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摘要：
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摘要：目的 探讨孕中晚期乙型肝炎病毒（hepatitis B virus，HBV）感染孕妇外周血T细胞亚群的变化
及临床意义。方法 选取2017年11月至2019年5月于哈尔滨医科大学附属第四医院就诊的150例孕中晚
期（孕周≥ 24周）HBV感染孕妇为研究对象，其中慢性HBV携带孕妇135例，慢性乙型肝炎（chronic
hepatitis B，CHB）孕妇15例，另选取20例同期健康体检的孕中晚期孕妇为健康对照组。采用流式细
胞术检测所有研究对象外周血中T细胞亚群百分比，比较慢性HBV感染组、CHB组及健康对照组孕
妇外周血中T细胞亚群百分比的差异。根据HBV DNA载量，将慢性HBV感染组孕妇分为中高病毒载
量组（HBV DNA ≥ 10 4 IU/ml）和低病毒载量组（HBV DNA ＜ 1.0 × 10 4 IU/ml），比较中高病毒载
量组、低病毒载量组和健康对照组间T细胞亚群百分比的差异。根据乙型肝炎病毒e抗原（hepatitis B
virus e antigen，HBeAg）状态，将慢性HBV感染组孕妇分为HBeAg阳性组和HBeAg阴性组，比较两
组间T细胞亚群百分比的差异。结果 CHB组、慢性HBV感染组及健康对照组孕妇外周血CD4 + T细胞百分比
[（30.4 ± 3.9）% vs（36.5 ± 5.1）% vs（39.5 ± 4.2）%]、CD8 + T细胞百分比[（38.9 ± 4.3）% vs（35.7 ± 5.8）%
vs（32.9 ± 3.7）%]及CD4 + /CD8 + 比值（0.7 ± 0.1 vs 1.0 ± 0.2 vs 1.2 ± 0.1）差异均有统计学意义（F值分
别为14.579、5.115、14.029，P均＜ 0.05），CD3 + T细胞百分比[（70.8 ± 6.0）% vs（73.3 ± 6.0）% vs
（72.5 ± 6.4）%]差异无统计学意义（F = 1.178，P = 0.310）。与健康对照组相比，CHB组及慢性HBV
感染组CD4 + T细胞百分比及CD4 + /CD8 + 比值显著降低，CD8 + T细胞百分比显著升高（P均＜ 0.05）。与
慢性HBV感染组相比，CHB组CD4 + T细胞百分比及CD4 + /CD8 + 比值显著降低，CD8 + T细胞百分比显著
升高（P均＜ 0.05）。中高病毒载量组、低病毒载量组和健康对照组孕妇CD4 + T细胞百分比[（35.3 ±
4.9）% vs（38.2 ± 4.9）% vs（39.5 ± 4.2）%]、CD8 + T细胞百分比[（36.3 ± 5.9）% vs（34.5 ± 5.3）%
vs（32.9 ± 3.7）%]及CD4 + /CD8 + 比值（0.9 ± 0.2 vs 1.1 ± 0.2 vs 1.2 ± 0.1）差异有统计学意义（F值分
别为8.898、4.555、9.347，P均＜ 0.05），CD3 + T细胞百分比[（73.3 ± 6.2）% vs（73.3 ± 5.9）% vs（72.5 ±
6.4）%）]差异无统计学意义（F = 0.148，P = 0.863）。与低病毒载量组及对照组相比，中高病毒
载量组CD4 + T细胞百分比和CD4 + /CD8 + 比值显著降低，CD8 + T细胞百分比显著升高（P均＜ 0.05）。与
HBeAg阴性组相比，HBeAg阳性组孕妇CD4 + T细胞百分比[（35.4 ± 5.0）% vs（38.0 ± 4.9）%]和CD4 + /
CD8 + 比值（0.9 ± 0.2 vs 1.1 ± 0.2）显著降低（t = -2.981、-3.119，P = 0.003、0.002），CD8 + T细胞
[（36.7 ± 5.9）% vs（34.5 ± 5.4）%]百分比显著升高（t = 2.192，P = 0.030），CD3 + T细胞百分比
[（73.4 ± 5.9）% vs（73.1 ± 6.2）%]差异无统计学意义（t = 0.262，P = 0.794）。结论 妊娠合并HBV感染
相较于健康孕妇外周血中T细胞亚群发生变化，HBV复制、免疫激活可加重细胞免疫功能的紊乱。检测
T细胞亚群在临床上可间接了解HBV感染孕妇的免疫状态，使HBV的作用机制得到进一步明确。
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Abstract: Objective To investigate the changes and clinical significances of T cell subset in pregnant
women infected with hepatitis B virus (HBV) in middle and late pregnancy. Methods Total of 150 pregnant
women infected with HBV in middle and late pregnancy in the Fourth Affiliated Hospital of Harbin Medical
University from November 2017 to May 2019 were selected, including 15 cases with chronic hepatitis B
(CHB) and 135 cases with chronic HBV infection. Another 20 pregnant women in middle and late pregnancy
were selected as healthy controls. Flow cytometry was used to detect the percentage of T cell subsets in
the peripheral blood of all subjects, and the difference of T cell subsets in the peripheral blood of pregnant
women in chronic HBV infection group, CHB group and healthy control group were compared. According
to HBV DNA load, pregnant women in chronic HBV infection group were divided into medium and high
viral load group (HBV DNA ≥ 10 4 IU/ml) and low viral load group (HBV DNA ＜ 1.0 × 10 4 IU/ml), and
the difference of T cell subpopulation percentage was compared. According to the state of hepatitis B virus
e antigen (HBeAg), pregnant women in chronic HBV infection group were divided into HBeAg positive
group and HBeAg negative group, and the difference of T cell subpopulation percentage between the two
groups was compared. Results The differences of CD4 + T cells percentage [(30.4 ± 3.9)% vs (36.5 ± 5.1)% vs
(39.5 ± 4.2)%], CD8 + T cells percentage [(38.9 ± 4.3)% vs (35.7 ± 5.8)% vs (32.9 ± 3.7)%] and CD4 + /CD8 + ratio (0.7 ±
0.1 vs 1.0 ± 0.2 vs 1.2 ± 0.1) of pregnant women in CHB group, chronic HBV infection group and healthy control
group were statistically significant (F = 14.579, 5.115, 14.029; all P ＜ 0.05), and the difference of CD3 + T cells
percentages [(70.8 ± 6.0)% vs (73.3 ± 6.0)% vs (72.5 ± 6.4)%] were not statistically significant (F = 1.178, P =
0.310). Compared with those in healthy control group, the percentage of CD4 + T cells and the ratio of CD4 + /
CD8 + of patients in CHB group and chronic HBV infected group decreased significantly, while the percentage
of CD8 + T cells increased significantly (all P ＜ 0.05). Compared with those in chronic HBV infection group,
the percentage of CD4 + T cells and the ratio of CD4 + /CD8 + of patients in CHB group reduced significantly,
and the percentage of CD8 + T cells increased significantly (all P ＜ 0.05). The differences of CD4 + T cells
percentage [(35.3 ± 4.9)% vs (38.2 ± 4.9)% vs (39.5 ± 4.2)%], CD8 + T cells percentage [(36.3 ± 5.9)%
vs (34.5 ± 5.3)% vs (32.9 ± 3.7)%] and CD4 + /CD8 + ratio (0.9 ± 0.2 vs 1.1 ± 0.2 vs 1.2 ± 0.1) of patients in
medium and high viral load group, low viral load group and healthy control group were statistically significant
(F = 8.898, 4.555, 9.347; P ＜ 0.05), and the difference of CD3 + T cells percentage was not statistically
significant (F = 0.148, P = 0.863). Compared with medium and high viral load group and healthy control
group, the percentage of CD4 + T cells and CD4 + /CD8 + ratio decreased significantly, the percentage of CD8 + T
cells increased significantly (all P ＜ 0.05). Compared with patients in HBeAg negative group, the percentage of
CD4 + T [(35.4 ± 5.0)% vs (38.0 ± 4.9)%] cells and CD4 + /CD8 + (0.9 ± 0.2 vs 1.1 ± 0.2) ratio of patients in
HBeAg positive group decreased significantly (t = -2.981, -3.119; P = 0.003, 0.002), and the percentage
of CD8 + T cells [(36.7 ± 5.9)% vs (34.5 ± 5.4)%] increased significantly (t = 2.192, P = 0.030). There was
no statistically significant difference of CD3 + T cells percentage of patients between HBeAg positive group
and HBeAg negative group [(73.4 ± 5.9)% vs (73.1 ± 6.2)%; t = 0.262, P = 0.794]. Conclusions Compared
with healthy pregnant women, the T cell subsets in peripheral blood changed in pregnant women with HBV
infection. HBV replication and immune activation can aggravate the disorder of cellular immune function.
Detection of T cell subset can indirectly understand the immune function status of pregnant women with HBV
infection, and furtherlly clarify the mechanisms of HBV action.
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