解毒化瘀通腑颗粒治疗亚急性和慢加急性肝衰竭患者的疗效及其对TLR4/NF-κB炎性通路的影响  

The curative effect of Jiedu Huayu Tongfu Decoction with SALF&ACLF patients and on TLR4/NF-κB

作　　者：刘巧红 刘江凯[2] 李素领[2] LIU Qiao-hong;LIU Jiang-ka;LI Suling(Department of Hepatology Diseases,Henan university of traditional Chinese medicine（zhengzhou henan,450046 China)

机构地区：[1]河南中医药大学第一临床医学院,河南郑州450046 [2]河南中医药大学第一附属医院脾胃肝胆科

出　　处：《中西医结合肝病杂志》2018年第5期264-267,共4页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：国家自然科学基金联合基金项目(No.U1504825);河南省中医药科研专项(No.2017ZY2092)

摘　　要：目的:评价解毒化瘀通腑颗粒对亚急性和慢加急性肝衰竭(SALF及ACLF)患者的治疗效果,并观察该方对TLR4/NF-κB炎性通路的影响。方法:将68例SALF及ACLF患者按随机数字表法随机分为两组,其中对照组患者给予常规内科综合支持治疗,试验组患者在对照组基础上加用解毒化瘀通腑颗粒。结果:治疗后试验组患者治疗总有效率明显高于对照组,差异有统计学意义(P <0. 05);与治疗前相比,两组患者肝功能相关指标、凝血酶原活动疫(PTA)、血浆内毒素(ET)均明显改善(P <0. 05),且试验组患者在血清总胆红素(TBil)、血清直接胆红素(DBil)、PTA、ET指标改善方面明显优于对照组(P <0. 05);而两组患者的血清胆碱酯酶(Che)、白蛋白(Alb)、谷氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)水平方面,差异无统计学意义(P> 0. 05);治疗后两组患者的肿癌坏死因子-α(TNF-α)、白细胞介素-6(IL-6)均降低,且试验组均明显低于对照组,差异具有统计学意义(P <0. 05);治疗后两组患者的TLR4mRNA及NF-κBm RNA的表达较治疗前均降低,且试验组明显低于对照组,差异具有统计学意义(P <0. 05)。结论:解毒化瘀通腑颗粒可减轻SALF及ACLF患者临床症状,改善肝脏胆汁淤积状态,减轻肝损伤。其作用机制可能是通过促进患者内毒素的排泄或者抑制其吸收,减少内毒素的肝脏毒性反应,减轻肝损伤;并通过降低血清内毒素水平,影响患者TLR4/NF-κB信号通路,减少TNF-a、IL-6等相关炎性因子的产生及释放,达到减轻肝损伤的目的。Objective：To evaluate the therapeutic effect of Jiedu Huayu Tongfu Granule on subacute and slowly acute hepatic failure. Methods： Sixty-eight eases who were diagnosed as subaeute or acute on chronic liver failure patients were divided into 2 groups randomly, the control group received routine comprehensive support treatment, the experimental group was given Jiedu Huayu Tongfu granuleson on the basis of the control group. Results ： After treatment, the total effective rate of experimental group was significantly higher than the control group, the difference was statistically significant （ P 〈 0.05 ） ; compared with before treatment, the related indicator of liver function, PTA and ET of 2 groups were significantly improved （ P 〈 0.05 ）, and in the experimental group, TBIL, DBIL, PTA, ET index improved significantly better than the control group （ P 〈 0.05 ）, while, there was no statistically significant between the two groups about the improvement of CHE, ALB, ALT, AST,ALP GGT（P 〉 0.05）. The TNF-α,IL-6 of the two groups were both decreased,and the experimental group was significantly lower than the control group（P 〈 0.05） ;After treatment,the expression of TLR4mRNA、NF-κBmRNA was lower than before treatment,and the experimental group was significantly lower than the control group （ P 〈 0.05 ）. Conclusion： Jiedu Huayu Tongfu decoction can improve the clinical symptoms of SALF＆ACLF patients ,improve the metabolism and synthesis function of liver;Jiedu Huayu Tongfu prescription may promote excretion or inhibit the absorption of SALF＆ACLF of endotoxin, reduce the liver toxicity from endotoxin, improve liver injury;Jiedu Huayu Tongfu may impact the TLR4/NF-κB signaling pathway by lowering the serum endotoxin level of the patients ,to reduce the release of inflammatory eytokines such as TNF-α , IL-6 and cut down the damage of liver cells, and to treat SALF＆ACLF.

关 键 词：肝衰竭 内毒素血症 解毒化瘀通腑颗粒 TLR4/NF-κB 

分 类 号：R259[医药卫生—中西医结合]