慢性乙型肝炎中医证型与IL-4相关性研究
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摘要
目的:探讨慢性乙型肝炎(简称慢乙肝) ALT、AST和IL-4之间的相关性。
     方法:对150例慢乙肝患者进行中医辨证分型,共分为肝郁脾虚型、湿热中阻型、瘀血阻络型、肝肾阴虚型、脾肾阳虚型五个证型,并且所有病例均行ALT、AST、IL-4水平的检查,通过对所得数据的分析,来尝试揭示人群中慢乙肝患者ALT、AST、IL-4的水平的相关性。
     结果: 1.不同证型患者的ALT、AST存在差异,以湿热中阻型患者ALT、AST升高最为显著,其次为瘀血阻络型,与其他证型比较差异显著,p<0.05。而肝郁脾虚型、肝肾阴虚型、脾肾阳虚型ALT、AST升高不明显。2.患者的IL-4水平明显不同(P<0.01),肝郁脾虚型<湿热中阻型<瘀血阻络型<肝肾阴虚型<脾肾阳虚型,随着病情的活动、病程的推延,IL-4水平逐渐上升。
     结论:1.不同证型的慢乙肝患者ALT、AST存在差异;2.IL-4与慢乙肝中医证型具有一定的相关性,表现为肝郁脾虚型<湿热中阻型<瘀血阻络型<肝肾阴虚型<脾肾阳虚型,IL-4水平逐渐上升。
Objective: It is to explore the correlation between chinese medcine syndrome of chronic hepatitis B and ALT, AST and IL-4.
     Methods: 150 patients with chronic hepatitis B were diagnosed with differential chinese medcine syndrome, such as stagnation of liver-energy and asthenia of spleen, middle-stagnation of wetness-heat, blood stasis obstruction of collaterals, deficiency of liver-Yin and kidney-Yin, deficiency of spleen and kidney Yang, and their indexes of liver function, and interleukin-4 were determined.By analyzing of the research data, to explore the correlation between chinese medcine syndrome of chronic hepatitis B and ALT, AST and IL-4.
     Results: 1.ALT and AST of different syndromes is different in these 150 patients, (P<0.01), the increased of ALT and AST of middle-stagnation of wetness-heat and blood stasis obstruction of collaterals are highest than other syndromes, but the latter than the former.And the others are not more higher than normal person.2.The IL-4 quantitation of different syndromes is different in these 150 patients,(P<0.01), stagnation of liver-energy and asthenia of spleen< middle-stagnation of wetness-heat< blood stasis obstruction of collaterals< deficiency of liver-Yin and kidney-Yin< deficiency of spleen and kidney Yang.
     Conclusion: 1.There are diversity between different chinese medcine syndrome of CHB in the aspect of liver function (ALT, AST). 2. There are some correlation between chinese medcine syndrome of CHB and IL-4.
引文
[1]孙锡贡.慢肝散治疗慢性乙型肝炎66例[J].中西医结合肝病杂志,2000,(4):38-39.
    [2]雷陵.慢性乙肝病毒感染的病因病机认识及辨证治疗经验.中医研究.2007,(12):37-39
    [3]裴建宏,王灵台.辨治慢性乙型肝炎经验[J].安徽中医临床杂志,2002,14(6):432-433.
    [4]童光东,彭胜权.从“肾虚伏气”论慢性乙型肝炎的治疗[J].中医杂志,2004,45(10):726.
    [5]蒋幼林.王育群治疗慢性乙肝经验辑要[J].江西中医药,2002,33(5):4-5.
    [6]华海清.慢性乙型肝炎病因病机探讨[J].南京中医药大学学报,2001,17(4):210-211.
    [7]阮公实.金实教授辨治慢性乙型肝炎经验[J].吉林中医药,2003,23(7):7-8
    [8]黄贤樟.乙型肝炎中医治疗之思考[J].中医药临床杂志,2006,18(5):446-447
    [9]王常松.基于文献研究的乙型肝炎病因病机及证治规律探析.河南中医学院学报.2009,24(142):100-102.
    [10]王学东.慢性乙型肝炎中西医治疗进展[J].中国中医药信息杂志,2007,14(10):93-96.
    [11]毛德西,朱光.乙型肝炎辨证用药思路.中医杂志,2002,43(2):144-145
    [12]刘绍能.慢性乙型肝炎肝纤维化辨证分型的研究[J].中医药信息,2002,19(5):15-16.
    [13]吴继勇.彭胜权教授治疗肝病经验.新中医,2000,32(1):8-9
    [14]刘绪银,石凯歌.老中医治疗乙型肝炎的经验[J].湖南中医药导报,2000,6(11):18.
    [15]刘克洲.中西医结合治疗慢性乙型病毒性肝炎—抗病毒治疗是关键[J].浙江中西医结合杂志,2005,15(1):1-3.
    [16]赵博智.关幼波肝病杂病论[M].北京:世界图书出版公司,2002:5.
    [17]王暴魁,谢宁.张琪治疗肝炎后肝硬化[J].中医杂志,1996,37(4):202.
    [18]孙钧.试论乙型肝炎的辨病与辨证.中西医结合肝病杂志,2002,12(1):52-53
    [19]刘坚.王伯祥治疗肝病的学术思想与临床经验.中西医结合肝病杂志,2001,11(3):165-166
    [20]赵汉鸣.吴德光诊治“乙肝”经验.江西中医药,2000,31(4):3-4
    [21]张志斌.证候名称及分类研究的回顾与假设的提出.北京中医药大学学报,2003,26(2):1-4.
    [22]郭蕾,王永炎.关于证候因素的讨论.中国中西医结合杂志,2004,24(7):43-44
    [23]王常松.基于文献研究的乙型肝炎病因病机及证治规律探析.河南中医学院学报.2009,24(142):100-102.
    [24]章铨荣,等.乙肝轻治疗慢性乙型肝炎60例[J].中医杂志,2007,48(11):1003-1005
    [25]陈延光.扶正解毒颗粒对低滴度慢性乙肝病毒携带者HBVDNA阴转的影响[J].广西中医药,2007,30(5):44-45
    [26]刘雪英.乙型肝炎后肝硬化专方治疗体会[J].光明中医,2007,22(1):33-34
    [27]王兴明,郭芬,王锋.肝活血丸联合拉米夫定治疗慢性乙型肝炎肝硬化30例[J].中西医结合肝病杂志,2005,15(2):114-115
    [28]金祥宁.拉米夫定联合扶正复肝方治疗慢性乙型肝炎及对YMDD变异的临床研究[J].实用中西医结合临床,2007,7(5):15
    [29]叶永安.慢性乙型肝炎的中西医结合治疗[J].中国中西医结合杂志2008,28(1):8-9
    [30]王常松.基于文献研究的乙型肝炎病因病机及证治规律探析.河南中医学院学报.2009,24(142):100-102.
    [31]李筠.重视慢性乙型肝炎YMDD变异的中医及中西医结合治疗[J].中国中西医结合杂志,2008,28(1):9-10.
    [32]叶树星.中医治疗慢性乙型肝炎概况.实用中医内科杂志.2008,22(10):77-78.
    [33]Erhardt A,Reineke U.Mutations of the core promoter and response tointerferon treatment in chronic replicative hepatitis B.Hepatology, 2000, 31(3):716-725.
    [34]肖倩.慢性乙型肝炎HBeAg阴性患者乙肝病毒变异与中医辨证分型的关系.中医杂志. 2006,47(6):444-445.
    [35]杨宏志,边壮,王拥泽,等.慢性乙型肝炎虚实病机与病毒复制及T细胞关系的研究.中国中西医结合急救杂志2003,10(3):159-161.
    [36]LIN C L,LIAO L Y.Hepatitis B genotypes and precore baselaore promotermutants in HBeAg-nepative chronic hepatitis B[J].Jastroentero, 2002,37(4):283-287.
    [37]李黎,毕胜利,崔富强等,全国人群乙型病毒性肝炎血清流行病学调查的总体方案,中国疫苗和免疫2009,15(4):379-381
    [38]崔恒春,闫永平,邵中军,等.HBIG阻断乙型肝炎病毒母婴传播[J].第四军医大学学报,2006,27(11):1027-1030.
    [39]Mcmahon BJ,et al.Screening for hepatocellular carcinoma in Alask natives infected with chronic hepatitisB:a 16-year population-based study[J].Hepatology,2000,32(4):2-6.
    [40]Yu MW,Chang HC.Familial risk of hepatocellula carcinoma among chronic hepatitisB carriers and their relatives[J].NatlCancer Inst,2000, 92(14):1159-1164.
    [41]肝衰竭诊疗指南.中华医学会感染病学分会肝衰竭与人工肝学组和中华医学会肝病学分会重型肝病与人工肝学组.实用肝脏病杂志,2006,9(3)1-3.
    [42]ZhangXX,Fabien Z,Francois H,et al.Analysis of Hepatitis Virus Genotyes and Pre-Core Region Variability During Interferon Treatment Of Hbe Antigen Negative Chronic Hepatitis B.J Med Virol,1996,48:8-16.
    [43]Patricia AR,Helen N,Betty H,et al.Genotype H:A New Amerindian Genotype Of Hepatitis B Virus Revealed in Central Ameriea.J Gen virol, 2002,83:2059-2073.
    [44]Yuasa R,Takahashi K,Dien BV,et al.Properties Of Hepatitis B Virus Genome Recovered From Viet namese Patients With Fulminant Hepatitis inComparison With Those Of Aeute HePatits.J Med Virol,2000,61:23-28.
    [45]李梦东,王宁明.实用传染病学[M].第3版.北京:人民卫生出版社,2005:382-383.
    [46]Guidotti LG,Chisari FV.Noncytolytic control of viral infections by the innate and adaptive immune response[J].Annu Rev Immuno,l 2001,19:65-91.
    [47]GuidottiLG,Ishikawa T,HobbsMV,et al.Intracellular inactivation of the hepatitis B virus by cytotoxic T lymphocytes[J].Immunity, 1996,4(1): 25-36.
    [48]ChisariFV,FerrariC.HepatitisB virus immunopathogenesis[J].Annu RevImmuno,l 1995,13(1):29-60
    [49]Grakoui A,DonermeyerDL.TCR-independent pathways mediate the efects of anti-ell dose and altered peptide ligands on Th cell polarization [J]. J Immunol, l999, 162(4): 1923-1930.
    [50]张萍,颜学兵,吴文漪等.慢性乙型肝炎患者外周血单个核细胞Th1、Th2型细胞标记物及其细胞因子的表达.中华传染病杂志, 2003,21(1):41-42
    [51]姜颖.疾病的Th1 /Th2模式[J].国外医学免疫学分册,1999,(6):3057.
    [52]Mchugh S,Deihton J,Rifkin I,et al. Kinetics and functionalimpli- cations of Th1 and Th2 cytokine pattern[J].Eur J Immuno, 1996,26(6):1260.
    [53]曹泽毅,主编.中华妇产科学[M].第2版,北京:人民卫生出版社,2005.538.
    [54]金伯泉.细胞和分子免疫学[M].2版.北京:科学技术出版社,2001.399.
    [55]IhleN.The Stat family in cytokine signaling[J].CurrentOpinion In cellBiology, 2001,13:211-217.
    [56]FalascaK,UcciferriC,DalessandroM,etal.Cytokine patterns correl- atewith liver damage in patients with chronic hepatitis B and C[J].Ann Clin Lab Sci,2006,36 (2):144-150.
    [57]段国荣,等.成人急性HBV感染后免疫指标的变化及不同转归的比较[J].胃肠病学和肝病学杂志,2006,15(1):65-68.
    [58]Milich DR.Influence of T-helper cell subsets and crossregulation in hepatitis B virus infection.J Viral Hepat 1997;4(Suppl):248-259
    [59]Milich DR,et al.The secreted hepatitisB p recore antigen canmo-dulate the immune response to the nucleocapsid: amechanism forpersistence [J].J Immuno,1998,160:2013-2021.
    [60]Lin SJ,Shu PY,Chang C,et al.IL-4 suppresses the expression and the replication ofhepatitisB virus in the hepatocellular carcinoma cell lineHep3B[J].J Immunol,2003,171 (9):4708-4716
    [61]王茸,等.李正求.乙型肝炎、肝硬化患者外周血中IL-1β和IL-4水平的变化[J].细胞与分子免疫学杂志,2001,17(6):589.
    [62]Beckebaum S,CicinnatiVR,ZhangX,et al.HepatitisB virus-induced defect of monocyte derived dendritic cells leads to impaired T helper type 1 responsein vitro:mechanisms forviral immune escape[J]. Immunology, 2003, 109(4):487-495.
    [63]Duan XZ,ZhuangH. Decreased numbers and impaired function of circulating dendritic cell subsets in patients with chronic hepatitis B infection (R2) [J].J Gastroenterol Hepato, 2005,20(2):234-242.
    [64]Kurose K,Akbar SM,Yamamoto K,et al.Production of antibody to hepatitisB surface antigen (anti-HBs) bymurine hepatitisB virus carriers: neonatal toleranceversusantigen presentation by dendritic cells[J]. Immuno- logy,1997,92(4):494-500.
    [65]Butterfield LH.Immunotherapeutic strategies for hepatocellular carcinoma[J]. Gastroenterology, 2004,127(5 Suppl 1):S232-S241.
    [66]白培胜,黄茜华,唐妮,等.乙型肝炎病毒荧光PCR基因分型方法的建立和应用[J].中国检验医学杂志,2006,7(2):69-71.
    [67]黄燕萍,兰林,李俊刚,等.逆向斑点杂交检测乙型肝炎病毒病毒基因型及YMDD型[J].中国检验医学杂志,2006,29(2):140-142.
    [68]宋爱云,王占英.乙型肝炎病毒前S1蛋白与病毒复制的关系[J].包头医学,2008,32(3): 129-130.
    [69]朱合,吴书笔.检测乙肝病毒前S1蛋白的临床意义[J].人民军医,2006,49(2):80-81.
    [70]杨益,李琪玲.前S1蛋白与乙肝病毒复制及HBV-DNA的关系[J].实用医技杂志, 2006,13(12):2038-2039.
    [71]梁扩寰.肝脏病学.第1版.北京:人民卫生出版社,1995,208-209.
    [72]杨九华,黄颖.免疫抑制法测定肝脏病患者血清m-AST的临床意义.上海医学检验杂志,2000,15(4):201.
    [73]宗敏,司端勤,朱维林.联合测定血清肝功能酶学在病毒性乙型肝炎诊断中的意义[J].青海医药杂志2004,34(1):11-12
    [74]Dienstag J.The role of 1iver biopsy in chronic hepatitisC.Hepa- tology, 2002, 36(5suppl):S152 -160.
    [75]Bedossa P,Dargere D,Paradis V.Sampling variability of liver fibrosis in chronic hepatitis C.Hepatology,2003,38:1449-1457.
    [76]张文胜,王宝恩,王泰龄,等.慢性乙型肝炎肝纤维化无创性诊断模型的建立.中华肝脏病杂志2006,14(3):169-173.
    [77]Lai M,Hyatt B,Nasser I,et al.The clinical significance of persis- tently normal ALT in chronic hepatitis B infection[J].J Hepatol,2007 ;47(6):760-767.
    [78]Keeffe EB,Dieterich DT,Han SH,et al.A treatment algorithm for the management of chronic hepatitis B virus infection in the United States:an update[J].Clin Gastroenterol Hepatol,2006;4(8):936-962.
    [79]Wang CC,Lim LY,Deubner H,et al.Factors predictive of significant hepatic fibrosis in adults with chronic hepatitis B and normal serum ALT [J].J Clin Gastroentrol,2008;42(7):820-826.
    [80]Chen YC,Chu CM,Liaw YF.Age-specific prognosis following sponta- neous hepatitis B e antigen seroconversion in chronic hepatitis B. Hepa- tology.2010 Feb;51(2):435-44.
    [81]秦恩强,王福生.持续ALT正常、HBeAg阴性慢性乙型肝炎患者的预后与HBVDNA水平的关系.临床医学工程2009,16(5)
    [82]Suarez A,Castro P,Alonso R,et al.Inter individual variations in constitutive interleukin-10 messenger RNA and protein levels and their association with genetic polymorphisms[J].Transplantation, 2003,75(5): 711-717.
    [83]张平安,李艳,杨相升.IL-10基因启动子-592A/C多态性与HBV感染预后的关系.实用医学杂志2008,24(3):361-364.
    [84]任红.慢性乙型肝炎治疗的热点和难点.中华肝脏病杂志,2009,17(10):721
    [85]Blumberg BS,Alter HS,Visnich s A“now”antigen In leukemia sera JAMA, 1965, 199:541-546
    [86]Buropean Association For The Study Of The Live⒈EASL Clinical Practice Guidelines: management of chronic hepatitis B J Hepatol, 2009, 50:227-242
    [87]Lok AS,McMahon BJ Chronic hepa"Lis B∶update 2009 Hepa tology, 50:661-662
    [88]Shamliyan TA,MacDonald R,Shaukat A,et al Antiviral therapy for adults with chronic hepatitis B: a systematic review for a NationalInsti- tutes of Health Consensus Development Conf erence Ann Intern Med, 2009,150: 111-124
    [89]Sorrell MF,Belongia EA,Costa J,et al. National Institutes of Health Consensus Development Conference Statement: management of hepatitis B Ann Intern Med,2009,150:104-110
    [90]林青.核苷(酸)类似物治疗慢性乙型病毒性肝炎.中华肝脏病杂志,2009,17(10):725
    [91]Chinese Scociety of Hepatology and Chinses Society of Infectious Diseases,Chinese Medical Association The guideline of prevention and treatment for chronic hepatitis B Zhonghua Ganzangbing Zazhi, 2005,13: 881-891
    [92]Yao GB,Zhu M,Cui ZY,etal A 7-year study oflamivudine therapy for hepatitis B virus antigen-positive chronic hepatitis B patients In China J Dig Dis,2009,10:131-137.
    [93]Marcellin P,Chang TT,Lim SC,et al.Long term efficacy and safety of adefovir dipivoxil for the treatment of hepatitis B e antigen-positlvc chronic hepatitis B Hepatology,2008,48:750-758.
    [94]Scott LJ,Keating GM Entecavir : a levle of its use In chronichepatitis B Drugs, 2009,69:1003-1033.
    [95]R ijnders JG,Pas SD,Schutten M,et al Entecavir shows limited efficacy In HBeAg-positi e hepatitis B patients a partial V110-logic response to adefovir therapy J Hepatol,2009,50:674-683
    [96]Tenney DJ,Rose RE,Baldick CJ,et al.Long-term monitoring shows hepatitis B virus resistance to entecavir in nucleoside-naive patients is rare through 5 years of therapy.Hepatology,2009,49:1503-1514.
    [97]Liaw YE,Gane E.2-Year GLOBE trial results:telbivudine Is superior to lamivudine in patients with chronic hepatitis B.Gastroenterology, 2009, 136:486-495.
    [98]Zeuzem S,Cane E,Liaw YF,et al.Baseline characteristics and early on-treatment response predict the outcomes of 2 years of telbivudinetreat- ment of chronic hepatitis B.J Hepatol,2009,51:11-20.
    [99]Hann HW,Chae HB,Dunn SR.Tenofovir (TDF) has stronger antiviral effect than adefovir (ADV) against lamivudine (LAM)-resistant hepatitis B virus (HBV).Hepatol lnt, 2008,2:244-249.
    [100]Korba BE,Furman PA,Otto MJ.Clevudine: a potent inhibitor of heap- titis B virus in vitro and in vivo.Expert Rev Anti Infect Thor,2006,4: 549 -561.
    [101]Peffillo R Benefits and risks of interferon therapy for hepatitis B.Hepatology, 2009,49(5 Suppl):103-111
    [102]Cootksley WG,Piratvisuth. Peginterferon alpha-2a ( 40kDa ) :an advance In the treatment of hepattitis B c antigen-positive chronic hepatitis BJ Viral Hepat,2003,lO:298-305
    [103]Lau GK,Piratvisuth T,Luo KX,et al Peginterferon alfa 2a,amivudine, and the combination for HbeAg-positive chronic heaptitis B N Engl J Med, 2005,352∶2682-2695
    [104]European Association For The Study Of The Liver. EASL Clinical Practice Guidenos:management of chronic hepatitis B J Hepatol,2009,50: 227-242
    [105]Buster EH,Flind HJ,Simsek H,et al.Early HBeAg loss during pegin- terferon alpha-2b therapy predicts HBsAg loss: results of a long-term follow-up strdy in chronic hepatitis B patients.Am J Gastroenterol,2009 Epub ahead of print.
    [106]Brunetto MR,Moriconi F,Bonino F,et al.Hepatitis B virus surface antigen levels: a guide to sustained response to peginterferon alfa-2a in HBeAg-negative chronic hepatitis B.Hepatology, 2009,49:1411-1150
    [107]中华医学会传染病与寄生虫病学分会、肝病学分会.病毒性肝炎的诊断标准[J].中西医结合肝病杂志,2001,11(1):56-60
    [108]中国中医药学会内科肝病专业委员会.病毒性肝炎中医辨证标准(试行)[J].中医杂志,1992,33(5):39-40
    [109]王吉耀,刘天舒等.肝硬化及其并发症的防治[J].中华医学杂志,2002,82(17):63-67

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