A clinical study of autologous cytokine-induced killer cells in treatment of patients with chronic hepatitis B
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摘要: 目的观察自体细胞因子诱导的杀伤细胞(CIK)治疗慢性乙型肝炎(CHB)患者的疗效及安全性,探索CHB治疗的新策略。方法收集2009年12月1日至2012年12月1日南京军区福州总医院收治的84例CHB患者,称为CIK治疗组,采集其外周血单个核细胞,在体外经干扰素γ、白细胞介素2、抗CD3单克隆抗体等细胞因子诱导成CIK,分次自体回输,观察治疗前及治疗后12、24、48周患者肝功能、HBV血清标志物变化及HBV DNA水平;50例接受恩替卡韦(ETV)治疗的患者作为对照组,称为ETV治疗组。将两组HBe Ag阳性和HBe Ag阴性患者分组进行比较分析,同时对不良反应和肾功能进行评估。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果随着观察时间延长,CIK治疗组无论是HBe Ag阳性患者还是HBe Ag阴性患者,其ALT水平均降低,其中HBe Ag阳性患者治疗12、24周时与ETV治疗组相比,两组差异均具有统计学意义(t值分别为5.03、4.72,P值均<0.01);CIK治疗组在不同时间点的HBe Ag阴转率和血清转换率均高于ETV治疗组,其中治疗24周和48周时两组...Abstract: Objective To evaluate the safety and efficacy of autologous cytokine- induced killer( CIK) cells in the treatment of patients with chronic hepatitis B( CHB),and to investigate a new therapeutic strategy for CHB. Methods Peripheral blood mononuclear cells were isolated from 84 patients with CHB,and then induced to CIK cells in vitro with cytokines such as interferon- γ,interleukin- 2,and monoclonal antibody against CD3. The autologous CIK cells obtained were infused back into the individual patient. Liver function parameters,serum markers,and HBV DNA levels were evaluated before treatment and at 12,24,and 48 weeks after treatment. Fifty patients who received entecavir( ETV) treatment were used as controls. Comparison was made between HBe Ag- positive patients and HBe Ag- negative patients.Adverse reactions and kidney function were evaluated. Comparison of continuous data between the two groups was made by t test,and comparison of categorical data was made by chi- square test. Results The alanine aminotransferase( ALT) levels in both HBe Ag- positive patients and HBe Ag- negative patients in the treatment group decreased as the observation time went on. HBe Ag- positive patients in the treatment group had significant lower ALT levels than those in the control group at 12 and 24 weeks after treatment( t = 5. 03,P < 0. 01; t =4. 72,P < 0. 01). The treatment group had higher HBe Ag clearance rate and seroconversion rate than the control group at each time point.Particularly,there were significant differences in HBe Ag clearance rates at 24 and 48 weeks after treatment between the two groups( χ2=6. 85,P < 0. 05; χ2= 4. 83,P < 0. 05). Both HBe Ag- positive patients and HBe Ag- negative patients in the treatment group had higher HBV DNA levels and lower incidence rates of undetectable HBV DNA level than those in the control group. However,as the observation time went on,the HBV DNA copy level gradually decreased,and the HBV DNA clearance rate gradually increased in the treatment group. Conclusion The therapy with autologous CIK cells is safe and effective in patients with CHB during 48 weeks after treatment. In spite of a lower HBV DNA clearance rate,this therapy results in higher HBe Ag clearance rate and seroconversion rate than ETV therapy as the observation time goes on,which suggests a probably sustainable immune response after treatment with autologous CIK cells.
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Key words:
- hepatitis B,chronic /
- cytokines /
- killer cells /
- entecavir
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