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淋巴细胞亚群检测对抗病毒治疗的慢性乙型肝炎患者HBsAg下降的预测价值

彭真 靳慧鸣 宁会彬 李宽 尚佳

彭真, 靳慧鸣, 宁会彬, 等. 淋巴细胞亚群检测对抗病毒治疗的慢性乙型肝炎患者HBsAg下降的预测价值[J]. 临床肝胆病杂志, 2021, 37(9): 2071-2074. DOI: 10.3969/j.issn.1001-5256.2021.09.014
引用本文: 彭真, 靳慧鸣, 宁会彬, 等. 淋巴细胞亚群检测对抗病毒治疗的慢性乙型肝炎患者HBsAg下降的预测价值[J]. 临床肝胆病杂志, 2021, 37(9): 2071-2074. DOI: 10.3969/j.issn.1001-5256.2021.09.014
PENG Z, JIN HM, NING HB, et al. Value of lymphocyte subset testing in predicting HBsAg decline in chronic hepatitis B patients receiving antiviral therapy[J]. J Clin Hepatol, 2021, 37(9): 2071-2074. DOI: 10.3969/j.issn.1001-5256.2021.09.014
Citation: PENG Z, JIN HM, NING HB, et al. Value of lymphocyte subset testing in predicting HBsAg decline in chronic hepatitis B patients receiving antiviral therapy[J]. J Clin Hepatol, 2021, 37(9): 2071-2074. DOI: 10.3969/j.issn.1001-5256.2021.09.014

淋巴细胞亚群检测对抗病毒治疗的慢性乙型肝炎患者HBsAg下降的预测价值

DOI: 10.3969/j.issn.1001-5256.2021.09.014
基金项目: 

中国肝炎防治基金会天晴肝病研究基金 TQGB20190252

详细信息
    通讯作者:

    尚佳,shangjia666@126.com

  • 中图分类号: R512.62

Value of lymphocyte subset testing in predicting HBsAg decline in chronic hepatitis B patients receiving antiviral therapy

Funds: 

Tianqing Liver Disease Research Foundation of Chinese Foundation for Hepatitis Prevention and Control TQGB20190252

  • 摘要:   目的  明确不同抗病毒治疗方案的慢性乙型肝炎患者淋巴细胞亚群水平是否有差异,寻找HBsAg下降相关预测指标。  方法  回顾性研究2019年10月—12月河南省人民医院感染科门诊就诊的68例经治CHB患者,按照抗病毒治疗方案的不同分为PEG-IFNα治疗组(n=10),PEG-IFNα联合核苷(酸)类似物(NAs)治疗组(n=21)和NAs治疗组(n=37),记录人口学特征、血常规、白蛋白、HBsAg,淋巴细胞亚群测定等资料。符合正态分布的计量资料多组间比较采样单因素方差分析;不符合正态分布的计量资料多组间比较采用Kruskal-Wallis H检验。计数资料多组间比较采用χ2检验。利用多因素logistic回归筛选影响患者HBsAg下降的独立影响因素。  结果  3组间HBsAg下降情况(H=8.348,P=0.015)、淋巴细胞绝对值(F=4.643,P=0.013)、T淋巴细胞数(F=7.721,P=0.001)比较差异均有统计学意义。多因素logistic回归分析结果显示,性别(OR=0.227,95%CI:0.059~0.878,P=0.032)、年龄(OR=0.931,95%CI:0.868~0.999,P=0.047)、抗病毒治疗方案[PEG-IFNα治疗组vs NAs治疗组,OR=9.600,95%CI:1.982~46.498,P=0.005;联合治疗组vs NAs治疗组,OR=4.800,95%CI:1.336~17.243,P=0.016]、T淋巴细胞数(OR=0.804,95%CI:0.684~0.944,P=0.008)是HBsAg下降的独立影响因素。  结论  CHB患者接受PEG-IFNα单药或联合NAs治疗,在治疗过程中监测淋巴细胞亚群,有助于判断HBsAg下降,T淋巴细胞绝对值越低,HBsAg下降的可能性越大。

     

  • 表  1  患者一般资料

    组别 例数 男/女(例) 年龄(岁) 白细胞(×109/L) 中性粒细胞(×109/L) 血小板(×109/L) 白蛋白(g/L)
    NAs治疗组 37 20/17 38.2±9.9 5.4±1.4 3.0±1.9 162±72 46.3±3.8
    PEG-IFNα治疗组 10 7/3 36.4±13.2 4.8±1.6 2.3±0.9 149±49 45.8±3.9
    联合治疗组 21 17/4 38.7±9.6 4.8±1.7 2.2±0.9 123±52 45.9±3.4
    统计值 χ2=4.388 F=0.191 F=1.220 F=1.851 F=2.515 F=0.141
    P 0.111 0.827 0.302 0.165 0.089 0.869
    下载: 导出CSV

    表  2  3组患者HBsAg下降、淋巴细胞绝对数、CD4+/CD8+的比较

    组别 例数 HBsAg下降(log) 淋巴细胞绝对值(/μl) T淋巴细胞数(/μl) B淋巴细胞数(/μl) NK细胞数(/μl) CD4+/CD8+
    NAs治疗组 37 0.25(0.04~0.52) 1752±605 1244±446 109±18 273±221 1.34±0.56
    PEG-IFNα治疗组 10 1.31(0.32~2.21) 1426±714 906±432 222±142 282±198 1.24±0.41
    联合治疗组 21 0.47(0.19~1.53) 1288±446 843±275 165±109 256±139 1.47±0.62
    统计值 H=8.348 F=4.643 F=7.721 F=1.291 F=0.075 F=0.666
    P 0.015 0.013 0.001 0.282 0.927 0.517
    下载: 导出CSV

    表  3  患者HBsAg下降幅度的多因素logistic回归分析

    变量 B SE Wald P OR(95%CI)
    年龄 -0.071 0.036 3.936 0.047 0.931(0.868~0.999)
    性别 -1.483 0.691 4.614 0.032 0.227(0.059~0.878)
    抗病毒方案(vs NAs治疗组)
      PEG-IFNα治疗组 2.262 0.805 7.895 0.005 9.600(1.982~46.498)
      联合治疗组 1.569 0.652 5.780 0.016 4.800(1.336~17.243)
    T淋巴细胞数 -0.218 0.082 7.061 0.008 0.804(0.684~0.944)
    常数 -1.856 0.481 14.901 <0.001
    下载: 导出CSV
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    王昊亮, 邓国宏. 慢性HBV感染者病毒特异性T淋巴细胞: 耗竭还是沉默?[J]. 临床肝胆病杂志, 2020, 36(5): 980-982. DOI: 10.3969/j.issn.1001-5256.2020.05.005.
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  • 收稿日期:  2021-02-22
  • 修回日期:  2021-04-30
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