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目的:探讨慢性乙型肝炎(CHB)患者不同血清HBV DNA水平诱导细胞免疫不同及其意义。方法:对189例CHB患者进行滤泡辅助性T淋巴细胞(Tfh)、HBV特异性CTL、非特异性CTL、白细胞介素-21(IL-21)和肝功能的检测。根据HBV DNA水平分为甲组(91例)和乙组(98例)。结果:甲组HBV DNA水平低于乙组(t=27.56,P<0.001),Tfh高于乙组(t=4.99,P<0.01),IL-21高于乙组(t=8.95,P<0.01),HBV特异性CTL高于乙组(t=19.91,P<0.01),非特异性CTL低于乙组(t=3.27,P<0.01),ALT低于乙组(t=3.92,P<0.01),TBil低于乙组(t=3.86,P<0.01)。结论:CHB患者不同HBV DNA水平诱导Tfh反应不同,HBV DNA水平高者,Tfh水平低,IL-21水平和HBV特异性CTL水平也低,并启动非特异性CTL,导致肝功能损害加重。基线HBV DNA水平影响抗病毒疗效的机制可能与不同HBV DNA水平引起Tfh反应不同有关。
Objective: To investigate the difference of serum HBV DNA levels induced by different serums in patients with chronic hepatitis B (CHB) and its significance. Methods: Tfh, HBV specific CTL, nonspecific CTL, interleukin-21 (IL-21) and liver function were detected in 189 CHB patients. According to the level of HBV DNA divided into Group A (91 cases) and Group B (98 cases). Results: HBV DNA level in group A was lower than that in group B (t = 27.56, P <0.001), Tfh was higher in group B than in group B (t = 4.99, (T = 3.27, P <0.01). The specific CTL of HBV was higher than that of group B (t = 19.91, P <0.01) 0.01), TBil was lower than that of group B (t = 3.86, P <0.01). CONCLUSIONS: Different HBV DNA levels induce different Tfh responses in CHB patients. High levels of HBV DNA, low Tfh levels, low levels of IL-21 and HBV-specific CTLs, and non-specific CTLs are initiated, leading to worsening of liver dysfunction. The mechanism by which baseline HBV DNA levels affect antiviral efficacy may be related to differences in Tfh responses due to different HBV DNA levels.