淋巴细胞亚群检测对抗病毒治疗的慢性乙型肝炎患者HBsAg下降的预测价值

彭真; 靳慧鸣; 宁会彬; 李宽; 尚佳

doi:10.3969/j.issn.1001-5256.2021.09.014

淋巴细胞亚群检测对抗病毒治疗的慢性乙型肝炎患者HBsAg下降的预测价值

DOI: 10.3969/j.issn.1001-5256.2021.09.014

河南省人民医院感染科，郑州 450003

基金项目:

中国肝炎防治基金会天晴肝病研究基金 (TQGB20190252)

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：彭真、靳慧鸣负责课题设计，资料分析，撰写论文；宁会彬、李宽参与收集数据，修改论文；尚佳负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
尚佳，shangjia666@126.com

中图分类号: R512.62
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出版历程
- 收稿日期: 2021-02-22
- 录用日期: 2021-04-30
- 出版日期: 2021-09-20

Value of lymphocyte subset testing in predicting HBsAg decline in chronic hepatitis B patients receiving antiviral therapy

Department of infectious Diseases, Henan Provincial People's Hospital, Zhengzhou 450003, China

Research funding:

Tianqing Liver Disease Research Foundation of Chinese Foundation for Hepatitis Prevention and Control (TQGB20190252)

摘要

摘要: 目的明确不同抗病毒治疗方案的慢性乙型肝炎患者淋巴细胞亚群水平是否有差异，寻找HBsAg下降相关预测指标。方法回顾性研究2019年10月—12月河南省人民医院感染科门诊就诊的68例经治CHB患者，按照抗病毒治疗方案的不同分为PEG-IFNα治疗组(n=10)，PEG-IFNα联合核苷(酸)类似物(NAs)治疗组(n=21)和NAs治疗组(n=37)，记录人口学特征、血常规、白蛋白、HBsAg，淋巴细胞亚群测定等资料。符合正态分布的计量资料多组间比较采样单因素方差分析；不符合正态分布的计量资料多组间比较采用Kruskal-Wallis H检验。计数资料多组间比较采用χ²检验。利用多因素logistic回归筛选影响患者HBsAg下降的独立影响因素。结果 3组间HBsAg下降情况(H=8.348，P=0.015)、淋巴细胞绝对值(F=4.643，P=0.013)、T淋巴细胞数(F=7.721，P=0.001)比较差异均有统计学意义。多因素logistic回归分析结果显示，性别(OR=0.227，95%CI：0.059~0.878，P=0.032)、年龄(OR=0.931，95%CI：0.868~0.999，P=0.047)、抗病毒治疗方案[PEG-IFNα治疗组vs NAs治疗组，OR=9.600，95%CI：1.982~46.498，P=0.005；联合治疗组vs NAs治疗组，OR=4.800，95%CI：1.336~17.243，P=0.016]、T淋巴细胞数(OR=0.804，95%CI：0.684~0.944，P=0.008)是HBsAg下降的独立影响因素。结论 CHB患者接受PEG-IFNα单药或联合NAs治疗，在治疗过程中监测淋巴细胞亚群，有助于判断HBsAg下降，T淋巴细胞绝对值越低，HBsAg下降的可能性越大。
- 乙型肝炎, 慢性 /
- 乙型肝炎表面抗原 /
- 淋巴细胞亚群
Abstract: Objective To investigate whether there are differences in lymphocyte subsets between chronic hepatitis B (CHB) patients receiving different antiviral treatment regimens, and to determine related predictive factors for HBsAg decline. Methods A retrospective analysis was performed for 68 treatment-experienced CHB patients who attended the outpatient service in Department of Infectious Diseases, Henan Provincial People's Hospital, from October to December 2019, and according to the antiviral treatment regimen, they were divided into PEG-IFNα treatment group with 10 patients, PEG-IFNα+nucleos(t)ide analogues (NAs) treatment group with 21 patients, and NAs treatment group with 37 patients. Related data were recorded, including demographic features, blood routine, albumin, HBsAg, and measurement of lymphocyte subsets. A one-way analysis of variance was used for comparison of normally distributed continuous data between groups, and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups; the multivariate logistic regression analysis was used to investigate independent influencing factors for HBsAg decline. Results There were significant differences between the three groups in HBsAg decline (H=8.348, P=0.015), absolute value of lymphocytes (F=4.643, P=0.013), and T lymphocyte count (F=7.721, P=0.001). The multivariate logistic regression analysis showed that sex (odds ratio [OR]=0.227, 95% confidence interval [CI]: 0.059-0.878, P=0.032), age (OR=0.931, 95%CI: 0.868-0.999, P=0.047), antiviral treatment regimen (PEG-IFN-α treatment group vs NAs treatment group: OR=9.600, 95%CI: 1.982-46.498, P=0.005; PEG-IFN-α+NAs treatment group vs NAs treatment group: OR=4.800, 95%CI: 1.336-17.243, P=0.016), and T lymphocyte count (OR=0.804, 95%CI: 0.684-0.944, P=0.008) were independent influencing factors for HBsAg decline. Conclusion For CHB patients receiving PEG-IFNα alone or in combination with NAs, monitoring of lymphocyte subsets during the treatment process may help to judge HBsAg decline, and the lower the absolute value of T lymphocytes, the greater the possibility of HBsAg decline.
- Hepatitis B, Chronic /
- Hepatitis B Surface Antigens /
- Lymphocyte Subsets

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表 1 患者一般资料

组别	例数	男/女(例)	年龄(岁)	白细胞(×10⁹/L)	中性粒细胞(×10⁹/L)	血小板(×10⁹/L)	白蛋白(g/L)
NAs治疗组	37	20/17	38.2±9.9	5.4±1.4	3.0±1.9	162±72	46.3±3.8
PEG-IFNα治疗组	10	7/3	36.4±13.2	4.8±1.6	2.3±0.9	149±49	45.8±3.9
联合治疗组	21	17/4	38.7±9.6	4.8±1.7	2.2±0.9	123±52	45.9±3.4
统计值		χ²=4.388	F=0.191	F=1.220	F=1.851	F=2.515	F=0.141
P值		0.111	0.827	0.302	0.165	0.089	0.869

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表 2 3组患者HBsAg下降、淋巴细胞绝对数、CD4⁺/CD8⁺的比较

组别	例数	HBsAg下降(log)	淋巴细胞绝对值(/μl)	T淋巴细胞数(/μl)	B淋巴细胞数(/μl)	NK细胞数(/μl)	CD4⁺/CD8⁺
NAs治疗组	37	0.25(0.04~0.52)	1752±605	1244±446	109±18	273±221	1.34±0.56
PEG-IFNα治疗组	10	1.31(0.32~2.21)	1426±714	906±432	222±142	282±198	1.24±0.41
联合治疗组	21	0.47(0.19~1.53)	1288±446	843±275	165±109	256±139	1.47±0.62
统计值		H=8.348	F=4.643	F=7.721	F=1.291	F=0.075	F=0.666
P值		0.015	0.013	0.001	0.282	0.927	0.517

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表 3 患者HBsAg下降幅度的多因素logistic回归分析

变量	B值	SE	Wald	P值	OR(95%CI)
年龄	-0.071	0.036	3.936	0.047	0.931(0.868~0.999)
性别	-1.483	0.691	4.614	0.032	0.227(0.059~0.878)
抗病毒方案(vs NAs治疗组)
PEG-IFNα治疗组	2.262	0.805	7.895	0.005	9.600(1.982~46.498)
联合治疗组	1.569	0.652	5.780	0.016	4.800(1.336~17.243)
T淋巴细胞数	-0.218	0.082	7.061	0.008	0.804(0.684~0.944)
常数	-1.856	0.481	14.901	＜0.001

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