CAJ | 학술논문

目的：观察中药芪灵合剂对慢性乙型肝炎（ CHB）患者外周血CD4＋T淋巴细胞表面程序性死亡1（ Pro-grammed death-1， PD-1）及程序性死亡配体1（Programmed death-1 ligand1， PD-L1）表达水平的影响。方法：收集56例CHB患者随机分为芪灵合剂联合拉米夫定片（ LAM）治疗组29例和单用LAM对照组27例，于抗病毒治疗的第0、24、48周用流式细胞术检测外周血CD4＋T淋巴细胞及其表面的PD-1/PD-L1的表达情况。结果：治疗48周后，治疗组患者HBV DNA转阴率、 ALT复常率均高于对照组，与对照组比较， HBV DNA转阴率具有统计学意义（ P＜0.05）。治疗组患者外周血CD4＋T细胞表面PD-124周、48周表达水平与治疗前比较逐渐下降；48周时与本组治疗前比较差异有统计学意义（P＜0.01），与对照组比较差异有统计学意义（P＜0.05）。治疗组患者CD4＋T细胞PD-L148周后表达水平与治疗前比较差异有统计学意义（P＜0.01），与对照组比较差异有统计学意义（P＜0.05）。结论：中药芪灵合剂联合LAM能够提高CHB患者HBV DNA转阴率， ALT复常率，其作用机制可能与抑制CD4＋T淋巴细胞表面PD-1/PD-L1的表达有关。
목적：관찰중약기령합제대만성을형간염（ CHB）환자외주혈CD4＋T림파세포표면정서성사망1（ Pro-grammed death-1， PD-1）급정서성사망배체1（Programmed death-1 ligand1， PD-L1）표체수평적영향。방법：수집56례CHB환자수궤분위기령합제연합랍미부정편（ LAM）치료조29례화단용LAM대조조27례，우항병독치료적제0、24、48주용류식세포술검측외주혈CD4＋T림파세포급기표면적PD-1/PD-L1적표체정황。결과：치료48주후，치료조환자HBV DNA전음솔、 ALT복상솔균고우대조조，여대조조비교， HBV DNA전음솔구유통계학의의（ P＜0.05）。치료조환자외주혈CD4＋T세포표면PD-124주、48주표체수평여치료전비교축점하강；48주시여본조치료전비교차이유통계학의의（P＜0.01），여대조조비교차이유통계학의의（P＜0.05）。치료조환자CD4＋T세포PD-L148주후표체수평여치료전비교차이유통계학의의（P＜0.01），여대조조비교차이유통계학의의（P＜0.05）。결론：중약기령합제연합LAM능구제고CHB환자HBV DNA전음솔， ALT복상솔，기작용궤제가능여억제CD4＋T림파세포표면PD-1/PD-L1적표체유관。
Objective: To investigate the dynamic changes that occur in T cell subsets , particularly involving the surface expression of programmed death 1 (PD-1) and programmed death-Ligand 1 (PD-L1), in response to mixture Qi Ling therapy in patients with chronic hepatitis B ( CHB) .Methods: Fifty-six patients with CHB were random allocation into treatment group ( mixture Qi Ling therapy and lamivudine ) and control group ( only lamivudine ) in the study.All the CHB patients at treatment weeks 0 (baseline), 24 and 48, the level of PD-1 protein expression on the surface of total periphera1 CD4 +T cells was deter-mined by flow cytometry.Results: Over the course of antiviral therapy , after 48 weeks treatment , the ALT normalization rate , HBV DNA negative rate of combination therapy group were statistical significanc higher then the control group ( P<0.05) .Af-ter 48 weeks'treatment , the combination therapy group of PD-1/PD-L1 expression leve1 in CD4 +T cell was down (P<0.01), and there were statistical significance compared with the control group , ( P<0.05 ) .Conclusion: The ability of mixture Qi Ling therapy based antiviral therapy to suppress HBV DNA replication may involve reduction of PD -l/PD-L1 protein expression on the surface of CD4 +T cells.