目的 探索乙肝相关性肝病肝移植受者抗乙肝主动免疫构建与外周血Th17细胞及Treg细胞比例变化的相关性,为提高免疫构建成功率提供理论支撑和临床经验。方法 选取2015-02至2017-06医院随访诊疗的肝移植受者144例,随机分为传统组、传统加强组、快速组和胸腺肽组四组,每组36例,给予不同的抗乙肝主动免疫诱导方案。比较抗乙肝主动免疫成功率的组间差异,分析Th17细胞及Treg细胞占淋巴细胞百分比及血清乙肝表面抗体(抗-HBs)滴度的组内和组间变化规律,观察疫苗接种的安全性。结果 传统组、传统加强组、快速组和胸腺肽组抗乙肝主动免疫构建成功率分别为2.78%(1/36)、5.56%(2/36)、22.9％(8/35)和34.3%(12/35),差异均有统计学意义(P<0.05);四组抗-HBs滴度之试验后较试验前增加幅度的组间差异有统计学意义(P<0.05);四组Th17细胞占比试验后较试验前均显著下降(P<0.05),降低幅度的组间差异有统计学意义(P<0.05);各组Treg细胞占比试验前后变化无统计学意义(P>0.05);全组病例抗-HBs增幅与Th17降幅呈显著正相关(r=0.276,P=0.002)而与Treg变化无相关性;血常规、尿常规和肝功能等生化指标在研究前后变化无统计学差异。结论 对于肝移植受者,通过合理接种乙肝病毒疫苗诱导抗乙肝主动免疫安全、可行,Th17细胞低表达对抗乙肝免疫构建可能具有促进作用而Treg细胞对构建似乎没有影响。

Objective To explore the correlations between the anti-hepatitis B active immune construction and the percentage of peripheral blood Th17 cells and Treg cells in liver transplantation recipients with hepatitis B-related liver disease, and provide theoretical support and practical experience for improving the success rate of construction.Methods One hundred and forty-four liver transplant recipients who were followed up in our hospital from February 2015 to June 2017 were enrolled according to the established criteria. These patients were randomly divided into four groups with informed consent(n=36): traditional group, traditional booster group, fast group and thymosin group. Each group was given a different anti-hepatitis B active immunization induction program. The difference between these groups in the anti-hepatitis B active immunization success rate was compared. The changes of the percentage of Th17 cells and Treg cells in lymphocytes and those of serum hepatitis B surface antibody (anti-HBs) titer were analyzed. The safety of vaccination was observed.Results The success rates of active immunization against hepatitis B in the four groups were 2.78% (1/36), 5.56% (2/36), 22.9% (8/35) and 34.3%(12/35)respectively, so the difference between these groups was statistically significant (P<0.05). The difference between the four groups in terms of increase of anti-HBs titers was significantly higher after the test (P<0.05). The percentage of Th17 cells decreased significantly in each group after the test. There was significant difference between the four groups (P<0.05). There was no significant difference in the percentage of Treg cells between these groups after the test (P>0.05). There was a significant positive correlation between the increase of -HBs and decline of Th17 (r=0.276, P=0.002) but no correlation with Treg changes was observed. Such biochemical parameters as blood routine, urine routine and liver function were not significantly different after the study.Conclusion For liver transplant recipients, it is safe and feasible to construct anti-hepatitis B active immunity via proper inoculation with hepatitis B vaccines. The lower expression of Th17 cells may promote the immune construction against hepatitis B and Treg cells seem to have no effect on the construction.