茵陈五苓散加减联合阿德福韦酯对慢性乙型肝炎病毒复制及免疫功能的影响  

Effect of Yinchen Wuling Powder combined with adefovir dipivoxil on virus replication and immune function of chronic hepatitis B

作　　者：高乾峰 

机构地区：[1]安徽医科大学附属六安医院,安徽六安237005

出　　处：《现代中西医结合杂志》2018年第6期597-600,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的探讨茵陈五苓散加减联合阿德福韦酯对慢性乙型肝炎病毒复制及免疫功能的影响。方法将158例慢性乙型肝炎患者随机分为2组,西医组79例给予阿德福韦酯治疗,联合组79例给予阿德福韦酯联合茵陈五苓散加减治疗,疗程均为48周。观察2组治疗前、治疗24周、治疗48周时血清HBV-DNA、HBeAg、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)和总胆红素(TBil)、HBV特异性细胞毒性T淋巴细胞(HBV特异性CTL)、外周血HBV特异性CTL表面PD-1表达和外周血滤泡辅助性T淋巴细胞(Tfh)的水平,统计HBV DNA和HBeAg转阴率、HBeAg血清转换率和治疗期间的不良反应。结果治疗24周、48周时联合组AST、ALT、TBil、外周血HBV特异性CTL表面PD-1表达水平均显著低于同期西医组(P均<0.05),HBV特异性CTL、Tfh水平均显著高于同期西医组(P均<0.05);治疗48周时HBV-DNA和HBeAg转阴率、HBeAg血清转换率均高于西医组(P均<0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论茵陈五苓散加减联合阿德福韦酯治疗慢性乙型肝炎具有协同作用,可提高机体抗病毒免疫功能,抑制病毒复制,改善肝功能,具有临床应用价值。Objective It is to investigate the effect of Yinchen Wuling Powder combined with adefovir dipivoxil on replication and immune function of chronic hepatitis B virus. Methods 158 patients with chronic hepatitis B were randomly divided into 2 groups and 79 patients in each group. The patients were treated with adefovir dipivoxil in the western medicine group,and with Yinchen Wuling Powder combined with adefovir dipivoxil in the combination group,the course of treatment was 48 weeks. The levels of serum HBV DNA,HBeAg,aspartate aminotransferase（ AST）,alanine aminotransferase（ ALT） and total bilirubin（ TBil）,HBV specific cytotoxic T lymphocytes（ HBV specific CTL）,the expression of PD-1 on the surface of peripheral blood HBV specific CTL,and follicular helper T lymphocyte（ Tfh） in peripheral blood were detected in the two groups before treatment,and after 24 weeks and 48 weeks of treatment,the negative rate of HBV DNA and HBeAg,the seroconversion rate of HBeAg and the adverse reaction during the treatment were analyzed. Results The level of AST,ALT,TBil and the expression of PD-1 on the surface of peripheral blood HBV specific CTL after 24 weeks and 48 weeks of treatment were significantly lower than those of the western medicine group over the same period（ all P 0. 05）,and the specific CTL and Tfh of HBV were significantly higher than those in the western medicine group（ all P 0. 05）. At 48 weeks,the negative rate of HBV DNA and HBeAg and the conversion rate of HBeAg were significantly higher than those in the western medicine group（ all P 0. 05）. There was no significant difference in the incidence of adverse reactions between the 2 groups（ P 0. 05）. Conclusion Yinchen Wuling Powder combined with adefovir dipivoxil has a synergistic effect in treatment of chronic hepatitis B,it can improve the immune function of the body,inhibit viral replication,improve liver function,it has clinical application value.

关 键 词：慢性乙型肝炎 茵陈五苓散 阿德福韦酯 HBV特异性细胞毒性T淋巴细胞 外周血滤泡辅助性T淋巴细胞 

分 类 号：R512.62[医药卫生—内科学]