乙型肝炎患者的T淋巴细胞水平与胃黏膜炎性病变程度

摘要/Abstract

摘要： 目的观察不同胃黏膜炎性病变程度乙型肝炎(HB)患者的T淋巴细胞水平。方法纳入2015年4月至2020年4月收治的HB患者273例,其中急性乙型肝炎85例,慢性乙型肝炎93例,肝炎后肝硬化95例,分别设为急性乙型肝炎组、慢性乙型肝炎组、肝炎后肝硬化组;另外选取同期于医院体检且身体健康的95名志愿者纳入研究,设为健康组。三组患者(治疗前)及志愿者入院后行T淋巴细胞CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺水平检测,再对三组患者行胃镜检查,记录患者胃黏膜炎性病变程度。对比四组T淋巴细胞水平,对比三组患者胃黏膜炎性病变程度及不同胃黏膜炎性病变程度患者T淋巴细胞水平差异,最后通过相关性分析T淋巴细胞水平与胃黏膜炎性病变程度间的关系。结果健康组T淋巴细胞CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺水平分别为(67.58±6.81)%、(46.19±4.16)%、(30.17±2.44)%、(1.60±0.41),急性乙型肝炎组分别为(63.24±5.02)%、(43.02±3.77)%、(26.15±2.10)%、(1.33±0.34),慢性乙型肝炎组分别为(55.12±4.22)%、(35.16±2.15)%、(21.16±1.84)%、(1.15±0.27),肝炎后肝硬化组分别为(47.15±3.19)%、(28.65±1.41)%、(17.19±1.41)%、(0.94±0.22);健康组＞急性乙型肝炎组＞慢性乙型肝炎组＞肝炎后肝硬化组,且P<0.05。三组胃黏膜炎性病变程度存在明显差异,慢性浅表性胃炎重度占比急性乙型肝炎组为3.53%、慢性乙型肝炎组为9.68%、肝炎后肝硬化组为17.89%,萎缩性胃炎重度病变占比急性乙型肝炎组为7.06%、慢性乙型肝炎组为20.43%、肝炎后肝硬化组为45.26%,对比急性乙型肝炎组＜慢性乙型肝炎组＜肝炎后肝硬化组,且P<0.05。胃黏膜炎性病变程度轻度患者T淋巴细胞CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺水平分别为(63.84±5.17)%、(42.19±3.55)%、(25.80±2.41)%、(1.28±0.33),中度患者分别为(57.23±4.31)%、(36.21±2.58)%、(20.53±1.72)%、(1.05±0.24),重度患者分别为(48.24±3.54)%、(30.78±1.87)%、(17.58±1.06)%、(0.90±0.18);重度＜中度＜轻度,且P<0.05。经相关性分析证实,T淋巴细胞水平与胃黏膜炎性病变程度呈现出负相关,均有P<0.05。结论 HB患者T淋巴细胞水平CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺呈现出明显的降低,且其水平表达与胃黏膜炎性病变严重程度关系密切。

关键词: 乙型肝炎, 胃黏膜炎性病变, T淋巴细胞, 相关性

Abstract: Objective To observe the T lymphocyte level in hepatitis B virus (HBV) infected patients with different degree of inflammatory gastric mucosal lesions. Methods A total of 273 HBV infected-patients were enrolled in this study from April 2015 to April 2020, including 85 cases with acute hepatitis B, 93 cases with chronic hepatitis B, and 95 cases with post-hepatitis cirrhosis. They were divided into acute hepatitis B group, chronic hepatitis B group and post-hepatitis cirrhosis group, respectively. In addition, 95 healthy volunteers who had physical examination during the same period were included and assigned into a healthy control group. The CD3⁺, CD4⁺, CD8⁺, and CD4⁺/CD8⁺ levels of T lymphocytes were detected in these three groups of patients after admission (before treatment) and the healthy controls. Gastroscopy was then performed in all patients to record the degree of inflammatory lesions in gastric mucosa. The levels of T lymphocytes in all groups, and the degree of inflammatory gastric mucosal lesions in different patient groups were compared. The association between T lymphocyte levels and the degree of gastric mucosal lesion were analyzed. Results The levels of CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺ in T lymphocytes of healthy group were (67.58±6.81)%, (46.19±4.16)%, (30.17±2.44)%, (1.60±0.41)%; in acute hepatitis B group were (63.24±5.02)%, (43.02±3.77)%, (26.15±2.10)%, (1.33±0.34)%; in chronic hepatitis B group were (55.12±4.22)%, (35.16±2.15)%, (21.16±1.84)%, (1.15±0.27)%; and in post-hepatitis cirrhosis group were (47.15±3.19)%, (28.65±1.41)%, (17.19±1.41)%, (0.94±0.22), respectively, which had significantly difference between the groups (healthy group> acute hepatitis B group>chronic hepatitis B group>post-hepatitis cirrhosis group, P<0.05). Significant difference in the inflammatory degrees of gastric mucosa lesions existed in the patient groups. The percentage of severe chronic superficial gastritis patients in acute hepatitis B group was 3.53%, chronic hepatitis B group was 9.68%, post-hepatitis cirrhosis group was 17.89%. Severe lesions of atrophic gastritis accounted for 7.06% patients in acute hepatitis B group, 20.43% in chronic hepatitis B group, 45.26% in post-hepatitis cirrhosis group, which had significant difference within the groups (acute hepatitis B group<post-hepatitis cirrhosis group<chronic hepatitis B group, P<0.05). The levels of CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺T lymphocytes in mild gastric mucosal inflammatory lesions were (63.84±5.17)%, (42.19±3.55)%, (25.80±2.41)%, (1.28±0.33)%, respectively, while in those of moderate patients were (57.23±4.31)%, (36.21±2.58)%, (20.53±1.72)%, (1.05±0.24)%, respectively, and in those of severe patients were (48.24±3.54)%, (30.78±1.87)%, (17.58±1.06)%, (0.90±0.18)%, respectively, which had significantly difference (severe<moderate<mild, and P<0.05). The correlation analysis confirmed that the level of T lymphocyte was positively correlated with the degree of inflammatory gastric mucosal lesions (P<0.05). Conclusion The levels of CD3⁺, CD4⁺, CD8⁺ and CD4⁺/CD8⁺ in T lymphocytes of HBV-infected patients were significantly decreased, and their expression levels were closely associated with the severity of inflammatory gastric mucosal lesions.

Key words: Viral hepatitis B, Inflammatory gastric mucosal lesions, T lymphocytes, Association

王炎, 许娜, 李小心. 乙型肝炎患者的T淋巴细胞水平与胃黏膜炎性病变程度[J]. 肝脏, 2021, 26(11): 1236-1239.

WANG Yan, XU Na, LI Xiao-xin. An analysis of T lymphocyte level in hepatitis B virus infected patients with different degree of inflammatory gastric mucosal lesions[J]. Chinese Hepatolgy, 2021, 26(11): 1236-1239.

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