Objective To investigate the changes of peripheral blood T lymphocyte subpopulations and hepatitis B virus (HBV) specific cytotoxic T lymphocytes (CTL) in patients with severe hepatitis B,and to understand the significance of cellular immunity in the progress of severe hepatitis B.Methods By flow cytometry,42 patients with severe hepatitis B(8 cases of death and 34 cases of survival),20 healthy controls,20 patients with acute hepatitis B and 40 patients with chronic hepatitis B were determined for T lymphocyte subpopulations and 3 types of CD8 + CTL levels.The T lymphocyte percentages in severe hepatitis B group were compared with those in healthy control group,severe hepatitis B survival group and death group.Results Compared with the other groups,the percentages of CD3 + and CD4 +,CD4 +/CD8 + ratio and the specific CTL levels of core18-27,polymerase 575-583 and envelope335-343 were significantly lower in chronic severe hepatitis B group(P ＜ 0.05).CD8 + percentage increased significantly.Compared with severe hepatitis B survival group,the changes of T lymphocyte percentages in severe hepatitis B death group were more obvious.Conclusions Cellular immunity function in patients with chronic severe hepatitis B has a sharp decline,lacking of HBV specific CTL response,and the cellular immunity involves in the progress of severe hepatitis.%目的 探讨重型乙型肝炎患者外周血T淋巴细胞亚群及乙型肝炎病毒(HBV)特异性细胞毒性T淋巴细胞(CTL)的变化,了解细胞免疫变化在重型乙型肝炎进展中的作用.方法 用流式细胞术检测42例重型乙型肝炎患者(死亡患者8例,存活患者34例)、20名健康对照者、20例急性乙型肝炎患者和40例慢性乙型肝炎患者的T淋巴细胞亚群和3种CD8+ CTL的水平,比较重型乙型肝炎和其他对照组、重型乙型肝炎存活和死亡患者各种T淋巴细胞百分比的变化.结果 与其他各组比较,慢性重型乙型肝炎患者的外周血淋巴细胞的CD3+和CD4+百分比、CD4+/CD8+比值,以及core 18-27、polymerase 575-583和envelope335-343特异性CTL水平均明显降低(P＜0.05),CD8+百分比明显升高.与存活患者比较,重型乙型肝炎死亡患者上述各T淋巴细胞百分比的变化更加明显.结论 慢性重型乙型肝炎患者细胞免疫功能急剧下降,HBV特异性CTL应答缺乏,细胞免疫参与了重型乙型肝炎的进展过程.
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