CAJ | 학술논문

目的：通过检测不同病毒载量慢性乙型肝炎（CHB）患者和HBV携带者（ASC）外周血T淋巴细胞各亚群变化的规律，探讨T淋巴细胞与人转化生长因子（TGF）β、ALT及TBil相关性。方法选择2012年7月至2012年12月兰州市第二人民医院收治的175例HBV感染者作为研究对象，分为ASC组（112例）、CHB组（63例），以同期健康体检者84例作为对照组。运用流式细胞术检测3组血清中T淋巴细胞亚群水平，同时检测肝功能指标等。正态分布的计量资料多组间比较采用方差分析，偏态分布的计量资料组间比较采Kruskal-Wallis H秩和检验。结果与健康对照组相比，ASC和CHB组TGFβ表达水平显著升高（P均＜0．05），CD3＋、CD4＋T淋巴细胞百分数显著降低（P＜0．05或P＜0．01），CD4＋与CD8＋T淋巴细胞比值显著降低（P＜0．01），CD8＋T淋巴细胞百分数显著升高（P＜0．05或P＜0．01）。ASC与CHB组HBeAg阳性组和HBeAg阴性组患者CD3＋、CD4＋T淋巴细胞百分数均降低，CD8＋T淋巴细胞百分数升高，CD4＋与CD8＋T淋巴细胞百分数降低。结论 TGFβ可能参与了CHB的发病过程，其免疫抑制作用可能是通过对T淋巴细胞、抗原递呈细胞成熟分化的抑制等多个环节发挥作用。
목적：통과검측불동병독재량만성을형간염（CHB）환자화HBV휴대자（ASC）외주혈T림파세포각아군변화적규률，탐토T림파세포여인전화생장인자（TGF）β、ALT급TBil상관성。방법선택2012년7월지2012년12월란주시제이인민의원수치적175례HBV감염자작위연구대상，분위ASC조（112례）、CHB조（63례），이동기건강체검자84례작위대조조。운용류식세포술검측3조혈청중T림파세포아군수평，동시검측간공능지표등。정태분포적계량자료다조간비교채용방차분석，편태분포적계량자료조간비교채Kruskal-Wallis H질화검험。결과여건강대조조상비，ASC화CHB조TGFβ표체수평현저승고（P균＜0．05），CD3＋、CD4＋T림파세포백분수현저강저（P＜0．05혹P＜0．01），CD4＋여CD8＋T림파세포비치현저강저（P＜0．01），CD8＋T림파세포백분수현저승고（P＜0．05혹P＜0．01）。ASC여CHB조HBeAg양성조화HBeAg음성조환자CD3＋、CD4＋T림파세포백분수균강저，CD8＋T림파세포백분수승고，CD4＋여CD8＋T림파세포백분수강저。결론 TGFβ가능삼여료CHB적발병과정，기면역억제작용가능시통과대T림파세포、항원체정세포성숙분화적억제등다개배절발휘작용。
Objective To study the changes in peripheral blood T cell subsets among chronic hepatitis B (CHB)patients and asymptomatic hepatitis B virus (HBV)carriers (ASC),who have different viral loads,and to investigate the correlation of T cell subsets with transforming growth factor beta (TGFβ),alanine aminotransferase,and total bilirubin.Methods A total of 175 HBV infection patients admitted to our hospital from July to December,2012 were recruited and divided into ASC group (n=112)and CHB group (n=63);84 healthy controls who underwent physical examination in the same period were selected as control group.The percentages of T cell subsets in serum were determined by flow cytometry,and liver function parameters were measured.For normally distributed continuous data,comparison between groups was made by analysis of variance;for non-normally distributed continuous data,comparison between groups was made by Kruskal-Wallis H rank sum test.Results Among the 175 HBV infection patients,the percentages of CD3 +,CD4+,and CD8 +T cells and CD4+/CD8 +ratio were 72.14%-74.07%,38.43%-39.47%,30.74%-31.42%,and 1.31 -1.34,respectively.Compared with the control group,the ASC group and CHB group had significantly increased TGFβlevels (P<0.05 for both),significantly reduced percentages of CD3 +and CD4+T cells (P<0.05 or P<0.01),significantly reduced CD4+/CD8 +ratios (P<0.01),and significantly increased percentages of CD8 +T cells (P<0.05 or P<0.01 ).In the ASC and CHB groups,both HBeAg-positive and HBeAg-negative patients had reduced percentages of CD3 +and CD4+T cells,increased percentages of CD8 +T cells,and reduced CD4+/CD8 +ratios.In addition,no correlation was found be-tween HBV DNA loads and T cell subsets in the two groups (P>0.05).Conclusion TGFβmay be involved in the pathogenesis of CHB,and its immunosuppressive effect may be exerted by inhibiting T cells and antigen-presenting cell maturation.