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摘要：
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摘要：目的 观察替诺福韦酯抗病毒经治乙型肝炎和乙型肝炎肝硬化患者血清免疫球蛋白IgG、
IgA、IgM和补体C3、C4的变化，探讨替诺福韦酯治疗对于患者体液免疫功能的影响。方法 选取
2017年1月至2017年9月于兰州军区总医院安宁分院就诊的慢性乙型肝炎患者（31例）和乙型肝
炎肝硬化患者（19例）为研究对象，所有患者均给予替诺福韦酯（300 mg口服，1次/ d）抗病毒
治疗。于治疗前、治疗3个月和治疗6个月采集血液标本，采用免疫透视比浊法检测血清免疫球
蛋白IgG、IgA、IgM和补体C3、C4水平，并进行统计分析。结果 慢性乙型肝炎组患者血清IgG、
IgA、IgM和C4水平在治疗3个月和6个月与治疗前相比，差异均有统计学意义（P均＜ 0.05），
C3水平差异无统计学意义（P ＞ 0.05）；治疗6个月时血清IgG、IgA和IgM水平显著低于治疗3个
月（P均＜ 0.05），血清C3和C4水平差异无统计学意义（P均＞ 0.05）。肝硬化组患者血清IgG、
IgA、IgM和C4水平在治疗3个月时与治疗前相比，差异均有统计学意义（P均＜ 0.05），C3水平
差异无统计学意义（P ＞ 0.05）；治疗后6个月与治疗前相比，IgG、IgA、IgM、C3和C4水平差
异有统计学意义（P均＜ 0.05）；治疗6个月和3个月相比血清IgG显著下降（P均＜ 0.05），血
清IgA、IgM、C3和C4水平差异无统计学意义（P均＞ 0.05）。Child Pugh B级肝硬化患者较Child
Pugh A级患者各指标变化更显著，差异有统计学意义（P ＜ 0.05）。结论 经替诺福韦酯抗病毒治
疗后，慢性乙型肝炎患者和乙型肝炎肝硬化患者血清免疫球蛋白IgG、IgA、IgM和补体C3、C4
水平均有不同程度的恢复。
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Abstract: Objective To observe the alteration of serum immunoglobulin (IgG, IgA, IgM) and complement
(C3, C4) in patients with chronic hepatitis B and hepatitis B cirrhosis after treatment with tenofovir
diphosphate, and to investigate the effects of tenofovir diphosphate on humoral immunity of the patients.
Methods Total of 31 cases with chronic hepatitis B and 19 cases with hepatitis B cirrhosis in Anning Branch
of General Hospital, Lanzhou Military Command from January 2017 to September 2017 were selected.
The patients were all treated with tenofovir diphosphate orally (300 mg, one time per day). Blood samples
were collected before treatment, 3 months after treatment and 6 months after treatment. The levels of serum
immunoglobulin (IgG, IgA and IgM) and complement (C3 and C4) were detected by immuno-fluoroscopy
turbidimetric method, and statistical analysis was carried out. Results The serum levels of IgG, IgA, IgM
and C4 of patients with chronic hepatitis B after treatment for 3 months and 6 months were significantly
different from those before treatment (P ＜ 0.05), however, there was no significant difference in C3 levels (P ＞
0.05). The levels of serum IgG, IgA and IgM of patients with chronic hepatitis B after treatment for 3 months were
significantly lower than those after treatment for 6 months (P ＜ 0.05). There were no significant differences in serum
C3 and C4 levels (P ＞ 0.05). The serum levels of IgG, IgA, IgM and C4 of patients with hepatitis B cirrhosis after
treatment for 3 months were significantly different from those before treatment (P ＜ 0.05), however, there was no
significant difference in C3 levels (P ＞ 0.05). After treatment for 6 months, the levels of IgG, IgA, IgM, C3 and C4
were significantly different from those before treatment (P ＜ 0.05). Compared with treatment for 3 months, serum
levels of IgG decreased significantly at 6 months (P ＜ 0.05), and there were no significant differences in serum
IgA, IgM, C3 and C4 levels (P ＞ 0.05). The changes of the above indexes in cirrhosis patients with Child Pugh
B grade were significant higher than those with Child Pugh A grade (P ＜ 0.05). Conclusions The levels of serum
immunoglobulin (IgG, IgA and IgM) and complement (C3 and C4) in patients with chronic hepatitis B and hepatitis
B cirrhosis recovered in varied degrees after antiviral treatment with tenofovir diphosphate.
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