目的 分析慢性乙型肝炎重叠急性戊型肝炎患者血清γ-干扰素(IFN-γ)、白细胞介素-2(IL-2)、白细胞介素-10(IL-10)的表达及临床意义.方法 采用酶联免疫吸附试验(ELISA)测定慢性乙型肝炎重叠急性戊型肝炎患者(重叠组)、急性戊型肝炎患者(AHE组)、慢性乙型肝炎患者(CHB组)和健康体检者(对照组)的血清IFN-γ、IL-2、IL-10水平;分别采用实时荧光PCR和ELISA方法测定重叠组和CHB组的乙肝病毒(HBV)基因定量(HBV DNA)和HBV血清标记物;同时检测重叠组、AHE组和CHB组的主要肝功能指标.结果 重叠组IFN-γ高于CHB组和对照组,IL-10低于CHB组和对照组,IL-2高于CHB组(P<0.05);CHB组IL-10高于其他3组(P<0.05).重叠组丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、血清总胆红素(TBIL)高于CHB组,胆碱酯酶(CHE)、白蛋白(ALB)、凝血酶原活动度(PTA)低于CHB组(P<0.05).重叠组乙型肝炎e抗原(HBeAg)和HBV DNA阴性率高于CHB组(P=0.00).重叠组组中HBV-DNA阴性者IFN-γ、IL-2水平高于HBV-DNA阳性者,IL-10水平低于HBV DNA阳性者(P<0.01).结论 IFN-γ、IL-2、IL-10参与慢性乙型肝炎重叠急性戊型肝炎肝细胞免疫损伤过程;IFN-γ、IL-2、IL-10可作为判断重叠感染后肝细胞损伤程度的指标;重叠感染后IFN-γ、IL-2可能影响HBV的复制.%Objective To analyze the expression and clinical significance of three serum cytokines (IFN-γ, IL-2,IL-10) in patients with chronic hepatitis B overlapping acute hepatitis E. Methods The serum levels of IFN-γ, IL-2 and IL-10 of chronic hepatitis B overlapping acute hepatitis E (overlapping group), acute hepatitis E (AHE group) ,chronic hepatitis B (CHB group) and the healthy check-up (control group) were determined by Enzyme-linked Immunosorbent Assay test (ELISA). Real-time tracking fluorescence PCR was used to determine HBV DNA of overlapping group and CHB group , ELISA was used to determine the serum markers of CHB group. At the same time, the main liver function of overlapping group, AHE group and CHB group were determined. Results The IFN-γ in overlapping group was significant higher than that in CHB and control groups, while the IL-10 in overlapping group was lower than that in CHB and control groups, IL-2 in overlapping group was higher than that in CHB group , IL-10 in CHB group was the highest (P ＜0.05 ). Compared with CHB group, the main liver function such as alanine aminotransferase (ALT),aspertate aminotransferase (AST), total bilirubin (TBIL) increased obviously, and cholinesterase (CHE), albumin (ALB) , prothrombin activity (PTA) decreased obviously in overlapping group ( P ＜0.05 ). The negatie rates of HBeAg and HBV DNA in overlapping group were significantly higher than those in CHB group(P =0.00). The serum levels of IFN-γ and IL-2 in overlapping group which HBV DNA were negative were significantly higher than positive ones, and the serum level of IL-10 was lower ( P ＜ 0. 01 ). Conclusion IFN-γ, IL-2 and IL-10 were involved in the immunologic injury process that occurred for HBV overlapping HEV. Detecting the serum levels of IFN-γ, IL-2 and IL-10 can be used as indexes of hepatic cell damage degree of HBV overlapping HEV. IFN-γand IL-2 may have some effects in HBV replication.
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