本文選題：乙型肝炎 + 干擾素α��； 參考：《山東大學(xué)》2008年碩士論文

【摘要】： 背景: 乙肝病毒的持續(xù)感染是乙型肝炎慢性化的主要原因,并促使乙型肝炎發(fā)展成為肝硬化和肝細(xì)胞癌。因此進(jìn)行抗病毒治療,最大限度的長期抑制或消除乙型肝炎病毒,減輕肝細(xì)胞炎癥壞死及其所導(dǎo)致的肝纖維化,對(duì)于減少肝硬化、原發(fā)性肝癌及其并發(fā)癥的發(fā)生,非常重要。干擾素、核苷類藥物抗乙肝病毒治療的療效有限,而且其療效的發(fā)揮在很大程度上還要依賴患者自身的免疫狀態(tài),因此患者自身的免疫狀態(tài)在抗病毒治療中處于十分重要的地位。但有關(guān)這方面的研究還很缺乏。由于社會(huì)的歧視、經(jīng)濟(jì)的壓力、身體的不適,絕大多數(shù)乙肝患者承受著來自身、心方面的巨大壓力,嚴(yán)重影響著患者自身的免疫狀態(tài),這對(duì)抗病毒治療非常不利�，F(xiàn)已有報(bào)道,心理干預(yù)治療可以提高腫瘤患者的免疫功能,但心理干預(yù)治療是否可以提高慢乙肝患者免疫功能,國內(nèi)尚無有關(guān)研究,需進(jìn)行探索。 目的: 探討心理干預(yù)治療后患者心境是否有改善,繼而能否提高慢乙肝患者細(xì)胞免疫功能,患者體內(nèi)CD8+T淋巴細(xì)胞、NK細(xì)胞數(shù)量是否有增加、活性是否增強(qiáng)、血清干擾素α濃度是否增加等。 方法: 濟(jì)南市傳染病醫(yī)院2007年至2008年住院的慢性乙型肝炎患者共62人,心理干預(yù)組患者32人,對(duì)照組患者30人。對(duì)治療組患者定期進(jìn)行心理干預(yù),每周3次,指導(dǎo)患者正確的思維方法、行為方法、心理狀態(tài),療程8周,同時(shí)采用保肝治療及核苷類藥物抗病毒治療。對(duì)照組患者僅采用保肝治療及核苷類藥物抗病毒治療。用BFS心境量表對(duì)所有患者治療前后心境狀態(tài)進(jìn)行評(píng)估。采用流式細(xì)胞術(shù)對(duì)所有患者治療前后外周血CD8+T淋巴細(xì)胞、NK細(xì)胞百分比及其活化抗原CD69、HLA-DR百分比進(jìn)行檢測;采用ELLISA法檢測治療前后患者體內(nèi)血清干擾素α濃度;觀察患者治療前后HBV血清學(xué)指標(biāo)及HBV DNA定量的變化。 結(jié)果 (1)心境量表分析顯示:心理干預(yù)組患者治療后活躍性、愉悅性、平靜性計(jì)分升高,治療前后差異顯著(P＜0.05);憤怒性、抑郁性、無活力性計(jì)分于治療后下降,治療前后差異顯著(P＜0.05);心理干預(yù)治療前后患者激動(dòng)性、思量性計(jì)分差異不顯著(P＞0.05);對(duì)照組患者活躍性、愉悅性、平靜性、思量性、激動(dòng)性、憤怒性、抑郁性、無活力性計(jì)分治療前后差異均不顯著(P＞0.05)。 (2)CD8+T淋巴細(xì)胞、NK細(xì)胞分析顯示:心理干預(yù)組患者治療后CD8+T淋巴細(xì)胞百分比、NK細(xì)胞百分比增加,但治療前后差異不顯著(P＞0.05);對(duì)照組患者治療后CD8+T淋巴細(xì)胞百分比、NK細(xì)胞百分比降低,治療前后差異顯著(P＜0.05);兩組患者治療后結(jié)果相比較,心理干預(yù)組CD8+T淋巴細(xì)胞百分比、NK細(xì)胞百分比顯著高于對(duì)照組(P＜0.05)。 (3)CD8+T淋巴細(xì)胞HLA-DR、CD69以及NK細(xì)胞HLA-DR分析顯示:心理干預(yù)組患者治療后CD8+T淋巴細(xì)胞HLA-DR百分比、NK細(xì)胞HLA-DR百分比均顯著高于治療前水平(P＜0.05);對(duì)照組患者CD8+T淋巴細(xì)胞HLA-DR百分比、NK細(xì)胞HLA-DR百分比均顯著低于治療前水平(P＜0.05);兩組患者CD8+T淋巴細(xì)胞CD69治療前后百分比均低下,且治療前后無明顯差異(P＞0.05)。 (4)血清干擾素α濃度分析顯示:心理干預(yù)組患者治療后血清干擾素α濃度治療前后差異不顯著(P＞0.05);對(duì)照組患者血清干擾素α濃度治療后顯著下降(P＜0.05);兩組患者治療后結(jié)果相比較,心理干預(yù)組患者血清干擾素α濃度顯著高于對(duì)照組(P＞0.05)。 (5)相關(guān)性研究發(fā)現(xiàn)愉悅性、平靜性計(jì)分與CD8+T細(xì)胞HLA-DR百分比、NK細(xì)胞HLA-DR百分比、血清干擾素α濃度均呈正相關(guān);平靜性計(jì)分與NK細(xì)胞百分比呈正相關(guān);憤怒性、抑郁性、無活力性計(jì)分與CD8+T細(xì)胞HLA-DR百分比呈負(fù)相關(guān);抑郁性、無活力性計(jì)分與NK細(xì)胞百分比呈負(fù)相關(guān);憤怒性、抑郁性計(jì)分與NK細(xì)胞HLA-DR百分比呈負(fù)相關(guān)。 (6)HBV血清學(xué)指標(biāo)及HBV DNA定量顯示:心理干預(yù)組患者治療后HBeAg下降的幅度顯著高于對(duì)照組(P＜0.05),兩組患者HBV DNA下降的幅度無明顯差異(P＞0.05)。 結(jié)論: (1)心理干預(yù)治療可以改善患者的心境狀態(tài),提高患者良性情緒(活躍性、愉悅性、平靜性);降低患者負(fù)性情緒(憤怒性、抑郁性、無活力性)。 (2)患者心境改善后CD8+T淋巴細(xì)胞及其HLA-DR百分比增加,NK細(xì)胞百分比及其HLA-DR百分比增加,血清干擾素α濃度增加,患者細(xì)胞免疫功能增強(qiáng)。 (3)患者良性情緒(活躍性、愉悅性、平靜性)與細(xì)胞免疫呈正相關(guān),負(fù)性情緒(憤怒性、抑郁性、無活力性)與細(xì)胞免疫呈負(fù)相關(guān)。 (4)心理干預(yù)組患者治療后HBeAg下降的幅度顯著高于對(duì)照組,心理干預(yù)治療可有效協(xié)助抗乙肝病毒治療。
[Abstract]:Background:
The persistent infection of hepatitis B virus is the main cause of chronic hepatitis B and promotes the development of hepatitis B to become liver cirrhosis and hepatocellular carcinoma. Therefore, antiviral therapy has been carried out to minimize or eliminate hepatitis B virus, reduce inflammation and necrosis of liver cells and lead to liver fibrosis, and to reduce liver cirrhosis and primary liver disease. The occurrence of liver cancer and its complications is very important. The effect of interferon and nucleoside on the treatment of HBV is limited, and its efficacy depends on the immune state of the patient to a large extent, so the immune state of the patient is very important in the antiviral treatment. Because of social discrimination, economic pressure and physical discomfort, the overwhelming majority of patients with hepatitis B suffer from the great pressure on themselves and heart, which seriously affect the immune state of the patients themselves, which is very unfavorable to the treatment of the virus. Whether pretreatment can improve the immune function of patients with chronic hepatitis B has not been studied in China.
Objective:
Whether the mental state of the patients after psychological intervention is improved, then whether the cell immune function of the patients with chronic hepatitis B can be improved, the number of CD8+T lymphocyte, the number of NK cells in the patient's body is increased, the activity is enhanced, and the concentration of serum interferon alpha is increased.
Method:
There were 62 patients with chronic hepatitis B hospitalized in Jinan Infectious Disease Hospital from 2007 to 2008, 32 in the psychological intervention group and 30 in the control group. The patients in the treatment group were regularly intervened with psychological intervention, 3 times a week to guide the patient's correct thinking method, behavior method, psychological state, and the course of treatment for 8 weeks. Meanwhile, liver preservation treatment and nucleoside drugs were used. Antiviral therapy. The patients in the control group were treated with only liver preservation and nucleoside antiviral therapy. The mood state of all patients before and after treatment was evaluated with the BFS mood scale. Flow cytometry was used to detect the percentage of CD8+T lymphocyte, the percentage of NK cells, the percentage of activated antigen CD69, and the percentage of HLA-DR before and after treatment. ELLISA method was used to detect serum interferon alpha concentration before and after treatment, and the changes of HBV serological indexes and HBV DNA before and after treatment were observed.
Result
(1) the mood scale analysis showed that the patients in the psychological intervention group had a significant difference (P < 0.05) before and after treatment (P < 0.05), and the difference was significant (P < 0.05) before and after treatment (P < 0.05). > 0.05): the control group had no significant difference (P > 0.05) before and after the treatment of activity, pleasure, calmness, thought, excitement, anger and depression.
(2) CD8+T lymphocyte and NK cell analysis showed that the percentage of CD8+T lymphocytes and the percentage of NK cells increased after treatment in the psychological intervention group, but the difference was not significant before and after treatment (P > 0.05). The percentage of CD8+T lymphocytes in the control group decreased and the percentage of NK cells decreased significantly (P < 0.05) before and after treatment (P < 0.05); the two groups were treated after treatment. Compared with the control group, the percentage of CD8+T lymphocytes and the percentage of NK cells in the psychological intervention group were significantly higher than those in the control group (P < 0.05).
(3) the HLA-DR analysis of HLA-DR, CD69 and NK cells in CD8+T lymphocytes showed that the percentage of CD8+T lymphocyte HLA-DR and the percentage of HLA-DR in NK cells were significantly higher than those before treatment (P < 0.05) in the intervention group (P < 0.05), and the percentage of CD8+T lymphocyte HLA-DR in the control group was significantly lower than that before the treatment (0. 05); the percentages of CD8+T lymphocyte CD69 before and after treatment in the two groups were all low, and there was no significant difference before and after treatment (P > 0.05).
(4) the serum interferon alpha concentration analysis showed that the serum interferon alpha concentration of the patients in the psychological intervention group was not significant before and after treatment (P > 0.05), and the serum interferon alpha concentration in the control group was significantly decreased after treatment (P < 0.05). The serum interferon alpha concentration in the two groups was significantly higher than that of the control group. Group (P > 0.05).
(5) the correlation study found that pleasure, calm score and the percentage of HLA-DR in CD8+T cells, the percentage of HLA-DR in NK cells, and the concentration of interferon alpha in the serum were positively correlated; the calmness score was positively correlated with the percentage of NK cells; the percentage of anger, depressive, non active and HLA-DR was negatively correlated with the percentage of HLA-DR in CD8+T cells; depressive and inactive score There was a negative correlation between the percentage of NK cells and the percentage of HLA-DR cells, and the correlation between anger and depression scores and NK cell percentage was negatively correlated.
(6) the HBV serological index and HBV DNA showed that the decrease of HBeAg in the psychological intervention group was significantly higher than that in the control group (P < 0.05), and there was no significant difference between the two groups (P > 0.05).
Conclusion:
(1) psychological intervention can improve the state of the patient's mood and improve the benign mood (activity, pleasure and calmness) of the patient, and reduce the negative emotion (anger, depressive, inactive) of the patient.
(2) the percentage of CD8+T lymphocyte and its HLA-DR increased, the percentage of NK cells and its percentage of HLA-DR increased, the concentration of serum interferon alpha was increased, and the cellular immune function of the patients was enhanced.
(3) positive emotions (activity, pleasure, and calmness) were positively correlated with cellular immunity, negative emotions (anger, depressive, inactive) were negatively correlated with cellular immunity.
(4) the rate of HBeAg decline in the psychological intervention group was significantly higher than that in the control group after treatment. Psychological intervention therapy can effectively assist in the treatment of anti HBV.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R512.62;R395.5

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