Abstract:

Objective    To investigate  the correlations between T cell subsets and HBV  replication  levels， liver function and liver pathology in children with hepatitis B virus. Methods    Outpatient and inpatient treatment according to A total of 124 cases of HBV-DNA positive hepatitis B were included in the study. The Department of Pediatrics in The People’s Hospital of Gansu Province and Institute of Infectiou Diseases the First Hospital of Lanzhou University from April 2008 to April 2010 outpatient and hospitalized children with chronic hepatitis B， Among the 124 patients， 84 were male， 40 female；65 were HBV carriers， 59 chronic hepatitis（31 mild，18 moderate and 10 severe）；peripheral blood T cell subsets， cccDNA， DNA， hepatitis B virus markers and liver function were detected； histopathological  examinations were  performed  in  46 cases. Mean while 60 cases of HBsAg (-) were included as the normal control group. Results    In each group of children with hepatitis B，peripheral blood CD3+， CD4+and CD4+/CD8+ were significantly lower than the control group( F = 13.26、12.34、14.73，P＜ 0.01)， CD8+ higher than the control group（F = -11.87，P＜0.01）； in carriers group and mild group CD3+， CD4+and CD4+/CD8+ were significantly lower than the moderate group and severe group， differences being statistically significant. In the moderate and severe groups， HBV cccDNA positive rate was higher than that in the HBV carriers or the mild group（F = 25.429，P＜0.01）. HBVcccDNA positive group and HBeAg positive group were compared with HBVcccDNA negative group and HBeAg negative group， and CD3+， CD4+and CD4+/CD8+ were reduced，while CD8+ cells were increased， while was statistically significant . CD8+ cells increased with increasing viral load（F =-11.43  P＜0.01），while CD3+， CD4+and CD4+/CD8+ decreased with the increase（F＝12.42，13.87，12.75，P ＜0.01）. Abnormal transaminases group was compared with normal group， and CD3+， CD4+and CD4+/CD8+ were reduced (t＝15.28，14.63，27.74，P ＜0.01），while CD8+ cells were increased（t =-16.39，P ＜0.01）， which was statistically significant. CD3+， CD4+and CD4+/CD8+ increased with the degree of inflammation，and fibrosis tended to increase（t＝9.25，11.85，26.34，P＜0.01），and CD8+ increased with the degree of inflammation，and fibrosis showed a downward trend（t =-10.18，P ＜0.01）. Conclusion    T-cell immune dysfunction and the level of viral replication and liver function and liver pathology have a certain relationship. HBV active replication increases immune disorders and immune function recovery，which remoues virus and at the same time leads to pathological changes in liver tissue.

Key words:  , Hepatitis B；T cell subsets；HBVcccDNA

摘要：

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。

关键词: 乙型肝炎, T细胞亚群, 共价闭合环状 DNA, 病毒复制, 儿童, 肝功能