Research On Immunodynamics Of Patients With Chronic Hepatitis B

Objective:To study pathogenesis of chronic hepatitis B further and provide rationale for immunotherapy, associated detection of patients with chronic hepatitis B were done to observe the dynamic change of immune function in patients with chronic hepatitis Bafter acute episode and to analyze the relationship among liver damage and clearanceof HBVDNA and immune response.Methods:Thirty five patients with chronic hepatitis B were divided into two groups randomly by their qualitative results of HBc-IgM. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected by colourimetry; DNA of hepatitis B virus (HBV) was detected by polymerase chain reaction (PCR); Serum immunoglobulin G (IgG) was detected by laser light scattering turbidimetry; Percentage of CD3~+, CD4~+ and CD8~+T lymphocytes in peripheral blood were detected by flow cytometry. T-test and rank-sum test were used to analyze data from both groups.Serum ALT, AST, HBV DNA , IgG and percentage of CD3~+, CD4~+ and CD8~+T lymphocytes in peripheral blood of 10 patients with chronic hepatitis B and positive HBc-IgM were detected at the time when the patients were hospitalized and rechecked 31(30.80+12.60 days) days later respectively. Paired-samples t test was used to analyze data from HBc-IgM positive group; T-test and rank-sum test were used to analyze data from both HBc-IgM positive and negative groups. Results:1.Means of serum ALT, AST, HBVDNA , IgG and CD4~+T lymphocytes in peripheral blood of 25 patients in HBc-IgM positive group were higher than those of 10 patients in HBc-IgM negative group. Difference between the two groups reached statistic significance (P<0.05). There was no significant difference between HBc-IgM positive and negative groups in the percentage of CD3~+ and CD8~+ T lymphocytes in patients' peripheral blood.( P>0.05)2. Means of serum ALT, AST and HBVDNA in the first detection of 10 patients in HBc-IgM positive group were higher than those in the second detection 31(30.80+ 12.60) days later, difference between the two groups reached statistic significance (PO.05). There was no significant difference between the two groups in serum IgGand the percentage of CD3\ CD4+ and CD8+ T lymphocytes in patients' peripheral blood. (P>0.05)3. One case from the HBc-IgM positive group that included 10 patients was classified into the HBc-IgM negative group whose total therefore became 11 cases because its HBc-IgM transformed negative when rechecked 29 days later. Means of serum HBVDNA in the second detection of 9 patients in HBc-IgM positive group were higher than those of the HBc-IgM negative group, difference between the two groups reached statistic significance (PO.05). There was no significant difference between the two groups in serum IgG and the percentage of CD3~\ CD4+ and CD8+ T lymphocytes in patients' peripheral blood. (P>0.05) Conclusions:1 .Mean of serum HBVDNA from the first detection of patients with chronic hepatitis B in HBc-IgM positive group was higher than that of serum HBVDNA from the second detection. Difference between the two groups reached statistic significance (PO.05). Each mean of serum HBVDNA from the two dynamic detections of patients with positive HBc-IgM was higher than that of serum HBVDNA of patients with nagative HBc-IgM. Differences among the three groups all reached statistic significance (PO.05). The results suggest that clearance of serum HBVDNA occur along with the decrease of aminotransferase since acute episode in patients with chronic hepatitis B; The process of serum HBVDNA clearance lasts till transform of HBc-IgM at least.2. Means of serum HBVDNA> IgG and percentage of CD4+T lymphocytes in peripheral blood of patients with chronic hepatitis B in HBc-IgM positive group was lower than that of patients in HBc-IgM negative group. Difference between the two groups reached statistic significance (P<0.05). The results indicate that clearance of serum HBVDNA depended mainly on the specific immunity activated by HBV infection and little on the nonspecific immunity. Means of serum ALT and AST of patients in HBc-IgM positive group were higher than that of patients in HBc-IgMnegative group. Difference between the two groups reached statistic significance (PO.05). The results suggest that specific immunity play an important role in the process of liver damage and nonspecific immunity probably play a secondary role.3. Level of serum IgG coincided with that of serum transaminase during acute episode of chronic hepatitis B. The result suggests that level of serum IgG parallel that of inflammation of liver tissue in patients with chronic hepatitis B. Level of serum IgG is helpful in judging active process in liver of patients with chronic hepatitis B.4. Mean of percentage of CD4+T lymphocytes in peripheral blood of patients with chronic hepatitis B in HBc-IgM positive group was significantly higher than that of patients in HBc-IgM negative group (P<0.05). Mean of percentage of CD4+T lymphocytes in peripheral blood of the first detection of patients in HBc-IgM positive group was higher than that of the second detection, but difference between the two groups didn't reach statistic significance (P>0.05). Mean of percentage of CD4+T lymphocytes in peripheral blood of the second detection of patients in HBc-IgM positive group was higher than that of the HBc-IgM negative group. Difference between the two groups didn't reach statistic significance either (P>0.05). The results suggest that there may be tendency of progressing decrease of CD4+T lymphocytes in peripheral blood of patients with chronic hepatitis B along with acute episode and transform of HBc-IgM, which leads to an astable and nonpersistent establishment of specific immunity of patients and persistent infection of HB V. T cell subsets can be regarded as an important index to judge condition of patients with chronic hepatits B.