Hepati̇t b olan çocuklarda çeşi̇tli̇ tedavi̇ler i̇le bağişikli si̇stemi̇ olan i̇li̇şki̇si̇

Chronic hepatitis B that has spesific clinical, biochemical, serologic and histopathologic charecteristics is a long term (at least six month) inflammatuar disease of the liver. It is strongly suggested Immunity plays a key role in chronicity of the disease. Ninety three patients (59 males and 34 female) diagnosed as having chronic hepatitis B, aged between 2-18 years were studied. In this study, the relationship between two immunomodulator drugs, levamisole and HBsAg vaccine, which are used in child patients with Chronic hepatitis B, and the immune response to these drugs (as well as how some of the immune parameters can be affected quantitatively) including viral replication were investigated. The lymphocyte subgroups; CD3, CD19, CD4, CD8, CD4/CD8, CD16/56, serum immunoglobulins; IgG, IgA, IgM and complement components; C3, C4 and HBV DNA, HBV markers, serum ALT, AST were assessed by using flow cytometric methods, nephelometric method, microcolon DNA probe RIA (Abbot) and ELISA, Olympus AU 800 autoanalyzer, respectively. Before treatment the quantitative investigation results of immunological parameters of 93 patients were as follows; of the patients, absolute lymphocyte in %6,04, total T lymphocyte (CD3) in %12,8, total B lymphocyte (CD19) in %22.5, helper T lymphocyte (CD4), in %3,22, cytotoxic/supressor T lymphocyte (CD8) in %2,15 and natural killer lymphocyte in %6,04 were found to be below than their age matched controls. While the same values were 3,22%- 3,22%- 13,9%- 0,9%- 0% and 0% respectively, after treatment. The increase seen in levamisole and/or vaccine groups in absolute lymphocyte count, absolute CD19 and absolute CD16/56 were not statistically significant (p>0,05). However, the treatment in all groups seemed to be effective in increasing the absolute CD3 count (p<0,05). The vaccine was found to increase CD4 subset in patients while it caused a decrease in CD8 subset in with choronic active hepatitis 13 patients (p<0,05), but levamisole showed no effect in the same patients group. Two patients' serum IgM levels were below the standart deviation of normals. This condition remained unchanged after treatment. The treatment of levamisole and/or vaccine had no effect on C3 levels while they leaded to a decrease in C4 levels. The study suggested that levamisole and/or vaccine had an important effect in the loss of HBeAg antigen (34%), in occurence of anti•HBe antibody (25%) and in the normalization ALT levels (28%) while these drugs result in marked elevation in HBV DNA levels As in conclusion, the patients with choronic hepatitis B possess quantitative deficiencies in the immune parameters investigated. Levamisole and/or HBV vaccine is likely to be very effective in the normalization immune status in some of the patients. while levamisole does not exert a substantive effect on T-helper (CD4) and cytotoxic T lymphocytes (CD8) which eventually participates in the clearence and persistance of HBV, vaccination with HBV gives rise to substantial in increase in CD4 T lymphocytes and to decrease CD8 T subsets. Key word: HBV, immune parameters, lymphocyte subpopulation, levamisole, HBsAg vaccine