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目的探讨儿童慢性乙型肝炎T细胞亚群与病毒复制水平、肝功能及肝组织病理之间的关系。方法甘肃省人民医院儿科和兰州大学第一医院感染科按门诊和住院就诊的先后顺序选择慢性乙型肝炎病毒(HBV)-DNA阳性124例中乙型肝炎患儿,其中男84例,女40例。124例中HBV携带者65例、慢性乙肝59例(轻度31例、中度18例、重度10例),对患儿均进行外周血T细胞亚群、cccDNA、DNA、乙肝病毒标志物、肝功检测,对其中的46例行肝组织病理学检测。同时以60例HBsAg(-)患儿作为正常对照组。结果各组乙肝患儿外周血CD3+,CD4+及CD4+/CD8+明显低于正常对照组(F值分别为13.26、12.34、14.73,P均<0.01),CD8+高于正常对照组(F=-11.87,P<0.01),携带者组和轻度组CD3+,CD4+及CD4+/CD8+明显低于中度组和重度组差,异有统计学意义;中、重度慢性乙肝患儿HBVcccDNA阳性率,高于携带者和轻度组(F=25.429,P<0.01);HBVcccDNA阳性组及HBeAg(+)组分别与HBVcccDNA阴性组及HBeAg(-)组比较,CD3+,CD4+,CD4+/CD8+均减低,CD8+均细胞增高,均有统计学意义,CD8+随病毒载量升高而增加(F=-11.43,P<0.01),CD3+,CD4+,CD4+/CD8+随其增加而降低(F值分别为12.42、13.87、12.75,P均<0.01);转氨酶异常组和转氨酶正常组比较,CD3+、CD4+、CD4+/CD8+下降(t值分别为15.28、14.63、27.74,P均<0.01),CD8+细胞增高(t=-16.39,P<0.01),有统计学意义;CD3+、CD4+、CD4+/CD8+随炎性和纤维化程度加重有升高趋势(t值分别为9.25、11.85、26.34,P均<0.01),CD8+随炎性和纤维化程度加重呈下降趋势(t=-10.18,P<0.01)。结论 T细胞免疫功能紊乱与病毒复制水平、肝功能及肝组织病理有一定关系,HBV活跃复制加重免疫功能紊乱,免疫功能的恢复,一方面可清除病毒,一方面引起肝组织病理改变。
Objective To investigate the relationship between chronic hepatitis B T cell subsets and viral replication, liver function and pathological changes in children. Methods A total of 124 hepatitis B patients with chronic hepatitis B virus (HBV) -DNA were selected according to the sequence of outpatient and inpatient visits in pediatrics department of Gansu Provincial People’s Hospital and Department of Infectious Diseases, the First Hospital of Lanzhou University. There were 84 males and 40 females example. Totally 65 children with HBV carriers and 59 chronic hepatitis B patients (mild 31, moderate 18, severe 10) were enrolled in this study. T cell subsets, cccDNA, DNA, hepatitis B virus markers, Liver function tests, of which 46 cases of liver histopathology. At the same time, 60 cases of HBsAg (-) children as a normal control group. Results The levels of CD3 +, CD4 + and CD4 + / CD8 + in peripheral blood of children with HBV were significantly lower than those of normal controls (F = -13.26, 12.34 and 14.73, respectively, P <0.01) P <0.01). The CD3 +, CD4 + and CD4 + / CD8 + in carriers and mild groups were significantly lower than those in moderate and severe groups (P <0.01). The positive rates of HBVcccDNA in carriers of moderate and severe chronic hepatitis B were higher than that of carriers (P <0.01). The levels of CD3 +, CD4 +, CD4 + / CD8 + in both HBVcccDNA positive group and HBeAg (+) group were lower than those in HBVcccDNA negative group and HBeAg group (-) (F = -11.43, P <0.01), while CD3 +, CD4 +, CD4 + / CD8 + decreased with the increase of the viral load (F = 12.42, 13.87, 12.75 , P <0.01). The levels of CD3 +, CD4 + and CD4 + / CD8 + decreased significantly in the group of abnormal aminotransferase and the group of normal aminotransferase (t = -15.68, 14.63 and 27.74 respectively, P <0.01) (T = 9.25, 11.85, 26.34 respectively, P <0.01). CD8 + increased with the severity of inflammation and fibrosis (P <0.01), and there was statistical significance And increased degree of fibrosis showed a downward trend Potential (t = -10.18, P <0.01). Conclusion T cell immune dysfunction is related to the level of virus replication, liver function and pathological changes of liver tissue. Active replication of HBV aggravates immune dysfunction and immune function. On the one hand, it can clear the virus and cause pathological changes of liver tissue on the other hand.