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目的 探讨外周血淋巴细胞穿孔素/颗粒酶的表达在重型乙型肝炎(乙肝)肝细胞损伤中的作用,及其与乙型肝炎病毒(HBV)-DNA载量的关系.方法 取38例重型乙肝患者入院次日晨空腹静脉血备检;同期选择20例成年健康体检志愿者作为健康对照组;采用流式细胞仪测定外周血淋巴细胞穿孔素/颗粒酶的表达;采用荧光定量聚合酶链反应(PCR)测定血清HBV-DNA载量.结果 重型肝炎组外周血淋巴细胞穿孔素及颗粒酶阳性率均较健康对照组显著升高[穿孔素:(43.42±19.28)%比(19.65±9.27)%,颗粒酶:(40.35±12.26)%比(22.28±9.35)%,P均＜0.01],且血清HBV-DNA载量越高,重型乙肝患者外周血淋巴细胞穿孔素/颗粒酶表达强度越低,均呈明显负相关(r 孔素=0.92,r颗料酶=-0.96,P均＜0.01).结论 外周血淋巴细胞穿孔素/颗粒酶的过度表达是造成重型肝炎肝细胞损伤的重要因素,这种表达作用与乙型肝炎患者的HBV-DNA清除有关.

Objective To explore role of perforin/granzyme expression of peripheral blood lymphocyte in injury of hepatocyte in severe hepatitis B,and evaluate relationship between perforin/granzyme expression levels and hepatitis B virus(HBV)-DNA load.Methods Thirty eight patients of severe hepatitis B were enrolled in the study.Fasting venous blood was collected on following morning of admission.Twenty adult healthy subjects served as healthy control group.Perforin/granzyme expression of peripheral blood lymphocyte was detected by flow eytometry,and serum HBV-DNA load was detected by fluorescence quantitative polymerase chain reaction(PCR).Results Positive rate of perforin/granzyme in peripheral blood lymphocyte in severe hepatitis B was higher than that of the healthy control group[perforin:(43.42±19.28)%vs.(19.65±9.27)%,granzyme:(40.35±12.26)%vs.(22.28±9.35)%,both P＜0.01].There was a significant negative correlation between the perforin/granzyme expression of peripheral blood lymphocyte and serum HBV-DNA load(perforin=-0.92,raranzyme=-0.96,both P＜0.01),the higher serumHBV-DNA load,the lower perforin/granzyme expression in severe hepatitis B.Conclusion Perforin/granzyme overexpression in peripheral blood lymphocyte is an important factor in injury of hepatocyte in patients with severe hepatitis B,and the expression may be involved in HBV-DNA cleanup.