摘要
目的探讨富马酸替诺福韦二吡呋酯治疗乙型肝炎肝硬化的疗效及对患者外周血T淋巴细胞亚群及细胞因子水平的影响。方法选取上海市松江区中心医院2017年1月至2018年12月收治的慢性乙型肝炎肝硬化患者36例作为观察组,选取同期健康体检人员30名作为对照组。分析观察组富马酸替诺福韦二吡呋酯治疗前和治疗后肝肾功能、HBV DNA等临床指标,对比分析两组患者T淋巴细胞亚群和细胞因子(IL-2、IFN-γ、IL-4和IL-10)的水平。结果治疗后,观察组患者ALT为(28.32±17.19)U/L较治疗前的(76.23±38.21)U/L明显下降(t=13.728,P<0.05),肾功能无明显变化,HBV DNA均由阳性转为阳性。治疗后的CD3+T淋巴细胞为(68.6±12.3)%、CD4+T淋巴细胞为(40.6±9.3)%和CD4+/CD8+为(1.3±0.6),较治疗前显著增高(t=9.382、14.175、9.753,均P<0.05),但仍低于对照组(t=4.947、6.598、7.329,P<0.05);观察组CD8+T淋巴细胞百分比(30.3±6.2)%相比治疗前显著降低(t=12.368,P<0.05),但仍高于对照组(t=5.986,P<0.05)。乙肝肝硬化组患者治疗后IL-2(32.24±16.55)pg/mL和IFN-γ(9.08±5.23)pg/mL水平比治疗前明显下降(t=7.615、18.763,P<0.05),但仍高于对照组(t=5.784、13.643,P<0.05);治疗后IL-4(45.90±18.27)pg/mL和IL-10(19.85±5.63)pg/mL水平比治疗前明显升高(t=11.249、17.452,P<0.05),观察组治疗后水平明显低于对照组水平(t=10.476、9.415,P<0.05)。结论富马酸替诺福韦二吡呋酯能有效改善乙肝肝硬化患者肝功能和病毒学指标,改善T淋巴细胞亚群的免疫状态,对血清中细胞因子的分泌水平有明显的影响,抗病毒治疗后患者免疫功能部分恢复。
Objective To investigate the effect of optimized antiviral treatment with nucleoside(acid)analog tenofovir disoproxil fumarate on hepatitis B-related cirrhotic patients and its influence on peripheral blood T lymphocyte subsets and cytokines levels.Methods Thirty-six patients with chronic hepatitis B-related liver cirrhosis admitted from January 2017 to December 2018 were selected as the observation group.Thirty cases of healthy physical examination population during the same time period were selected as the control group.Clinical indicators such as liver and kidney function,HBV-DNA load in the observation group before and after treatment were collected and analyzed.The levels of T lymphocyte subsets and cytokines levels including IL-2,IFN-γ,IL-4 and IL-10 were detected and compared between these two groups.Results After antiviral treatment,the level of alanine aminotransferase(ALT)in the observation group was significantly improved than that of before treatment(tALT=13.728,P<0.05),without significant alteration in renal function.The negative change rate of HBV DNA titer was 100%.Although the percentage of CD3+cells(68.6±12.3)and CD4+cells(40.6±9.3),and the ratio of CD4+/CD8+(1.3±0.6)in the observation group after anti-viral treatment were significantly increased(tCD3+=9.382,tCD4+=14.175,tCD4+/CD8+=9.753,P<0.05),the levels were still lower than those of the control group(tCD3+=4.947,tCD4+=6.598,tCD4+/CD8+=7.329,P<0.05);On the contrary,the percentage of CD8+cells in the observation group(30.3±6.2)was significantly lower than that of before treatment(tCD8+=12.368,P<0.05),but still higher than that in the control group(tCD8+=5.986,P<0.05).Serum anti-Th1 cell cytokines IL-2(32.24±16.55pg/ml)and IFN-γ(9.08±5.23 pg/ml)levels in patients of the observation group were significantly lower after TDF treatment(tIL-2=7.615,tIFN-γ=18.763,P<0.05),but higher than that of the control group(tIL-2=5.784,tIFN-γ=13.643,P<0.05);The cytokine IL-4(45.90±18.27 pg/mL)and IL-10(19.85±5.63 pg/mL)levels of Th2 cells in the observation group were significantly higher than those of before treatment(tIL-4=11.249,tIL-10=17.452,P<0.05),but still significantly lower than that of the control group(tIL-4=10.476,tIL-10=9.415,P<0.05).Conclusion Antiviral therapy with TDF effectively improves liver function and reduces HBV DNA viral load in patients with hepatitis B-related liver cirrhosis.The treatment restores immune function and has a significant impact on the serum levels of immunological cytokines in the patients.
作者
高得勇
娄小丽
马爽
张昆仑
刘亮明
刘鸿翔
GAO De-yong;LOU Xiao-li;MA Shuang;ZHANG Kun-lun;LIU Liang-ming;LIU Hong-xiang(Department of Infectious Diseases,Shanghai Songjiang Hospital,Shanghai 201699,China;Department of Central laboratory,Shanghai Songjiang Hospital,Shanghai 201699,China;Department of Emergency Critical Care Unit Shanghai Songjiang Hospital,Shanghai 201699,China)
出处
《肝脏》
2021年第10期1142-1145,共4页
Chinese Hepatology
基金
上海市卫生和计划生育委员会面上项目(2017402111)
上海市松江区科技攻关项目(20SJKJGG9)
上海市松江区卫生和计划生育委员会重点项目(2012-Ⅲ-06)。
关键词
优化抗病毒治疗
乙型肝炎肝硬化
T细胞免疫
细胞因子
Optimize antiviral therapy
Hepatitis B-related liver cirrhosis
T cell immunity
Cytokines
