【作者】 邢宇锋； 童光东； 贺劲松； 陈英杰； 张晓晖； 魏春山； 高辉； 周小舟； 邱梅； 徐文军； 郑颖俊； 徐韶敏； 陈亮； 唐海鸿； 张来； 占伯林； 马文峰； 孙新锋； 李群； 周大桥；

【Author】 XING Yu-feng,TONG Guang-dong,HE Jing-song,CHEN Ying-jie,ZHANG Xiao-hui,WEI Chun-shan, GAO Hui,ZHOU Xiao-zhou,QIU Mei,ZHEN Ying-jun,XU Wen-jun,XU Shao-min,CHEN Liang,TANG Hai-hong, ZHANG Lai,ZHAN Bo-lin,MA Wen-feng,SUN Xin-feng,LI Qun,ZHOU Da-qiao Department of Hepatology,Shenzhen Hospital affiliated to Guangzhou University of Chinese Medicine,Shenzhen, 518033 China

【机构】 广州中医药大学深圳附属医院肝病科；

【摘要】 目的:分析中医补肾法为主治疗对慢性乙肝病毒携带者血清免疫因子的影响及其与HBV-DNA的相关性。方法:选择符合慢性乙肝病毒携带者诊断标准的病人600例,随机分为A、B、C、D共4组,其中A组、B组各200例,C组、D组各100例,A组、B组分别接收补肾清透方、补肾健脾方治疗,C组、D组分别接受补肾清透安慰剂方、补肾健脾安慰剂方治疗,疗程52周。分别观察治疗前及治疗后52周时血清HBV DNA定量和Th1/Th2型细胞因子(IL-2、IL-4、IL-10、IFN-γ、TNF-α)水平的变化。结果:治疗52W时A、B两组血清HBV-DNA水平均显著下降(与治疗前及与相应对照组比较,差异有统计学意义,P<0.01),而A、B两组下降幅度相当(P=0.079);HBV DNA较基线下降>1 lg比例分别为:A组41.36%(79/191)、B组45.98%(80/174)、C组15.96%(15/94)、D组11.83%(11/93),A组与C组、B组与D组比较差异有统计学意义(x~2=18.3926,P<0.0001;x~2=29.3552,P<0.0001),HBV-DNA较基线阴转比例各组间比较差异均无统计学意义(P>0.05);补肾清透方治疗组与补肾健脾方治疗组对IL-2、IL-4、IL-10、IFN-γ的改善与安慰剂组比较,差异均有统计学意义(P<0.05)。治疗组HBV-DNA下降与IL-2呈中度相关(Pearson相关系数为-0.417,P<0.01),与INF-γ呈弱相关(Pearson相关系数为-0.231,P<0.01);补肾清透组、补肾健脾组HBV-DNA下降大于1lg患者比下降≤1 lg的患者IL-2、IFN-γ升高,差异有统计学意义。结论:补肾清透方、补肾健脾方有一定的抑制慢性HBV携带者乙肝病毒复制的作用,可能通过恢复特异性T细胞免疫功能而实现。更多还原

【Abstract】 Objective:To observe the effect of TCM therapy focused on invigorating the kidney on serum cytokines in chronic hepatitis B virus carriers and its correlation with HBV-DNA level.Methods:600 patients meeting up with diagnostic standard of chronic hepatitis B carriers were randomly divided into 4 groups,A and B group each with 200 cases,C and D group each with 100 cases.Patients in A and B group received medication invigorating the kidney and the spleen prescription and invigorating the kidney and qingtou prescription respectively,and C and D group used placebo.The period of treatment was 52 weeks.The serum HBV-DNA level and Th1/Th2 Cytokines level(including IL-2、IL-4、IL-10、IFNγ、TNF-α)were detected before and after treatment for 52 weeks in all the patients.Results:After treatment for 52 weeks,the serum HBV DNA levels were distinctly declined in patients of A and B groups(compared with the before treatment and the corresponding control group,P<0.01),and the reduced level of A and B groups was same(P=0.079).The proportion of patients with serum HBV DNA a baseline values decline greater than 1log10IU/ml:group A was 41.36%(79/191)、group B 45.98%(80/174)、group C 15.96%(15/94)、group D 11.83%(11/93),and there was an obvious difference between group A and C、group B and D(x~2= 18.3926,P<0.0001;x~2= 29.3552,P<0.0001). HBV DNA values below the detection limit rates compared the baseline values in each group were no difference (P>0.05).The groups A and B improved the levels of IL-2,IL-4,IL-10,IFN-γsignificantly compared with placebo(P<0.05).The decline of HBV-DNA levels in treatment group were moderate related to IL-2(Pearson correlation coefficient was 0.417,P<0.01),and were weak related to INF-γ(Pearson correlation coefficient was 0.231,P<0.01);and there was an obvious difference about the increasing of IFN-γand IL-2 levels,compared the patients with HBV-DNA decline greater than log10IU/ml to the or decline less than 1log10IU/ml or equal to 1log10IU/ml.Conclusions:Invigorating the kidney and the spleen prescription and invigorating the kidney and qingtou prescription were effective in inhibiting hepatitis B virus replication in chronic hepatitis B virus carriers. It achieved probably the action by restoring immune function of specific T cells.更多还原