【摘要】 目的探讨阿德福韦酯联合扶正化瘀胶囊在治疗慢性乙型肝炎过程中对宿住免疫应答的影响。方法选择2010年3月~2014年10月在唐山市传染病医院门诊或住院的100名慢性乙型肝炎患者,随机分为阿德福韦酯治疗组及阿德福韦酯+扶正化瘀胶囊治疗组,每组50例。检测2组患者治疗前后AST、ALT、HBs Ag和HBV DNA水平。采用流式技术检测2组患者CD3+CD56+、CD244+NK、CD3+、CD3+CD4+、CD3+CD8+T细胞以及血清中CD4+T相关细胞因子的含量。结果治疗后各时点2组患者AST、ALT、HBV-DNA水平均较治疗前显著下降(P<0.05),且治疗3个月、6个月后阿德福韦酯+扶正化瘀胶囊组的AST、ALT水平显著低于阿德福韦酯组(P<0.05),但2组HBV-DNA相比差异无统计学意义。除治疗后3个月外,2组患者治疗后6、9、12个月的HBs Ag水平均较治疗前显著降低(P<0.05),但2组间比较差异无统计学意义。治疗后6、9、12个月,2组患者外周血中CD3-CD56+NK细胞均较治疗前显著增高(P<0.05),且阿德福韦酯+扶正化瘀胶囊组显著高于阿德福韦酯组(P<0.05)。治疗后各时点2组患者外周血中的CD244+NK、CD3+T细胞、CD3+CD4+T细胞均较治疗前显著增高(P<0.05),且阿德福韦酯+扶正化瘀胶囊组显著高于阿德福韦酯组(P<0.05)。但治疗后各时点2组CD3+CD8+T细胞均显著低于治疗前(P<0.05),2组比较,除治疗后3个月外,其余各时点阿德福韦酯+扶正化瘀胶囊组CD3+CD8+T细胞均较阿德福韦酯组更低(P<0.05)。治疗后2组患者血清中各细胞因子均显著增加(P<0.05)。且阿德福韦酯+扶正化瘀胶囊组较阿德福韦酯组各因子水平更高(P<0.05)。结论阿德福韦酯联合扶正化瘀胶囊治疗慢性乙型肝炎,能显著降低患者AST、ALT、HBV-DNA及HBs Ag的情况,促进NK细胞、T/B细胞表达和T细胞分泌细胞因子表达,且效果优于单纯使用阿德福韦酯。更多还原

【Abstract】 Objective To investigate the immune response of Adefovir ester combine the Fuzheng Huayu in the process of the treatment of chronic hepatitis B. Methods 100 cases with CHB from March 2010 to October 2014 collected in outpatients clinic or hospital were randomly divided into Adefovir ester treatment group and Adefovir ester joint the Fuzheng Huayu treatment group. Levels of AST,ALT,HBs Ag and HBV DNA pre-and-post treatment were detected. CD3-CD56+,CD244+NK,CD3+,CD3+CD4+,CD3+CD8+T cells and the contents of CD 4+T cells in serum of two groups were measured by flow cytometry analysis. Results The levels of AST、ALT、HBV-DNA of two group post-treatment were all significantly lower than pretreatment( P < 0. 05),and the level of AST and ALT in Adefovir ester and Fuzhengh Huayu treatment group at 3 months and 6 months were obviously lower than Adefovir ester treatment group. HBV-DNA contents between two groups had no significant difference. Hbs Ag levels of two groups were all significantly increased after 6,9,12 months’ treatment( P < 0. 05),While there was no significant difference between two groups post-treatment. CD3-CD56+cell at 6,9,12 months in two groups were all higher than pre-treatment( P < 0. 05),which in Adefovir ester and Fuzhengh Huayu treatment group were more higher than Adefovir ester treatment group( P < 0. 05). CD244+NK,CD3+T cell,CD3+CD4+Tcell at each point post-treatment in peripheral blood of two groups were all increased significantly( P < 0. 05),which in Adefovir ester and Fuzhengh Huayu treatment group increased more obviously than Adefovir ester treatment group( P < 0. 05). However,CD3+CD8+cells were reduced obviously after treatment in two groups( P < 0. 05),which besides 3 month point,its ratio in Adefovir ester and Fuzhengh Huayu treatment group decreased more significantly than Adefovir ester treatment group at other points( P < 0. 05). Cytokines in serum of two groups were all increased significantly post-treatment( P < 0. 05),which in Adefovir ester and Fuzhengh Huayu treatment group were more lower( P < 0. 05). Conclusion Adefovir ester and Fuzhengh Huayu treatment can improve the situation of AST,ALT,HBV DNA and HBs Ag in patients with chronic hepatitis B,promote the expression of NK cells,T cells and Tcell secrited cytokines,and the efficacy is better than Adefovir estertreatment alone.更多还原