不同HBeAg状态下慢性乙型肝炎患者肝组织内CD4+、CD8+、CD20+、CD57+T淋巴细胞的表达分析

摘要

目的：探讨HBeAg阳性和阴性慢性乙型肝炎（CHB）患者肝内免疫活性细胞（CD4＋、CD8＋、CD20＋、CD57＋T淋巴细胞）与肝脏病理及临床的关系。方法选取2008年1月－2013年12月在桂林市第三人民医院住院的70例CHB患者进行肝穿刺活组织检查，其中HBeAg阳性患者38例，HBeAg阴性患者32例。运用免疫组化染色分析肝组织内CD4＋、CD8＋、CD20＋、CD57＋T淋巴细胞的表达，比较不同HBeAg状态患者CD4＋、CD8＋、CD20＋、CD57＋T淋巴细胞与临床相关性。等级资料采用Kruskal－Walls H检验，组间比较采用Nemenyi法，相关性分析采用直线相关分析法。结果 HBeAg阳性和阴性患者的炎症程度到达G3～G4，其肝组织中CD8＋、CD20＋T淋巴细胞的表达均比G1组明显增加（P值均＜0．05）；HBeAg阳性患者炎症程度到达G4、而HBeAg阴性患者炎症程度到达G3，其肝组织中CD4＋T淋巴细胞的表达比G1组明显增加（P值均＜0．05）；在HBeAg阴性患者中CD4＋、CD8＋、CD20＋、CD57＋T淋巴细胞均与ALT水平呈正相关（r值分别为0．353、0．628、0．693、0．540，P值均＜0．05），且CD20＋T淋巴细胞还与HBV DNA水平呈正相关（r＝0．378，P＜0．05）。而在HBeAg阳性患者中只有CD8＋、CD20＋T淋巴细胞与ALT水平呈正相关，与HBV DNA水平无相关性。结论不同HBeAg状态患者肝组织内CD4＋、CD8＋、CD20＋T淋巴细胞表达与肝组织内炎症分级均有明显相关性，但肝内免疫活性细胞与ALT、HBV DNA水平的相关性存在差异。%Objective To investigate the relationship of hepatic immune cells (CD4 +,CD8 +,CD20 +,and CD57 +T lymphocytes)with liver pathology and clinical relevance in chronic hepatitis B (CHB)patients with different HBeAg status.Methods A total of 70 CHB pa-tients admitted to our hospital from January 2008 to December 2013 underwent liver biopsy,among whom 38 were HBeAg positive and 32 were HBeAg negative.Immunohistochemistry was used to examine the expression of CD4 +,CD8 +,CD20 +,and CD57 +T lymphocytes in hepatic tissues,and the correlation between their expression and clinical relevance was analyzed in patients with different HBeAg status. Ranked data were analyzed by Kruskal-Walls H test.Comparison between groups was made by Nemenyi test.Correlation analysis was made by linear regression method.Results When inflammation reached to the level of G3 -G4 in patients with either positive or negative HBeAg,the expression of hepatic CD8 +and CD20 +cells in them was significantly higher than that in patients with inflammation level of G1 (all P<0.05).When the levels of inflammation reached G4 in patients with positive HBeAg and G3 in those with negative HBeAg,the ex-pression of hepatic CD4 +cells was significantly higher than that in patients with G1 inflammation (all P<0.05).In patients with negative HBeAg,the CD4 +,CD8 +,CD20 +,and CD57 +lymphocytes all showed a positive correlation with alanine aminotransferase (ALT)level (r=0.353,0.628,0.693,and 0.540,respectively;all P<0.05).In addition,CD20 +lymphocytes also showed a positive correlation with hepatitis B virus (HBV)DNA (r=0.378,P<0.05).However,in patients with positive HBeAg,only CD8 +and CD20 +lympho-cytes showed a positive correlation with ALT level,and no correlation was found between all lymphocyte populations and HBV DNA.Con-clusion The expression of CD4+,CD8 +,and CD20+lymphocytes was significantly correlated with the grade of inflammation in hepatic tis-sues in patients with different HBeAg status,whereas the correlations between hepatic immune cells and levels of ALT and HBV DNA vary.