Analysis of immune-regulatory cell functions in patients with chronic active hepatitis

慢性活动性肝炎（CAH）的特点是门静脉周围淋巴细胞浸润伴肝细胞坏死（片状坏死）和循环中存在针对肝脏的自身抗体。因此，免疫调节系统的紊乱，特别是对肝脏的紊乱，一直被认为在发病机制中起作用，但其性质尚不清楚。为了澄清这一点，我们对12例CAH患者在皮质类固醇治疗前后进行了8周的外周血T淋巴细胞功能检测。经治疗，6例患者的临床症状和实验室数据均有明显改善，因此将这6例患者定义为皮质类固醇治疗有效组。另外6名患者没有表现出特别的改善，被归类为无效组。在皮质类固醇治疗前，抑制性T细胞的活性在皮质类固醇治疗有效组和无效组均明显低于对照组。同时，与对照组相比，两个CAH组的T淋巴细胞对白细胞介素-2（IL-2）的反应较低。然而，值得注意的是，当患者接受皮质类固醇治疗后，减少的T淋巴细胞功能恢复到正常范围，临床得到改善。相反，在无效组中，即使在皮质类固醇治疗后，T淋巴细胞功能也没有恢复。当在强的松龙存在的情况下测试预处理T淋巴细胞的活性或反应时，T淋巴细胞功能的改善也仅在皮质固醇油有效组中观察到。因此，可以想象，在CAH中，T淋巴细胞的功能反映了疾病的活动性。循环T细胞产生的IL-2也被测试，发现在两个CAH组是正常的。然而，患者循环巨噬细胞中前列腺素E的产生率较低。这些结果表明，T淋巴细胞功能的紊乱在CAH的发病机制中起着重要作用，因此皮质类固醇对CAH的作用至少部分是由于T淋巴细胞功能的免疫调节。少

Chronic active hepatitis(CAH) is characterized by periportal lymphocyte infiltration with hepatic cell necrosis(piecemeal necrosis) and the presence of circulating autoantibodies against the liver. Therefore, the disturbance in immune-regulatory system, in particular aginst the liver, has been thought to play a role in the pathogenesis, but its nature remains unknown. To clarify this, the function of T lymphocytes in the peripheral blood was tested in 12 patients with CAH both before and after the corticosteriod theraphy for 8 weeks. By the therapy, six patients had a clear improvements in the clinical symptoms and laboratory data, thus it was defined these six as a corticosteroid theraphy-effective group. Other six patients showed no particular improvements, and were classified as an ineffective group.Before the corticosteroid therapy, the activity of suppressor T cell was found to be significantily lower in both the corticosteroid therapy-effective and ineffective groups than in heal … More thy controls. Concomitantly, the responce in T lymphocytes to interleukin-2(IL-2) was low in the two CAH groups as compared with controls. It is noteworthy, however, that the reduced T lymphocyte functions returned to the normal range when the patients were treated with the corticosteroid administration and had the clinical improvement. By contast, in the ineffective group, no recovery of the T lymphocyte functions was observed even after the corticosteroid therapy. The improvement in the T lymphocyte functions was also observed only in the corticosteroil-effective group when the activity or responce was tested in the pretreated T lymphocytes in the presence of prednisolone. Thus, it is conceivable that in CAH, T lymphocyte function reflects to the activity of the disease.The production of IL-2 by the circutating T lumphocytes was also tested and found to be normal in both CAH groups. However, the production rate of prostaglandin E in the circulating macrophages was low in the patients. These results suggest that the disturbance in the T lymphocyte function plays a significant role in the pathogenesis of CAH thus the corticosteroid effect in CAH is due, at least in part, to an immunomodulation in T luymphocyte function. Less