乙肝患者外周血单核细胞比例与肝脏病变程度的关系研究

摘要

目的 探讨乙肝患者外周血单核细胞比例与肝脏病变程度的关系.方法 收集2010-2011年解放军302医院明确诊断的轻中度慢性乙型肝炎患者197例(肝炎组)、乙肝肝硬化患者248例(肝硬化组),以同期269例健康体检者作为对照组.采用Sysmex XE-2100血液分析仪进行全血细胞分析,实时荧光PCR扩增仪进行血清HBV DNA定量,ELISA法测定血清肝纤维化指标透明质酸(HA)、层粘连蛋白(LN)、Ⅳ型胶原(IV.C)、Ⅲ型前胶原(PCⅢ)水平.共390例患者进行了肝组织活检,参照中华医学会《病毒性肝炎防治方案》(2000年)进行肝脏炎症程度(G0-G4)及纤维化程度(S0-S4)评价.结果 全血细胞分析结果表明,肝炎组和肝硬化组外周血单核细胞比例(分别为8.93％±3.05％、9.85％±3.61％)明显高于对照组(8.16％±1.88％,P＜0.01),且肝硬化组明显高于肝炎组(P＜0.01)；血清HBV DNA定量分析表明,239例HBV DNA≥l00U/ml的患者单核细胞比例(8.61％±2.83％)显著高于206例HBV DNA＜ 100U/ml的患者(8.12％±2.53％,P＜0.05)；ELISA检测结果表明,肝硬化组肝纤维化指标HA、LN、IV.C、PCⅢ水平均明显高于肝炎组,且同组内肝纤维化指标升高者的单核细胞比例高于肝纤维化指标正常者；390例患者的肝组织活检病理结果显示,随肝脏炎症及纤维化程度加重,单核细胞比例升高的患者逐渐增多,差异有统计学意义(P＜0.01,P＜0.01).结论 乙肝患者外周血单核细胞比例升高与肝脏病变程度关系密切,可在一定程度上反映肝脏的炎症及纤维化水平.%Objective To discuss the relationship between the monocyte proportion in peripheral blood and the extent of liver lesions in HBV patients. Methods The clinical data of HBV patients, which were definitely diagnosed from 2010 to 2011 in our hospital, were studied, including 197 cases with mild or moderate hepatitis (hepatitis group) and 248 cases of cirrhosis (cirrhosis group). The data of 269 healthy people concurrently coming for physical examination served as control (control group). The peripheral blood were analyzed by Sysmex XE-2100 hematology analyzer. The real-time PCR was employed to quantitatively detect the HBV DNA in serum; ELISA was performed to determine the liver fibrosis indicators, including hyaluronic acid (HA), laminin (LN), type IV collegen (IV. C) and type HI precollegen (PC El), Liver biopsy was done in 390 patients, and the extents of liver inflammation (G0-G4) and hepatic fibrosis (S0-S4) were evaluated according to the "Program of Viral Hepatitis Prevention and Control" issued by Chinese Medical Association in 2000. Results The peripheral blood analysis revealed that the monocyte proportion were significantly higher in hepatitis group and cirrhosis group (8.93% ± 3.05% and 9.85% ± 3.61%) than in control group (8.16% ± L88%, P<0.0l), and also in cirrhosis group than in hepatitis group (P<0.0l). The result of real-time PCR showed that the monocyte proportion was significantly higher in 239 patients with HBVDNA2≥ l00U/ml (8.61% ± 2.83%) than that in the 206 patients with HBV DNA<100U/ml (8.12% ± 2.53%, P<0.05). The ELISA results indicated that the levels of liver fibrosis indicators (HA, LN, IVQ PC Ⅲ) were significantly higher in cirrhosis group than in hepatitis group, and moreover, in the same group the higher of those indicators, the higher of monocyte proportion- The results of liver biopsy in 390 patients showed that the monocyte proportion significantly elevated along with aggravation of liver inflammation and fibrosis (P<0.0l). Conclusion The elevation of monocyte proportion in the peripheral blood of hepatitis B patients is closely correlated with the extent of liver lesion, reflecting in certain extent the level of liver inflammation and that of hepatic fibrosis.