| The natural history of chronic HBV infection is identified at the National Institutes of Health Workshop on Management of Hepatitis B 2000: the immune tolerant phase, the chronic Hepatitis B (or immuneactive) phase, the inactive Hepatitis B (or asymptomatic) carrier phase and reactivation phase. The immune tolerant phase is characterized by the presence of HBeAg, high levels of serum HBV DNA (>10~5copies/ml), but normal or slightly increased alanine aminotransferase (ALT) levels, and minimal or no inflammation on liver biopsy.In recent years, many researchers have found that changes of CD3~+, CD4~+, CD8~+ T lymphocytes and B lymphocytes in peripheral blood of patients with chronic HBV infection are not significantly different from those in healthy individuals. While the variance of intrahepatic immune competent cells (ICCs) among these chronic HBV infection patients in immune tolerant phase is not yet clear.This study is conducted to investigate the characteristics of intrahepatic CD3~+, CD4~+, CD8~+T lymphocytes, B-cells, NK cells, kupffer cells among patients in immune tolerant phase. Meanwhile, we try to explore the relationship between intrahepatic different immune competent cells and the status of immune tolerance in chronic HBV infection.A total of 16 liver biopsies were selected from 115 patients in immune tolerant phase for detection of T lymphocyte subsets, B lymphocytes, Natural Killer cells and Kupffer cells in the liver biopsies of patients and determination of the characteristics of HBsAg and HBcAg expressed in hepatocytes. Six normal liver biopsies and 17 liver biopsies of patients in immuneactive phase and 16 liver biopsies of patients in inactive HBV carrier status were employed to serve ascontrol respectively.It was found that CD3~+, CD4~+, CD8~+ T lymphocyte subsets, CD68~+ cells in the liver biopsies of patients in immune tolerant phase were all significantly increased as compared with normal control and significantly decreased as compared with the patients in immuneactive phase (p<0.01). However, they were not significantly different from those in the patients in inactive HBV carrier status. The ratio of CD4/CD8 in portal tract was lower in immune tolerant phase than in immuneactive phase and in inactive HBV carrier status (p<0.01), but it was not markedly different from that in the normal control. The numbers of intrahepatic B cells in immune phase were decreased statistically compared with B cells in immuneactive phase (P<0.01) and were almost the same as those in normal control or inactive HBV carrier state (P>0.05). Meanwhile, the number of NK cells in the liver biopsies was almost the same among patients with the infection at different phases and the control (P>0.05). The rate of HBcAg expressing in hepatocytes of patients at immune tolerant phase was significantly higher than that of patients at immuneactive phase and inactive HBV carrier status (.P<0.01). The number of hepatocytes with HBcAg expression in the liver biopsies of all cases was correlated with the log value of HBV DNA concentrations in the serum (r=0.459, P=0.007). The number of liver infiltrating immune cells including CD3~+, CD4~+, CD8~+T lymphocytes, B-cells, kupffer cells among all cases was correlated with the grade of the liver tissue inflammation and injury respectively(r=0.819, 0.819, 0.790, 0.739, 0.749, P<0.01). The absolute number of lymphocyte subsets in peripheral blood of all cases was not correlated with the number of equivalent liver infiltrating lymphocyte subsets (P>0.05).These results indicated that the numbers of CD3~+, CD4~+, CD8~+ T lymphocytes, B-cells, kupffer cells were decreased significantly as compared with those in immuneactive phase. These findings also suggest that T lymphocytes, B lymphocytes and Kupffer cells may play important roles in clearance of HBV virus and in liver inflammation and injury in chronic HBV infection. The fewer...
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