cell subsets in the basic normal level. The percentage of CD4 ~ + T cells and the percentage of CD8 ~ + T cells in Ld T treated group were also increased compared with those in untreated high virus group, the ratio of CD4 ~ + / CD8 ~ + was significantly decreased, and the proportion of Tregs was significantly decreased. Conclusion: The immune function of cellular immunity in pregnant women with hepatitis B virus viraemia. Ld T treatment may relieve the inhibitory effect of Tregs on the cellular immune function of pregnant women and restore the balance between CD4 ~ + T cells and CD8 ~ + T cells. Ld T treatment may reduce the incidence of severe hepatitis and reduce maternal mortality while effectively blocking the vertical transmission of mother-infant through immunomodulation.