肝脂肪变性程度对慢性乙型肝炎中西医结合抗病毒治疗中免疫因子的影响  

The influence of hepatic steatosis on immune-related cytokines in chronic hepatitis B with integrative antiviral treatment

作　　者：邱梅[1] 周大桥[1] 童光东[1] 贺劲松[1] 鲁艳平[1] 张国辉[1] 

机构地区：[1]深圳市中医院肝病科,广东深圳518033

出　　处：《中西医结合肝病杂志》2015年第5期274-276,共3页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

摘　　要：目的:探讨肝脏脂肪变性在慢性乙型肝炎中西医结合抗病毒治疗中对免疫因子的影响。方法:将126例HBe Ag阳性慢性乙型肝炎(CHB)患者,根据其治疗前测定Fibroscan的受控衰减参数(CAP值,反映脂肪变性程度)的不同,将患者分成3组,所有患者予恩替卡韦0.5mg/d抗病毒,同时予中药汤剂调肝健脾解毒,分别在治疗12周、24周、48周观察肝功能、HBs Ag、HBe Ag、HBV DNA定量及治疗前后细胞因子IL-2、IL-4、IL-10、TNF-、IFN-的变化。结果:随着治疗时间的延长,3组患者HBe Ag均值逐步下降,与基线比较<0.05,肝脏脂肪变性程度较轻的A、B组同期与肝脏脂肪变性程度较重的C组比较,HBe Ag均值下降更显著(<0.05)。在HBs Ag lg值、细胞因子和ALT的复常率的观察上也得到同样的结果,但在HBs Ag lg值的变化上,治疗12周以后,3组患者均下降不明显(>0.05)。结论:肝脏脂肪变性在一定程度上影响了慢性乙型肝炎中西医结合抗病毒治疗的疗效,改善患者肝脏脂肪变性的治疗可能具有潜在的疗效价值,其机制可能与其对细胞因子的影响有关。Objective：To study the influence of hepatic steatosis on immune-related cytokines in chronic hepatitis B（CHB）with integrative antiviral treatment. Method：A total of 126 HBe Ag positive CHB patients were divided into three groups based on the controlled attenuation parameter（CAP）measured by the Fibroscan before treatment. All the patients were given ETV for antiviral therapy,combined with decoction which can regulate liver,tonify spleen and resolve toxin. The liver function,HBs Ag,HBe Ag and HBV DNA quantitation were tested respectively at 12,24 and 48 weeks after treatment,as well as the change of cytokines including IL-2,IL-4,IL-10,TNF-,IFN- before and after treatment. Results：The average level of HBe Ag was significantly declined in all groups compared with the baseline after treatment（ 〈0.05）,especially in group A and B,which patients with less hepatic steatosis（ 〈0.05）,and we can also got the same results from the HBs Ag lg value,cytokines and ALT normalization rate in all groups after 12 wk of treatment（ 〈0.05）,but after 24 and 48 wk of treatment,the HBs Ag lg value was declined not so significantly in all groups（ 〉 0.05）. Conclusion：Hepatic steatosis could partly affect the efficacy of CHB integrative antiviral treatment,so that the treatment of patients with hepatic steatosis may have potential medical value,the mechanism may be related to the effect of cytokines.

关 键 词：肝脂肪变 肝炎 乙型 慢性 中西医结合治疗 细胞因子 

分 类 号：R512.62[医药卫生—内科学]