CAJ | 학술논문

目的探讨HBV感染者外周血肝功能主要指标、T细胞亚群以及病毒载量在不同病程中的变化及其临床意义.方法 170例HBV感染患者根据病程分成急性乙肝组(18例)、慢性乙肝组(73例)、肝硬化组(41例)及肝癌组(38例),正常对照组40例.用全自动生化分析仪和流式细胞仪检测各组肝功能相关指标及T细胞亚群含量;采用实时荧光定量PCR法检测HBV-DNA含量.结果四组实验组与正常对照相比谷丙转氨酶(ALT)、谷草转氨酶(AST)均升高,差异具有统计学意义(P＜0.05),且以急性乙肝升高最为显著,慢性乙肝次之,组间比较可见慢性乙肝患者组比急性乙肝患者组ALT、AST有所下降,且差异具有统计学意义(P＜0.05),而肝癌患者组和肝硬化组之间则变化不显著,差异无统计学意义(P＞0.05);碱性磷酸酶ALP的升高见于肝癌患者组,慢性乙肝患者组ALP水平较低;各组总蛋白(TP)均在正常参考范围内.四组实验组外周血CD3+T细胞均比正常对照组低,其中肝癌组、肝硬化患者组降低最为明显,CD4+T细胞比例上升见于急性乙肝组,而CD8+T细胞的比例在急性乙肝患者组中最低.外周血中HBV病毒核酸载量升高的最为明显的是慢性乙肝患者组,而急性乙肝患者组、肝硬化患者组、肝癌患者组的HBV-DNA水平比较低,以急性乙肝最低,各组与其相比均具有统计学差异(P＜0.05).结论 HBV不同病程中患者的肝功能相应指标、T细胞亚群表达、HBV-DNA含量存在显著差异,联合检测这些项目可为临床正确评估患者的病情及病程提供相应指导,为疾病转归的判断及治疗提供可靠的依据.
목적 탐토HBV감염자외주혈간공능주요지표、T세포아군이급병독재량재불동병정중적변화급기림상의의.방법 170례HBV감염환자근거병정분성급성을간조(18례)、만성을간조(73례)、간경화조(41례)급간암조(38례),정상대조조40례.용전자동생화분석의화류식세포의검측각조간공능상관지표급T세포아군함량;채용실시형광정량PCR법검측HBV-DNA함량.결과 사조실험조여정상대조상비곡병전안매(ALT)、곡초전안매(AST)균승고,차이구유통계학의의(P＜0.05),차이급성을간승고최위현저,만성을간차지,조간비교가견만성을간환자조비급성을간환자조ALT、AST유소하강,차차이구유통계학의의(P＜0.05),이간암환자조화간경화조지간칙변화불현저,차이무통계학의의(P＞0.05);감성린산매ALP적승고견우간암환자조,만성을간환자조ALP수평교저;각조총단백(TP)균재정상삼고범위내.사조실험조외주혈CD3+T세포균비정상대조조저,기중간암조、간경화환자조강저최위명현,CD4+T세포비례상승견우급성을간조,이CD8+T세포적비례재급성을간환자조중최저.외주혈중HBV병독핵산재량승고적최위명현적시만성을간환자조,이급성을간환자조、간경화환자조、간암환자조적HBV-DNA수평비교저,이급성을간최저,각조여기상비균구유통계학차이(P＜0.05).결론 HBV불동병정중환자적간공능상응지표、T세포아군표체、HBV-DNA함량존재현저차이,연합검측저사항목가위림상정학평고환자적병정급병정제공상응지도,위질병전귀적판단급치료제공가고적의거.
Objective To explore the changes of main indexes of liver function of peripheral blood,T cell subsets and the viral load in hepatitis B virus infection patients in different course and its clinical significance.Method 170 cases of hepatitis B virus infection patients were divided into acute hepatitis B group (18 cases),chronic hepatitis B group (73 cases),liver cirrhosis group (41 cases),hepatic carcinoma group (38 cases),and normal control group of 40 cases according to the course.The related indexes of liver function and T cell subsets were detected by the automatic biochemical analyzer and flow cytometry,and the content of HBVDNA was detected by real-time fluorescent quantitative PCR method.Results Alanine transaminase (ALT) and aspartate transaminase (AST) increased in four experimental groups compared to normal controls,with significant difference (P ＜ 0.05),and the increase was most significant in acute hepatitis,chronic hepatitis B was the second.ALT and AST of chronic hepatitis B was decreased compared with acute hepatitis B,and the difference had statistical significance (P ＜ 0.05),but the change between liver cancer and liver cirrhosis group was not significant,have no significant difference (P ＞ 0.05).The increase of alkaline phosphatase(ALP) was in liver cancer patients,the levels of ALP in chronic hepatitis B was low.Groups of total protein (TP) were within the normal reference range.CD3 + T cells in peripheral blood of the four experimental groups were lower than in the normal controls,the patients with hepatic carcinoma and cirrhosis was obviously lower.The proportions of CD4 + T cells rose in acute hepatitis group,but the percentage of CD8 + T cells is the lowest in acute hepatitis B patients.The most obvious rise of HBV DNA virus load in peripheral blood was in chronic hepatitis B group,but the HBV-DNA level is relatively low in acute hepatitis,liver cirrhosis and liver cancer patients,the lowest was in acute hepatitis B,and the differences were all statistically significant(P ＜ 0.05) compared with other groups.Conclusion The liver function,the expression of T cell subsets and HBV-DNA content had significant difference in hepatitis B virus infection patients with different course,the combined detection of these projects can provide guidance for the clinical assessment of the disease and course,and provide reliable basis for judging the prognosis of the disease and treatment.