灵猫方联合替比夫定治疗慢性乙型肝炎患者的疗效及对NK细胞功能的影响  

Therapeutic Effect of “Lingmao Decoction” Combined with Telbivudine in Treating Patients with Chronic Hepatitis B and the Influence on the Function of NK Cells

作　　者：江云[1] 高月求[1] 李曼[1] 张鑫[1] 周振华[1] 

机构地区：[1]上海中医药大学附属曙光医院肝病科,上海201203

出　　处：《上海中医药大学学报》2017年第2期16-21,共6页Academic Journal of Shanghai University of Traditional Chinese Medicine

基　　金：国家自然科学基金资助项目(81403237;81473477;81403354;81473629;81403351;81503545);国家"艾滋病和病毒性肝炎等重大传染病防治"科技重大专项项目(2012ZX10005004-002);上海市青年科技启明星计划项目(13QA1403500);上海市科委科技支撑计划项目(13401902900);上海市科委扬帆计划项目(14YF1411600;15YF1412300);上海市中医药事业发展三年行动计划项目(ZYSNXD-CC-ZDYJ015;ZY3-CCCX-3-3027);上海市卫生局优秀青年人才培养计划项目(XYQ2013093);中国肝炎防治基金会王宝恩肝纤维化研究基金资助项目(CFHPC20131045;CFHPC20131046);上海中医药大学预算内项目(2013JW40;2014YSN39)

摘　　要：目的:观察灵猫方联合替比夫定治疗慢性乙型肝炎(CHB)患者的临床疗效及其对患者外周血自然杀伤细胞(NK)数量、功能的影响,探讨灵猫方治疗CHB的免疫调节机制。方法:纳入54例符合标准的CHB患者,随机分为单用组27例和联合组27例,同时纳入10例健康志愿者作为健康对照组。两组均给予口服替比夫定治疗,联合组加服灵猫方,疗程为24周。治疗3个月、6个月时,评价两组患者的中医证候积分,检测两组患者的谷丙转氨酶(ALT)、谷草转氨酶(AST)、HBV-DNA定量、HbeAg、外周血NK细胞数量及细胞表面和胞内Toll样受体(TLRs)的表达水平,比较两组患者的ALT、AST复常率,HBV-DNA阴转率和HBeAg血清转换率。结果:治疗3个月、6个月后,两组患者的中医证候积分较治疗前均显著降低(P<0.05,P<0.01),且联合组患者的中医证候积分明显低于单用组(P<0.01)。治疗3个月、6个月后,两组患者的ALT、AST水平均显著降低(P<0.01),且治疗3个月时,联合组患者的ALT、AST水平低于单用组(P<0.05),ALT、AST复常率明显高于单用组(P<0.05)。治疗3个月、6个月后,两组患者的HBVDNA、HBeAg水平均明显降低(P<0.01),但两组患者的HBV-DNA转阴率、HBeAg血清转换率比较,差异无统计学意义(P>0.05)。与健康对照组比较,CHB患者的外周血NK细胞数量明显减少(P<0.05),NK细胞胞内TLR3、TLR9表达水平显著降低(P<0.05);治疗3个月、6个月后,两组患者的NK细胞数量及胞内、胞外TLR3、TLR9表达水平较治疗前均明显提高(P<0.05),且联合组患者NK细胞数量及其胞内TLR3表达水平明显高于单用组(P<0.05)。结论:灵猫方联合替比夫定可显著改善CHB患者的中医证候和肝功能,灵猫方的作用机制可能与提高患者的NK细胞数量及其胞内外TLR3的表达水平,从而调节机体的免疫功能有关。Objective：To observe the clinical curative effect of ＂Lingmao Decoction＂ combined with telbivudine in the treatment of chronic hepatitis B（CHB） and its influence on the quantity and function of natural killer（NK） cells in peripheral blood,and explore the immune regulation mechanism of ＂Lingmao Decoction＂in treating CHB.Methods：A total of 54 patients of CHB who match the inclusion criteria were randomly divided into the single treatment group（27 cases） and the combination treatment group（27 cases）,meanwhile 10 healthy volunteers were selected as the healthy control group.The patients in both groups were treated with telbivudine orally and the patients in the combination treatment group were treated with＂Lingmao Decoction＂in addition,with a course of 24 weeks.Three months and six months after treatment,the scores of Chinese medical syndrome were evaluated,the levels of ALT,AST,HBV-DNA,Hbe Ag,NK cells in peripheral blood and the expressions of Toll-like receptors（TLR） on cell surface and within cell were detected,and the recovery rates of ALT and AST,the negative conversion rate of HBV-DNA and the HBeAg seroconversion rate were compared.Results：Three months and six months after treatment,the Chinese medical syndrome scores of both groups were markedly decreased（P0.05,P0.01）,and the scores of the combination treatment group were lower than those of the single treatment group（P0.01）.Three months and six months after treatment,the levels of ALT and AST of both groups were significantly decreased（P0.01）,and three months after treatment,the levels of ALT and AST of the combination treatment group were lower than those of the single treatment group（P0.05） and the recovery rates of ALT and AST of the combination treatment group were obviously higher than those of the single treatment group（P0.05）.Three months and six months after treatment,the levels of HBV-DNA and HBeAg of both groups were obviously decreased（P0.01）,while there were no statistical differences o

关 键 词：灵猫方 替比夫定 慢性乙型肝炎 NK细胞 TLR3 TLR9 

分 类 号：R512.62[医药卫生—内科学]