慢性HBV感染免疫耐受期外周血T淋巴细胞亚群变化特征及临床意义

doi:10.19871/j.cnki.xfcrbzz.2022.04.002

摘要/Abstract

摘要： 目的研究慢性HBV感染患者免疫耐受期外周血T淋巴细胞亚群的特征,并评估其在免疫耐受期抗病毒时机选择的意义及HBV感染中的作用。方法入组2018年12月至2020年12月在南昌大学第一附属医院感染科就诊及住院的慢性HBV感染免疫耐受期患者共79例（免疫耐受组）、非免疫耐受患者152例（非免疫耐受组）及健康志愿者44（健康对照组）44例,收集基本资料及各临床指标值,观察T淋巴细胞亚群评估免疫状态的诊断效能;同时对55例免疫耐受期慢性HBV感染患者进行随访,观察T淋巴细胞亚群对打破免疫耐受的诊断效能及打破免疫耐受和未打破免疫耐受患者外周血T淋巴细胞亚群的差异。结果 ①HBV感染后免疫耐受组与非免疫耐受组CD3+、CD4+、CD8+T淋巴细胞绝对值及CD4+/CD8+T淋巴细胞比值均低于健康对照组,差异有统计学意义（P<0.05）。免疫耐受组CD3+、CD4+T淋巴细胞绝对值、CD4+T淋巴细胞比例及CD4+/CD8+T淋巴细胞比值均低于非免疫耐受组,差异有统计学意义（P<0.05）。②CD4+T淋巴细胞绝对值、CD4+T淋巴细胞比例、CD4+/CD8+T淋巴细胞比值对评估免疫状态的检验效能曲线下面积分别为0.774、0.827、0.721。③CD3+、CD4+、CD8+T淋巴细胞数量与CD4+/CD8+T淋巴细胞比值对打破免疫耐受状态的检验效能曲线下面积分别为0.831、0.892、0.802、0.837。结论 ①HBV感染后,普遍存在细胞免疫功能下降及免疫紊乱现象。②CD4+T淋巴细胞绝对值数量、比例及CD4+/CD8+T淋巴细胞比值对HBV感染患者免疫状态有较好的评估效应,CD3+、CD4+、CD8+T淋巴细胞数量与CD4+/CD8+T淋巴细胞比值对预测免疫耐受期患者打破免疫耐受状态有一定的参考价值,临床上可动态监测外周血T淋巴细胞辅助评估患者免疫状态及打破免疫耐受可能性,以了解患者机体免疫状态,及时开始抗病毒治疗。

关键词: 乙型肝炎病毒, 慢性乙型病毒性肝炎, 免疫耐受期, 抗病毒, T淋巴细胞亚群

Abstract: Objective To study the characteristics of peripheral blood T lymphocyte subsets in patients with chronic HBV infection during immune tolerance period, and to evaluate their role in immune tolerance status, the significance of antiviral timing during immune tolerance period, and the role in HBV infection. Method A total of 79 patients (immune tolerance group), 152 non immune tolerance patients (non immune tolerance group) and 44 healthy volunteers (healthy control group) in the immune tolerance period of chronic HBV infection hospitalized in the Infection Department of the First Affiliated Hospital of Nanchang University from December 2018 to December 2020. Basic data and clinical indicators were collected, and the diagnostic efficacy of T lymphocyte subsets in evaluating immune status was observed. At the same time, 55 patients with chronic HBV infection in immune tolerance stage were followed up to observe the diagnostic efficacy of T lymphocyte subsets for breaking immune tolerance and the difference of T lymphocyte subsets in peripheral blood of patients with and without breaking immune tolerance Result ①The absolute values of CD3+, CD4+, CD8+T lymphocytes and the ratio of CD4+/CD8+T lymphocytes in immune tolerance group and non-immune tolerance group after HBV infection were significantly lower than those in healthy group (P<0.05). The absolute values of CD3+ and CD4+T lymphocytes, the proportion of CD4+T lymphocytes and the ratio of CD4+/CD8+T lymphocytes in immune tolerance group were lower than those in non-immune tolerance group, and the differences were statistically significant (P<0.05). ②The area under the curve of the absolute value of CD4+T lymphocytes, the proportion of CD4+T lymphocytes and the ratio of CD4+/CD8T lymphocytes in evaluating immune status were 0.774, 0.827 and 0.721, respectively. ③The area under the curve of the number of CD3+, CD4+, CD8+T lymphocytes and the ratio of CD4+/CD8+T lymphocytes for breaking immune tolerance were 0.831, 0.892, 0.802, 0.837, respectively. Conclusion ①The decline of cellular immune function and immune disorder are common after HBV infection. ②The absolute number and proportion of CD4+ cells and CD4+/CD8+T ratio have a good effect on the evaluation of immune status in patients with HBV infection. The number of CD3+, CD4+, CD8+T cells and CD4+/CD8+T ratio have a certain reference value for predicting the breaking of immune tolerance status in patients with immune tolerance. Clinically, peripheral blood T lymphocytes can be dynamically detected to assist in evaluating the immune status of patients and the possibility of breaking immune tolerance, so as to understand the immune status of patients and start antiviral therapy in time.

Key words: Hepatitis B virus, Chronic viral hepatitis B, Immune tolerance period, Antiviral, T lymphocyte subsets

徐清浪, 黄建生, 付吉伟, 朱滢, 袁松松, 邬小萍. 慢性HBV感染免疫耐受期外周血T淋巴细胞亚群变化特征及临床意义[J]. 新发传染病电子杂志, 2022, 7(4): 6-11.

Xu Qinglang, Huang Jiansheng, Fu Jiwei, Zhu Ying, Yuan Songsong, Wu Xiaoping. Characteristics and clinical significance of T lymphocyte subsets in peripheral blood during immune tolerance period of chronic HBV infection[J]. Electronic Journal of Emerging Infectious Diseases, 2022, 7(4): 6-11.

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