Objective To observe the effect of telbivudine therapy and its influence on the serum level of Th1/Th2 cell related cytokines in patients with chronic hepatitis B.Methods Fifty-eight patients with HBeAg positive chronic hepatitis B were divided into three groups by the degree of liver damage,which were mild group 14 cases,moderate group 24 cases and severe group 20 cases.All cases were given 600mg of telbivudine daily for 48 weeks.Liver functions,HBVDNA loads and HBeAg titers were tested before and after treatment.Serum Th1 cell related cytokines which was IFN-γ and serum Th2 cell related cytokines which were IL-4 and IL-10 were tested before treatment and at week 12,24 and 48 after treatment.Results There were different response degrees in all patients,including 15 cases of complete response and 43 cases of partial response.The cases of complete response and partial response were l,13 in the mild group; 3,21 in the moderate group; 11,9 in the severe group; and with statistically significant differences among the three groups (all P ＜0.05).Compared with the same group before treatment,the levels of IFN-γ of severe group were increased gradually at week 12,24,48 after treatment (all P ＜ 0.05) and the levels of IL-4 and IL-10 were decreased gradually at week 24,48 after treatment (all P ＜ 0.05) ; there were no statistically significant differences in the levels of IFN-γ,IL-4 and IL-10 of the mild group and moderate group at each time point (all P ＞ 0.05).The levels of IFN-γ were increased gradually in the complete response patients at week 12 after treatment (P ＜ 0.05),IL-4 and IL-10 were decreased gradually at week 24 after treatment (all P ＜0.05) ; there were no statistically significant difference in the levels of IFN-γ,IL-4 and IL-10 in partial response patients at each time point after treatment (all P ＞ 0.05).Conclusions The effect of telbivudine therapy is better in patients with chronic hepatitis B,especially in the severe group of liver damage.Telbivudine may have an effect on immunoregulation.The level changes of Th1/Th2 cell related cytokines could predict antiviral therapy effectiveness.%目的 观察替比夫定治疗慢性乙型肝炎的疗效,及其对患者血清Th 1/Th2细胞相关细胞因子水平的影响.方法 选取HBeAg阳性慢性乙型肝炎患者58例,依肝功能损伤程度分为轻度组14例、中度组24例、重度组20例,均给予替比夫定600 mg/d抗病毒治疗,疗程48周；治疗前后检测肝功能、HBV DNA、HBeAg,治疗前及治疗后12、24、48周检测血清Th1细胞相关细胞因子IFN-γ和Th2细胞相关细胞因子IL-4、IL-10.结果 患者均有不同程度应答,其中完全应答15例、部分应答43例.轻度组完全应答、部分应答分别为1、13例,中度组分别为3、21例,重度组分别为11、9例.三组之间比较,P均＜0.05.与同组治疗前比较,重度组治疗12、24、48周血清IFN-γ水平逐渐升高(P均＜0.05),治疗24、48周血清IL-4、IL-10水平逐渐下降(P均＜0.05)；轻、中度组各时点IFN-γ、IL-4和IL-10比较,P均＞0.05.完全应答者治疗12周后血清IFN-γ水平逐渐升高(P＜0.05),治疗24周后血清IL-4和IL-10水平逐渐下降(P均＜0.05)；部分应答者治疗后各时点血清IFN-γ、IL-4和IL-10比较,P均＞0.05.结论 替比夫定抗病毒治疗慢性乙型肝炎的疗效较好,尤其是肝功能损伤程度重者；替比夫定可能具有一定的免疫调节作用,Th1/Th2细胞相关因子水平变化可以作为疗效预测指标.
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