柴苓汤对慢性乙型肝炎病毒感染不同阶段细胞免疫及病毒清除的影响
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摘要
目的:探讨柴苓汤对慢性乙型肝炎病毒(Hepatitis B virus,HBV)感染不同阶段细胞免疫及病毒清除的影响。方法:选取2015年12月—2017年12月就诊于医院收治慢性HBV感染患者100例随机分为观察组及对照组,对照组:给予拉米呋啶0.1 g,1次/d。观察组:在对照组治疗基础上给予柴苓汤。两组疗程均1年。观察两组:①免疫学指标:淋巴细胞亚群(流式细胞术), IFN-γ、IL-2(ELISA法)。治疗前及治疗后3、6、12月,停药后6个月进行检测。②肝功能指标:ALT、TBIL。治疗前及治疗后1、3、6、12月,停药后3、6个月进行检测。③血清病毒学指标:HBV-DNA(荧光定量法),病毒标志物(乙肝二对半ELISA法)。结果:观察组与对照组治疗前两组差异无统计学差异(P>0.05)。对照组CD~+_4、CD~+_8、CD~+_4/CD~+_8三者在治疗结束6个月后与治疗前相比较差异无统计学意义(P>0.05)。观察组CD~+_8治疗结束6个月后与治疗前相比较差异无统计学意义(P>0.05)。但是CD~+_4、CD~+_4/CD~+_8明显增高,与治疗前及与对照组比较,差异均有统计学意义(P<0.05)。观察组与对照组治疗前IFN-γ、IL-2两组差异无统计学差异(P>0.05)。观察组治疗后及治疗结束6个月后与治疗前相比较明显增高,差异有统计学意义(P<0.05),对照组治疗后及治疗结束6个月后与治疗前差异无统计学差异(P>0.05)。观察组治疗后ALT开始逐渐增高,与3个月开始高于治疗前,且与对照组比较。差异均有统计学意义(P<0.05),治疗6个月后逐渐下降,治疗结束及停药6个月后ALT下降至与治疗前比较差异有统计学差异(P<0.05)。胆红素在两组治疗前后差异无统计学意义(P>0.05)。病毒学指标主要HBV-DNA及HBeAg为主要的指标,观察组总有效率(完全应答和部分应答)为85%。对照组为70%,两者差异有统计学意义(P<0.05)。结论:柴苓汤对慢性HBV感染不同阶段细胞免疫及病毒清除的治疗效果确切,主要还是通过影响免疫小的增殖、分化及成熟,从而提高细胞因子的活性,正向调节免疫能力。
Objective: To investigate the effect of Chailing Decoction on cellular immunity and virus clearance in different stages of chronic HBV infection. Methods: From December 2015 to December 2017, 100 patients with chronic HBV infection in our hospital were randomly divided into observation group and control group. Observation group: Chailing Decoction was given on the basis of treatment in the control group.The course of treatment in both groups was 1 year.Two groups' immunological indexes: lymphocyte subsets(flow cytometry), IFN-γ and IL-2 by ELISA method) were observed.Before and after treatment, the liver function was measured 6 months after treatment.Before and after treatment, the serum virology index was detected by fluorescence quantitative method and virus marker(hepatitis B, two pairs and half ELISA method) 3 and 6 months after the withdrawal of the drug. The serum virology index was detected by the fluorescence quantitative method and the virus marker. Results: Before treatment,there was no significant difference in CD4,CD8 and CD4/CD8 in 6 months after treatment and before treatment(P>0.05).There was no significant difference of CD8 between the observation group and the pre-treatment group after 6 months(P>0.05).But CD4 and CD4/CD8 were significantly higher than those before treatment(P<0.05), and compared with those of the control group there was significance(P<0.05). There was no significant difference between the observation group and the control group inIFN-γ or IL-2 before treatment(P>0.05).After treatment and 6 months after treatment, the observation group's was significantly higher than that before treatment(P<0.05), but there was no significant difference in the control groupbefore and after treatment and 6 months after treatment.The ALT of the observation group began to increase gradually after treatment and was higher than that of the control group at the beginning of 3 months and compared with those of the control group there was significance(P<0.05), and gradually decreased after 6 months of treatment. And the ALT decreased to a significant difference after 6 months after treatment and at the end of treatment compared with that before treatment(P<0.05).HBV-DNA and HBEAG were the main indexes of virology, and the total effective rate(complete response and partial response) of observation group was 85% and that of the control group was 70% and there was significance(P<0.05). Conclusion: The effect of selfmade Chailing Decoction on cellular immunity and virus clearance in different stages of chronic HBV infection is definite, mainly through affecting the proliferation, differentiation and maturation of immunity, and thus enhancing the activity of cytokines and regulating the immune ability in a positive direction.
Objective: To investigate the effect of Chailing Decoction on cellular immunity and virus clearance in different stages of chronic HBV infection. Methods: From December 2015 to December 2017, 100 patients with chronic HBV infection in our hospital were randomly divided into observation group and control group. Observation group: Chailing Decoction was given on the basis of treatment in the control group.The course of treatment in both groups was 1 year.Two groups' immunological indexes: lymphocyte subsets(flow cytometry), IFN-γ and IL-2 by ELISA method) were observed.Before and after treatment, the liver function was measured 6 months after treatment.Before and after treatment, the serum virology index was detected by fluorescence quantitative method and virus marker(hepatitis B, two pairs and half ELISA method) 3 and 6 months after the withdrawal of the drug. The serum virology index was detected by the fluorescence quantitative method and the virus marker. Results: Before treatment,there was no significant difference in CD4,CD8 and CD4/CD8 in 6 months after treatment and before treatment(P>0.05).There was no significant difference of CD8 between the observation group and the pre-treatment group after 6 months(P>0.05).But CD4 and CD4/CD8 were significantly higher than those before treatment(P<0.05), and compared with those of the control group there was significance(P<0.05). There was no significant difference between the observation group and the control group inIFN-γ or IL-2 before treatment(P>0.05).After treatment and 6 months after treatment, the observation group's was significantly higher than that before treatment(P<0.05), but there was no significant difference in the control groupbefore and after treatment and 6 months after treatment.The ALT of the observation group began to increase gradually after treatment and was higher than that of the control group at the beginning of 3 months and compared with those of the control group there was significance(P<0.05), and gradually decreased after 6 months of treatment. And the ALT decreased to a significant difference after 6 months after treatment and at the end of treatment compared with that before treatment(P<0.05).HBV-DNA and HBEAG were the main indexes of virology, and the total effective rate(complete response and partial response) of observation group was 85% and that of the control group was 70% and there was significance(P<0.05). Conclusion: The effect of selfmade Chailing Decoction on cellular immunity and virus clearance in different stages of chronic HBV infection is definite, mainly through affecting the proliferation, differentiation and maturation of immunity, and thus enhancing the activity of cytokines and regulating the immune ability in a positive direction.
引文
[1] 冯敏,丁杰,刘颂,等.肝细胞癌患者内质网应激-凋亡信号通路的性别差异[J].江苏大学学报(医学版),2017,27(5):432-436.
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[10] 王高雄,王炜,王艳军,等. 乙肝病毒X蛋白抑制高迁移率族蛋白B1的表达和活性氧的产生[J].中华实验外科杂志,2018,35(1):69-71.
[11] 雷秀丽. 化学发光法与酶联免疫法应用于乙肝病毒血清学检验中的效果[J]. 临床医学,2018,23(6):141-123.
[12] 赵霞,盛慧萍,杨岩,等. 慢性乙型肝炎患者外周血IL-17细胞因子水平及其临床意义[J]. 西安交通大学学报(医学版),2017,38(1):176-179.
[13] 刘超,邓智勇. 加味柴苓汤及其拆方抗肿瘤作用的研究进展[J].现代肿瘤医学,2017,25(11):1849-18852.
[14] 李卓伟. 加味柴苓汤治疗肝癌腹水的效果及对患者免疫功能的影响[J].中医临床研究,2017,31(9):72-74.
[15] 周坚,潘陈为,郑园园,等.柴芩温胆汤治疗慢性乙型病毒性肝炎睡眠障碍的随机单盲对照试验研究[J].中华中医药学刊,2017,35(12):3214-3216.
[16] 李彩东,杨勇卫,陈锡莲,等.HBV感染者IL-4水平变化及与临床的相关性[J].国际检验医学杂志,2017,38(2):177-178,181.
[17] 梁宁,郑青,张淑芳,等.海府地区慢性HBV感染者病毒学特征与P16mRNA改变的研究[J].标记免疫分析与临床,2017,24(12):1355-1359.
[18] 梁宁,郑青,张淑芳,等.海府地区慢性HBV感染不同免疫状态患者基因分型、病毒变异研究[J].标记免疫分析与临床,2018,25(1):32-35.
[19] 李惠军,吴斌,李彩东.HBV感染者HBV血清标志物水平与HBV DNA及肝功能的相关性[J].国际检验医学杂志,2016,37(6):784-786.
[20] 许茵,华忠,俞萍,等.阿德福韦酯治疗慢性乙肝后细胞免疫水平的临床研究[J].中国现代医学杂志,2016,26(21):94-96.
[2] 蒋文秀,王利利,叶伟,等.共刺激基因工程细胞共培养的细胞因子诱导的杀伤细胞对HepG2.2.15细胞中乙肝病毒的抑制作用研究[J]. 东南大学学报医学版,2017,36(5):1345-1347.
[3] 张志奎,王耀光. 运用复杂网络分析中医治疗乙肝病毒相关性肾炎的用药规律[J]. 中医药学报,2017,45(3):165-168.
[4] 安纪红,乔杰,张亚丽,等. 乙型肝炎病毒DNA高敏检测在HBeAg阴性患者治疗监测中的作用[J]. 中华肝脏病杂志,2018,26(2):108-112.
[5] 中华医学会肝病学分会.慢性乙型肝炎防治指南(2015更新版)[S]. 肝脏, 2015,33(12):321-340.
[6] 拉米呋啶临床运用专家指导小组.2003年拉米呋啶临床运用专家共识[S].中华肝脏病杂志,2003,11(8):497.
[7] 朱彤,王兵. 乙肝抗纤汤联合恩替卡韦治疗乙肝肝硬化的疗效及对炎性因子的影响[J].河北医药,2017,39(8):197-199.
[8] 祈月英,张忠勇,高志远,等. 益肝化湿饮治疗乙肝肝硬化的临床疗效观察[J].中医药学报,2017,45(2):156-158.
[9] 王忠琼,刘翼,夏国栋,等. 前列地尔对乙肝肝硬化患者血清炎性因子及肝功能的影响[J].医学研究生学报,2017,30(6):167-170.
[10] 王高雄,王炜,王艳军,等. 乙肝病毒X蛋白抑制高迁移率族蛋白B1的表达和活性氧的产生[J].中华实验外科杂志,2018,35(1):69-71.
[11] 雷秀丽. 化学发光法与酶联免疫法应用于乙肝病毒血清学检验中的效果[J]. 临床医学,2018,23(6):141-123.
[12] 赵霞,盛慧萍,杨岩,等. 慢性乙型肝炎患者外周血IL-17细胞因子水平及其临床意义[J]. 西安交通大学学报(医学版),2017,38(1):176-179.
[13] 刘超,邓智勇. 加味柴苓汤及其拆方抗肿瘤作用的研究进展[J].现代肿瘤医学,2017,25(11):1849-18852.
[14] 李卓伟. 加味柴苓汤治疗肝癌腹水的效果及对患者免疫功能的影响[J].中医临床研究,2017,31(9):72-74.
[15] 周坚,潘陈为,郑园园,等.柴芩温胆汤治疗慢性乙型病毒性肝炎睡眠障碍的随机单盲对照试验研究[J].中华中医药学刊,2017,35(12):3214-3216.
[16] 李彩东,杨勇卫,陈锡莲,等.HBV感染者IL-4水平变化及与临床的相关性[J].国际检验医学杂志,2017,38(2):177-178,181.
[17] 梁宁,郑青,张淑芳,等.海府地区慢性HBV感染者病毒学特征与P16mRNA改变的研究[J].标记免疫分析与临床,2017,24(12):1355-1359.
[18] 梁宁,郑青,张淑芳,等.海府地区慢性HBV感染不同免疫状态患者基因分型、病毒变异研究[J].标记免疫分析与临床,2018,25(1):32-35.
[19] 李惠军,吴斌,李彩东.HBV感染者HBV血清标志物水平与HBV DNA及肝功能的相关性[J].国际检验医学杂志,2016,37(6):784-786.
[20] 许茵,华忠,俞萍,等.阿德福韦酯治疗慢性乙肝后细胞免疫水平的临床研究[J].中国现代医学杂志,2016,26(21):94-96.