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目的观察免疫应答不同期的慢性乙型肝炎(CHB)患者外周血中HBcAg特异性γ-干扰素(IFNγ)分泌细胞数,探讨其在评价患者体内非溶细胞机制清除乙型肝炎病毒(HBV)能力中的临床意义。方法采用酶联免疫斑点法(ELISPOT)检测83例免疫耐受期、49例免疫清除期患者和18名健康人HBcAg特异性IFNγ分泌细胞。结果健康人HBcAg特异性IFNγ分泌细胞数为11~19个/4×105个外周单个核细胞(PBMC),62.2%的免疫耐受期CHB患者低于正常值,44.9%的免疫清除期CHB患者高于正常值。HBcAg特异性IFNγ分泌细胞数与HBV DNA水平未发现有相关性,而HBcAg特异性IFNγ分泌细胞数与HBeAg S/N值在一定范围内有正相关趋势。13例免疫耐受期患者经乙型肝炎疫苗及草分枝杆菌制剂治疗3~6个月后,12例患者HBcAg特异性IFNγ分泌细胞数有不同程度提高。结论采用ELISPOT测定HBcAg特异性IFNγ分泌细胞数可从一个侧面反映大多数CHB患者免疫应答能力,并可以作为治疗效果的评价指标。
Objective To observe the number of HBcAg-specific IFN-γ secreting cells in peripheral blood of patients with chronic hepatitis B (CHB) at different stages of immune response and to evaluate the role of HBcAg-secreting IFN- The clinical significance of competence. Methods HBsAg-specific IFNγ secreting cells were detected in 83 immunocompromised patients, 49 immunosuppressed patients and 18 healthy controls by ELISPOT. Results The number of HBcAg-specific IFNγ secreting cells in healthy subjects was 11-19 / 4 × 105 peripheral mononuclear cells (PBMC), 62.2% of CHB patients with immune tolerance were lower than normal, and 44.9% of CHB patients Higher than normal. No correlation was found between the number of HBcAg-specific IFNγ secreting cells and the level of HBV DNA, while the number of HBcAg-specific IFNγ secreting cells and HBeAg S / N had a positive correlation trend within a certain range. Thirteen patients with immune tolerance were treated with Hepatitis B vaccine and Mycobacterium phlei preparation for 3 to 6 months. The number of HBcAg-specific IFNγ secreting cells in 12 patients increased to some extent. Conclusion The ELISPOT assay of HBcAg-specific IFNγ secreting cells can reflect the immune response ability of most patients with CHB on one side, and can be used as an evaluation index of therapeutic effect.