Study On The Expression And Clinical Significance Of PD-1 And CD28 In T Lymphocyte Subsets Of Patients With CHB

Objective: The content of programmed cell death factor-1 and CD28 in peripheral blood of patients with chronic hepatitis B at different stages of infection was detected to observe the difference in the expression of PD-1 and CD28;At the same time,observe the expression level of PD-1 and CD28 after treatment with different antiviral drugs,and study the correlation between the clinical indicators of patients with chronic hepatitis B and the expression of PD-1 and CD28 on T lymphocytes,and explore its clinical significance.Methods: 150 patients with CHB were selected from the Department of Hepatology Intervention,Kunming Third People’s Hospital from March 1,2022 to September 1,2022,and 50 healthy people were collected from the physical examination center of our hospital during the same period.According to the immune stage of CHB patients,CHB patients were divided into immune tolerance stage(29 cases),immune clearance stage(37 cases),immune control stage(53 cases)and reactivation stage(31 cases);According to the use of different antiviral drugs,they were divided into non-antiviral group(28 cases),entecavir group(46 cases),tenofovir dipivoxil group(27 cases),minofovir dipivoxil group(24 cases)and tenofovir dipivoxil group(16 cases).The expression of PD-1 and CD28 in peripheral blood of CHB group and control group was detected by flow cytometry.At the same time,hepatitis B viral load(HBV DNA),hepatitis B virus markers,blood biochemical indicators,blood routine indicators,blood lipid indicators,coagulation indicators and other clinical indicators of CHB patients were detected,and experimental data were collected for statistical analysis.Result:1.The results showed that compared with the control group,the expression of PD-1 in CD3,CD4,CD8+T cells in peripheral blood of CHB immune staging groups was significantly increased(P < 0.001);However,there was no statistically significant difference in the expression of PD-1 between two groups of CHB patients(P > 0.05).Compared with the control group,the expression level of CD28 in CD3 and CD4+T cells in each group of CHB patients decreased significantly(P < 0.001);The expression level of CD28 in CD8+T cells showed an up-regulation trend,and only the expression of CD28 in patients in the immune control stage group had statistical significance(P < 0.05);There was no statistically significant difference in the expression of CD28 between two groups of CHB patients(P > 0.05).2.By comparing the efficacy of different antiviral drugs in each group,the clinical symptoms and signs of patients were effectively improved: the effective rate of entecavir group was 89.1%,the effective rate of tenofovir dipivoxil group was77.8%,the effective rate of amitenofovir dipivoxil group was 91.7%,the effective rate of tenofovir dipivoxil group was 68.8%,and the effective rate of non-antiviral drug group was 35%.According to the guidelines,different antiviral drugs are recommended to have good therapeutic effects,but the efficacy of the amitinofovir dipivoxil group is superior to other antiviral groups.3.The expression of PD-1 and CD28 in CD3,CD4 and CD8+T cells in peripheral blood of patients with CHB was not statistically significant(P > 0.05).4.Correlation analysis showed that CD3+PD-1(%)was positively correlated with MO(r = 0.268,P < 0.001).CD3+CD28(%)was positively correlated with PLT(r = 0.184,P = 0.026)and PCT(r = 0.176,P = 0.042);It is negatively correlated with APTT level(r =-0.254,P = 0.002),TT(r =-0.248,P = 0.002),TBIL(r =-0.277,P <0.001),DBIL(r =-0.272,P < 0.001),IBIL(r =-0.262,P = 0.001),AST(r =-0.185,P= 0.033),ALT(r =-0.175,P = 0.033),P-LCR(r =-0.174,P = 0.043).CD4+PD-1(%)was positively correlated with MO(r = 0.174,P = 0.034),UREA(r = 0.163,P =0.048)and HDL-C(r = 0.196,P = 0.019);It was negatively correlated with ALB(r =-0.154,P = 0.047),RBC(r =-0.172,P = 0.037)and PCT(r =-0.195,P = 0.023).CD4+CD28(%)was negatively correlated with HBc Ab-Ig M level(r =-0.197,P =0.023)and UA(r =-0.167,P = 0.043).CD8+PD-1(%)was positively correlated with TT level(r = 0.177,P = 0.03),AST(r = 0.206,P = 0.017),ALT(r = 0.17,P = 0.038),GGT(r = 0.167,P = 0.042),MO(r = 0.234,P = 0.004);And ALB(r =-0.16,P =0.046).CD8+CD28(%)was negatively correlated with HBc Ab-Ig M level(r =-0.17,P = 0.05).The difference between the groups was statistically significant.Conclusion:1.There are significant differences in the expression of PD-1 and CD28 in patients with CHB at different stages of infection.It is suggested that the expression of PD-1 and CD28 is related to the hepatitis grading and staging of CHB.This may be because the virus stimulates the immune system of the body for a long time,leading to the dysfunction of the immune system of the body.2.This study found a total of 18 clinical indicators associated with PD-1 and CD28.It is suggested that as the condition of CHB patients progresses,the expression of MO,PLT,PCT,P-LCR,UA,UREA,RBC,APTT,TT,TBIL,DBIL,IBIL,AST,ALT,HDL-CALB,HBc Ab-Ig M,GGT,ALB and PD-1,CD28 interact with each other.The specific mechanism of influence needs to be further studied in the later stage.3.PD-1 and CD28 are significantly correlated with PLT,PCT,P-LCR and blood lipid indicators,while PLT,PCT,P-LCR and blood lipid indicators are effective indicators to evaluate the degree of liver fibrosis in patients with CHB.Therefore,PD-1 and CD28 have clinical value in evaluating the degree of liver fibrosis in patients with CHB.