心理干预治疗对慢乙肝患者免疫功能影响的临床研究

发布时间：2018-05-14 11:10

本文选题：乙型肝炎 + 干扰素α　；参考：《山东大学》2008年硕士论文

【摘要】： 背景: 乙肝病毒的持续感染是乙型肝炎慢性化的主要原因,并促使乙型肝炎发展成为肝硬化和肝细胞癌。因此进行抗病毒治疗,最大限度的长期抑制或消除乙型肝炎病毒,减轻肝细胞炎症坏死及其所导致的肝纤维化,对于减少肝硬化、原发性肝癌及其并发症的发生,非常重要。干扰素、核苷类药物抗乙肝病毒治疗的疗效有限,而且其疗效的发挥在很大程度上还要依赖患者自身的免疫状态,因此患者自身的免疫状态在抗病毒治疗中处于十分重要的地位。但有关这方面的研究还很缺乏。由于社会的歧视、经济的压力、身体的不适,绝大多数乙肝患者承受着来自身、心方面的巨大压力,严重影响着患者自身的免疫状态,这对抗病毒治疗非常不利。现已有报道,心理干预治疗可以提高肿瘤患者的免疫功能,但心理干预治疗是否可以提高慢乙肝患者免疫功能,国内尚无有关研究,需进行探索。目的: 探讨心理干预治疗后患者心境是否有改善,继而能否提高慢乙肝患者细胞免疫功能,患者体内CD8+T淋巴细胞、NK细胞数量是否有增加、活性是否增强、血清干扰素α浓度是否增加等。方法: 济南市传染病医院2007年至2008年住院的慢性乙型肝炎患者共62人,心理干预组患者32人,对照组患者30人。对治疗组患者定期进行心理干预,每周3次,指导患者正确的思维方法、行为方法、心理状态,疗程8周,同时采用保肝治疗及核苷类药物抗病毒治疗。对照组患者仅采用保肝治疗及核苷类药物抗病毒治疗。用BFS心境量表对所有患者治疗前后心境状态进行评估。采用流式细胞术对所有患者治疗前后外周血CD8+T淋巴细胞、NK细胞百分比及其活化抗原CD69、HLA-DR百分比进行检测;采用ELLISA法检测治疗前后患者体内血清干扰素α浓度;观察患者治疗前后HBV血清学指标及HBV DNA定量的变化。结果 (1)心境量表分析显示:心理干预组患者治疗后活跃性、愉悦性、平静性计分升高,治疗前后差异显著(P＜0.05);愤怒性、抑郁性、无活力性计分于治疗后下降,治疗前后差异显著(P＜0.05);心理干预治疗前后患者激动性、思量性计分差异不显著(P＞0.05);对照组患者活跃性、愉悦性、平静性、思量性、激动性、愤怒性、抑郁性、无活力性计分治疗前后差异均不显著(P＞0.05)。 (2)CD8+T淋巴细胞、NK细胞分析显示:心理干预组患者治疗后CD8+T淋巴细胞百分比、NK细胞百分比增加,但治疗前后差异不显著(P＞0.05);对照组患者治疗后CD8+T淋巴细胞百分比、NK细胞百分比降低,治疗前后差异显著(P＜0.05);两组患者治疗后结果相比较,心理干预组CD8+T淋巴细胞百分比、NK细胞百分比显著高于对照组(P＜0.05)。 (3)CD8+T淋巴细胞HLA-DR、CD69以及NK细胞HLA-DR分析显示:心理干预组患者治疗后CD8+T淋巴细胞HLA-DR百分比、NK细胞HLA-DR百分比均显著高于治疗前水平(P＜0.05);对照组患者CD8+T淋巴细胞HLA-DR百分比、NK细胞HLA-DR百分比均显著低于治疗前水平(P＜0.05);两组患者CD8+T淋巴细胞CD69治疗前后百分比均低下,且治疗前后无明显差异(P＞0.05)。 (4)血清干扰素α浓度分析显示:心理干预组患者治疗后血清干扰素α浓度治疗前后差异不显著(P＞0.05);对照组患者血清干扰素α浓度治疗后显著下降(P＜0.05);两组患者治疗后结果相比较,心理干预组患者血清干扰素α浓度显著高于对照组(P＞0.05)。 (5)相关性研究发现愉悦性、平静性计分与CD8+T细胞HLA-DR百分比、NK细胞HLA-DR百分比、血清干扰素α浓度均呈正相关;平静性计分与NK细胞百分比呈正相关;愤怒性、抑郁性、无活力性计分与CD8+T细胞HLA-DR百分比呈负相关;抑郁性、无活力性计分与NK细胞百分比呈负相关;愤怒性、抑郁性计分与NK细胞HLA-DR百分比呈负相关。 (6)HBV血清学指标及HBV DNA定量显示:心理干预组患者治疗后HBeAg下降的幅度显著高于对照组(P＜0.05),两组患者HBV DNA下降的幅度无明显差异(P＞0.05)。结论: (1)心理干预治疗可以改善患者的心境状态,提高患者良性情绪(活跃性、愉悦性、平静性);降低患者负性情绪(愤怒性、抑郁性、无活力性)。 (2)患者心境改善后CD8+T淋巴细胞及其HLA-DR百分比增加,NK细胞百分比及其HLA-DR百分比增加,血清干扰素α浓度增加,患者细胞免疫功能增强。 (3)患者良性情绪(活跃性、愉悦性、平静性)与细胞免疫呈正相关,负性情绪(愤怒性、抑郁性、无活力性)与细胞免疫呈负相关。 (4)心理干预组患者治疗后HBeAg下降的幅度显著高于对照组,心理干预治疗可有效协助抗乙肝病毒治疗。
[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.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R512.62;R395.5

【参考文献】