The Clinical Significance Of Peripheral Blood T Lymphocyte Subsets And Their PD-1 Expression In Therapeutic Evaluation Of Anti-Hepatitis B Fibrosis

Hepatitis B fibrosis refers to the pathological process of chronic and persistent hepatocyte inflammation,necrosis and the abnormal proliferation of connective tissues within the liver due to hepatitis B virus,and it represents an important intermediate process and necessary stage for the progression of chronic hepatitis B into hepatitis B cirrhosis.During the early hepatitis B fibrosis stage,intervention with the appropriate medications can prevent or even reverse the progression of liver fibrosis.Currently,the combination of Chinese and Western medicine for the treatment of hepatitis B fibrosis has yielded good clinical efficacy.In view of the involvement of PD-1/PD-L1 immune dysfunction in the important pathological mechanisms of chronic hepatitis B,our research observed the peripheral blood lymphocyte subsets and their PD-1 expression,and observed the change of PD-1 expression during the treatment of hepatitis B fibrosis,and explored the significance of PD-1 therapeutic evaluation of anti-hepatitis B Fibrosis,thereby provided experimental references for therapeutic evaluations of hepatitis B fibrosis.Section ? Effect observation of entecavir combined with Shenqierjia Pills in the treatment of hepatitis b fibrosisObjective:To observe the clinical efficacy of entecavi combined with Shenqierjia Pills for the treatment of hepatitis B fibrosis.Methods:The patients(n=40)with chronic hepatitis B liver fibrosis admitted to the Yancheng TCM Hospital as outpatients and inpatients from Jul.2018 to Feb.2019 who met the diagnostic and inclusion criteria for hepatitis B fibrosis were randomized into the western medicine group and the integrated Chinese and Western medicine group(hereinafter referred to as the combination group)group.Western medicine group:the patients were orally administered with entecavir 0.5 mg once per night before going to bed,with three months as a course of treatment.Combination group:the patients were orally administered with entecavir 0.5mg once per night before going to bed,and given additional oral Shenqierjia Pills 5 g b.i.d.,with three months as a course of treatment.The liver function,DNA indicators of hepatitis B virus,liver fibrosis indicators including hyaluronic acid,laminin,type ? collagen,type ? procollagen peptide and imaging changes in B-ultrasound were monitored before and after the treatment.Results:1.The DNA indicators of hepatitis B viras in the western medicine group and the combination medicine group showed a downward trend after treatment(P<0.05),but there was no significant difference between the two groups(P>0.05).2.The liver function indicators,4 liver fibrosis indicators and B-ultrasound imaging indicators in the Western medicine group and the combination group were improved after treatment(P<0.05),and the difference between the two groups were significant(P<0.05).3.The total clinical efficacy in the combination group was superior to that in the western medicine group(P<0.05).Conclusion:The clinical efficacy of combined Chinese and Western medicine for the treatment of hepatitis B fibrosis is superior to that of Western medicine alone.Section ? The Clinical Significance of Peripheral Blood T lymphocyte Subsets and Their PD-1 Expression in Therapeutic Evaluation of Anti-Hepatitis B FibrosisObjective:To investigate the significance of PD-1 expression on T lymphocytes of peripheral blood in the therapeutic evaluation of anti-hepatitis B fibrosis,and to provide reliable clinical observation reference for therapeutic evaluations of hepatitis B fibrosis.Methods:Test the expressions of lymphocyte subsets and their PD-1 expression in peripheral blood of the patients with hepatitis b fibrosis who were included in the first part of the study(n=40)and the healthy controls(n=20)by flow cytometry,and analysis its correlation with the clinical indicators.According to the clinical efficacy evaluation criteria in the first part of the experiment,patients were divided into the markedly efficacious group,efficacious group and inefficacious group.Analysis the change of T lymphocyte subsets and their expression PD-1level before and after treatment.Results:1.Compared with the healthy controls,the expression of PD-1 on CD4+T and CDS+T lymphocyte cells in peripheral blood of the patients with hepatitis B fibrosis was significantly increased(P<0.01);2.The T lymphocytes and their subsets in patients with hepatitis B fibrosis were not correlated with the clinical test indicators(P>0,05).The expression level of PD-1 molecule on CD4+T lymphocyte cells in peripheral blood was associated with DNA indicators of hepatitis B virus,P?P and HA(P<0.05).The expression level of PD-1 molecule on CD8+T lymphocyte cells in peripheral blood was associated with ALT and HBV-DNA indicators of hepatitis B(P<0.05);3.The expression level of PD-1 molecule on CD4+T and CD8+T lymphocyte cells in the markedly efficacious and efficacious groups were significantly decreased(P<0.01);the expression level of PD-1 molecule on CD4+T and CD8+T lymphocyte cells in the inefficacious group were not changed significantly(P>0.05).There were differences in the changes of the expression level of PD-1 molecule on CD4+T and CD8+T lymphocyte cells among three groups(P<0.01).Conclusion:The expression of PD-1 on CD4+T and CD8+T lymphocyte cells on the lymphocyte cells in peripheral blood of patients with hepatitis B was markedly elevated,and the change of PD-1 expression level on CD4+T and CD8+T lymphocyte cells may be immune indicators of therapeutic evaluation of hepatitis B fibrosis.