CAJ | 학술논문

目的探讨慢性乙型肝炎(慢乙肝)患者使用核苷类抗病毒药物前后对免疫球蛋白及补体的影响.方法选取慢乙肝患者共157例,50例接受抗病毒治疗,分别在其使用核苷类抗病毒药物前,抗病毒治疗后的第1、2、3、4周,用ELISA法检测HBV血清学标志物,RT-PCR法检测HBV DNA,免疫比浊法测定IgG、IgA、IgM和C3、C4、总补体(CH50)、C反应蛋白(CRP).均数比较采用t检验和Mann-Whitney检验.相关分析采用Pearson相关系数检验.结果慢性乙型重型肝炎及肝硬化组患者的IgA、IgM明显高于慢乙肝组(P＜0.01).三组间C3、C4、CH50、CRP水平比较,差异有统计学意义.HBeAg阳性与HBeAg阴性患者的C3、IgM、IgG及HBV DNA水平比较,差异有统计学意义.HBeAg阳性者中,高HBV DNA水平的患者与低水平HBV DNA患者相比,其IgA、IgM、C3和CH50水平均差异有统计学意义.HBeAg阴性患者中,高HBV DNA水平的患者与低水平HBV DNA患者相比,IgA水平差异有统计学意义.经抗病毒治疗,三组患者的免疫球蛋白及HBV DNA较治疗前下降,补体系统较前回升,在第4周时差异有统计学意义.HBV DNA的水平与C3呈负相关(r=-0.78,P=0.021).HBeAg定量与C3呈正相关(r=0.87,P=0.015).结论血清免疫球蛋白、CRP、C3、C4和CH50可以反映肝脏炎性活动状态；C3的变化可以预测抗病毒治疗的效果.
목적 탐토만성을형간염(만을간)환자사용핵감류항병독약물전후대면역구단백급보체적영향.방법 선취만을간환자공157례,50례접수항병독치료,분별재기사용핵감류항병독약물전,항병독치료후적제1、2、3、4주,용ELISA법검측HBV혈청학표지물,RT-PCR법검측HBV DNA,면역비탁법측정IgG、IgA、IgM화C3、C4、총보체(CH50)、C반응단백(CRP).균수비교채용t검험화Mann-Whitney검험.상관분석채용Pearson상관계수검험.결과 만성을형중형간염급간경화조환자적IgA、IgM명현고우만을간조(P＜0.01).삼조간C3、C4、CH50、CRP수평비교,차이유통계학의의.HBeAg양성여HBeAg음성환자적C3、IgM、IgG급HBV DNA수평비교,차이유통계학의의.HBeAg양성자중,고HBV DNA수평적환자여저수평HBV DNA환자상비,기IgA、IgM、C3화CH50수평균차이유통계학의의.HBeAg음성환자중,고HBV DNA수평적환자여저수평HBV DNA환자상비,IgA수평차이유통계학의의.경항병독치료,삼조환자적면역구단백급HBV DNA교치료전하강,보체계통교전회승,재제4주시차이유통계학의의.HBV DNA적수평여C3정부상관(r=-0.78,P=0.021).HBeAg정량여C3정정상관(r=0.87,P=0.015).결론 혈청면역구단백、CRP、C3、C4화CH50가이반영간장염성활동상태；C3적변화가이예측항병독치료적효과.
Objective To evaluate the effects of nucleoside/nucleotide analogue treatment on immunoglobulin and complement in patients with chronic hepatitis B (CHB).Methods A total of 157 CHB patients were recruited and divided into CHB group,liver cirrhosis (LC) group and severe hepatitis B (SHB) group.There were 50 patients who received oral antiviral treatment (lamivudine 100 mg/d,or entecavir 0.5 mg/d,or telbivudine 600 mg/d).Serum levels of complement 3 and 4 (C3,C4),C-reaction protein (CRP),hemolytic complement (CH50),immunoglobulin G,M,A (IgG,IgM,IgA),hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) were detected by enzyme-linked immunosorbent assay (ELISA) or immunoturbidimetry.Hepatitis B virus (HBV) DNA was quantified by real-time polymerase chain reaction (RT-PCR) before and 1,2,3 and 4 weeks after nucleoside antiviral therapy.Comparison of means was done by t test and Mann-Whitney test.The correlation was analyzed by Pearson correlation coefficient test.Results Serum IgA and IgM levels of SHB and LC patients were significantly higher than those of CHB patients (P＜0.01).Levels of C3,C4,CH50 and CRP were significantly different among three groups.Levels of C3,IgM,IgG and HBV DNA in HBeAg positive patients were significantly different from those in HBeAg negative patients.There was a statistically significant difference of IgA,IgM,C3 and CH50 levels between patients with high HBV DNA level and low HBV DNA level in HBeAg-positive patients.While in the HBeAg-negative patients,only the IgA level was significantly different with HBV DNA levels.After anti-viral treatment,immunoglobulin and HBV DNA levels were all decreased in three groups,while the serum complement level was increased compared to baseline,and the differences became significant at week 4 of treatment. HBV DNA level was negatively correlated with C3 (r=-0.78,P=0.021) and HBeAg titer was positively correlated with C3 (r=0.87,P=0.015).Conclusions The immunoglobulin,CRP,C3,C4,and C H50 could reflect the inflammatory activity in liver.The changes of C3 level can predict the efficacy of antiviral therapy.