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中华危重症医学杂志(电子版) ›› 2023, Vol. 16 ›› Issue (06) : 501 -509. doi: 10.3877/cma.j.issn.1674-6880.2023.06.011

综述

T细胞耗竭在乙型肝炎病毒相关疾病中的研究进展
贾文浩, 宋静娟, 马义磊, 张钧, 崔大伟()   
  1. 310000 杭州,浙江大学医学院附属邵逸夫医院检验科、医学精准检验与监测研究实验室
    310003 杭州,浙江大学医学院附属第一医院输血科
  • 收稿日期:2023-08-17 出版日期:2023-12-31
  • 通信作者: 崔大伟
  • 基金资助:
    国家自然科学基金项目(81871709)
  • Received:2023-08-17 Published:2023-12-31
引用本文:

贾文浩, 宋静娟, 马义磊, 张钧, 崔大伟. T细胞耗竭在乙型肝炎病毒相关疾病中的研究进展[J]. 中华危重症医学杂志(电子版), 2023, 16(06): 501-509.

乙型肝炎病毒(hepatitis B virus,HBV)感染是全球公共卫生面临的最大威胁之一,尽管有预防性疫苗,但每30秒就有一人死于HBV相关性疾病[1]。世界卫生组织的资料显示,全球约有2.57亿人患有慢性乙型肝炎(chronic hepatitis B,CHB),但这数字普遍被认为是低估的,且CHB与肝硬化、肝细胞癌(hepatocellular carcinoma,HCC)和肝纤维化等发生发展密切相关[2-3]。HBV感染后,部分患者能够产生有效的T细胞应答,清除病毒,但多数患者不能完全清除病毒,从而进入慢性感染状态,这与HBV能通过多种机制来抑制或损伤T细胞数量和功能以及介导T细胞耗竭密切相关[4]。T细胞耗竭是CHB患者一个重要的T细胞免疫特征,这与T细胞无能和衰老不同[5]。HBV特异性T细胞耗竭是指在持续高病毒载量和高抗原水平刺激下,T细胞逐渐丧失效应功能且记忆性T细胞特征分子也不断丢失,而免疫抑制性分子(也称耗竭分子)的表达增加,包括细胞程序性死亡受体1(programmed death receptor-1,PD-1)、细胞毒性T淋巴细胞抗原4(cytotoxic T-lymphocyte-associated antigen-4,CTLA-4)、淋巴细胞激活基因3(lymphocyte-activation gene-3,LAG-3)以及T细胞免疫球蛋白和黏蛋白结构域3(T-cell immunoglobulin and mucin domain-3,TIM-3)等,炎症细胞因子产生减少如白细胞介素2(interleukin-2,IL-2)、肿瘤坏死因子α(tumor necrosis factor-alpha,TNF-α)和干扰素γ(interferon-gamma,IFN-γ)等。此外,HBV患者中关键调节细胞如髓源性抑制细胞(myeloid-derived suppressor cells,MDSCs)和调节性T细胞(regulator T cell,Treg)及其产生的免疫抑制性细胞因子如IL-10和转化生长因子β(transforming growth factor-beta,TGF-β)等能够加剧HBV特异性T细胞耗竭[6]。研究表明,应用抗细胞程序性死亡-配体1(programmed cell death 1 ligand 1,PD-L1)抗体阻断PD-1/PD-L1通路后,CHB患者中耗竭的CD8+T细胞和CD4+T细胞功能得到有效逆转,IFN-γ的表达水平显著升高[7]。这些研究表明,HBV感染导致机体中免疫抑制性分子的表达水平显著上调,T细胞耗竭增加,而阻断免疫抑制性分子通路是逆转T细胞耗竭从而恢复T细胞功能的一种潜在有效的免疫新策略。阻断免疫抑制性分子通路能够有效地发挥抗肿瘤作用,这已得到有效证实并应用于临床。虽然T细胞耗竭的关键转录分子仍有待深入研究,但近期研究发现某些转录因子与T细胞耗竭密切有关,如转录因子B淋巴细胞诱导的成熟蛋白1(B lymphocyte-induced maturation protein-1,Blimp-1)、胸腺高迁移率族蛋白(thymocyte selection-associated high mobility group box protein,TOX)、T细胞因子1(T cell factor-1,TCF-1)以及活化T细胞核因子2(nuclear factor of activated T cell 2,NFAT2)能够在慢性病毒感染期间调节T细胞耗竭[8-9]。本研究就T细胞耗竭在HBV感染中的最新研究进展作一综述,为HBV的防治提供新的免疫治疗策略。

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