替比夫定片联合健脾补肾方对HBeAg阳性慢性乙型肝炎患者HBV特异性CTL及HBeAg血清转换的影响  

Effect of Telbivudine Tablet Combined Jianpi Bushen Recipe on HBV Specific Cytotoxic T Lymphocyte and HBe Ag Seroconversion in Patients with HBe Ag Positive Chronic Hepatitis B

作　　者：华忠[1] 徐微[1] 付德才[1] 李燚光[1] 过小叶[1] 徒康宛[1] 戴亚萍[1] 

机构地区：[1]江南大学附属无锡第五人民医院中西医结合肝科,江苏214005

出　　处：《中国中西医结合杂志》2016年第5期530-534,共5页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：江苏省第二批优秀中青年中医临床人才专项课题资助项目(No.YX2012-1226)

摘　　要：目的探讨替比夫定(telbivudine,LDT)片联合健脾补肾方治疗慢性乙型肝炎(chronic hepatitis B,CHB)患者对乙型肝炎病毒(hepatitis B virus,HBV)特异性细胞毒性T淋巴细胞(cytotoxic T lymphocyte,CTL)及乙型肝炎e抗原(HBeAg)血清学转换的影响。方法采用随机数字表法将90例HBeAg阳性和人白细胞抗原(HLA)-A2阳性的CHB患者分为治疗组及对照组,每组45例,对照组单用LDT片治疗(600 mg口服,每日1次),治疗组在LDT片治疗基础上加用健脾补肾方颗粒剂,每日2次口服;两组疗程均为1年。比较治疗1年后两组HBV DNA阴转率、HBeAg血清转换率及HBV特异性CTL水平,并评价肝功能、耐药变异及不良反应。结果治疗1年后,治疗组HBV DNA阴转率及HBeAg血清学转换率[分别为88.89%(40/45)、40.00%(18/45)]均高于对照组[分别为68.89%(31/45)、20.00%(9/45)],差异有统计学意义(均P<0.05)。治疗组HBV特异性CTL水平为(0.78±0.09)%,明显高于治疗前的(0.36±0.07)%,亦高于对照组治疗1年后的(0.54±0.11)%,差异有统计学意义(P<0.01)。HBeAg血清学转换者(27例)HBV特异性CTL水平为(0.81±0.10)%,明显高于63例无HBeAg血清学转换者的(0.60±0.09)%,差异有统计学意义(P<0.01)。治疗组发生ALT恢复正常44例(97.78%),对照组为42例(93.33%),两组比较,差异无统计学意义(P>0.05)。两组治疗后总胆红素全部正常。治疗组rtM204I耐药变异1例(2.22%),对照组2例(4.44%),两组患者均未发现明显不良反应。结论 LDT片联合健脾补肾方治疗CHB能提高患者的HBV特异性CTL水平和HBeAg血清学转换率。Objective To explore the effect of Telbivudine（LDT） Tablet combined with Jianpi Bushen Recipe（JBR） on serum hepatitis B virus（HBV） specific cytotoxic T lymphocyte（CTL） and HBe Ag seroconversion in chronic hepatitis B（CHB） patients. Methods Totally 90 HBe Ag-positive and human leukocyte antigen（HLA）-A2 positive CHB patients were randomly assigned to the treatment group and the control group, 45 cases in each group. Patients in the treatment group took LDT Tablet（600 mg, once per day） combined with JBR granule（twice per day）, while those in the control group took LDT Tablet alone. The therapeutic course for all was one year. HBV DNA negative conversion rate, HBe Ag seroconversion rate, and level of HBV specific CTL were compared after 1year treatment;liver function, drug resistance mutations, and adverse reactions were also compared between thetwo groups. Results After 1 year treatment, HBV DNA negative conversion rate and HBe Ag seroconversion rate were 88. 89%（40/ 45） and 40. 00%（18/ 45） in the treatment group, higher than those of the control group[68. 89%（31/45） and 20. 00%（9/45）], with statistical difference（P〈0. 05）. Level of HBV specific CTL in the treatment group was 0. 78% ± 0. 09% after treatment, higher than that of the control group after 1 year treatment（0. 54% ± 0. 11%） and that before treatment（0. 36% ± 0. 07%）, with statistical difference（P〈0. 01）. Level of HBV specific CTL in 27 patients with HBe Ag seroconversion was 0. 81% ± 0. 10%, higher than that of 63 patients without HBe Ag seroconversion（0. 60% ± 0. 09%）, with statistical difference（P〈0. 01）. ALT returned to normal in 44 cases of the treatment group（97. 78%）, while it was 42 cases（93. 33%） of the control group,with no statistical difference between the two groups（P〈0. 05）. Total bilirubin（TBil） in the two groups all turned to normal. rt M204 I variation occurred in 1 case（2. 22%） of the treatment group and 2 cases（4. 44%） in the cont

关 键 词：慢性乙型肝炎 替比夫定片 健脾补肾方 细胞毒性T淋巴细胞 HBEAG血清学转换 

分 类 号：R512.62[医药卫生—内科学]