解毒化瘀Ⅱ方对慢加急性肝衰竭患者免疫重建的影响  

Study on the Effect of Jiedu Huayu Formula Ⅱ on Immune Reconstitution in Patients with Chronic Acute Liver Failure

作　　者：石清兰[1] 吴金玉[1] 毛德文[1] 柏文婕[2] 韦华柱 黄祖鸿 莫展进 SHI Qinglan;WU Jinyu;MAODewen;BO Wenjie;WEI Huazhu;HUANG Zuhong;MO Zhanjin(The First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning 530023 Guangxi,China;Guangxi University of Chinese Medicine,Nanning 530200 Guangxi,China)

机构地区：[1]广西中医药大学第一附属医院,广西南宁530023 [2]广西中医药大学,广西南宁530200

出　　处：《中药新药与临床药理》2022年第3期392-397,共6页Traditional Chinese Drug Research and Clinical Pharmacology

基　　金：国家自然科学基金地区基金项目(81760849,82060847);广西自然科学基金面上项目(2020GXNSFAA297205,2020GXNSFAA297206);广西高校中青年教师科研基础能力提升项目(2020KY07024);广西中医药大学广西一流学科建设开放课题(2019xk022,2019XK011);广西中医药大学博士研究生科研创新项目(YCBSY2020001,YCBSY2020003)。

摘　　要：目的评价解毒化瘀Ⅱ方治疗慢加急性肝衰竭(ACLF)的临床疗效及对免疫重建的影响。方法将112例患者随机分为对照组和观察组,每组各56例。对照组采用西医综合治疗措施;观察组在对照组的基础上加服解毒化瘀Ⅱ方,2组疗程均为8周。观察两组患者治疗前后细胞免疫[T淋巴细胞亚群(CD4^(+)、CD8^(+))、调节性T细胞(Treg细胞)、辅助性T细胞17(Th17)]和相关炎症因子[白细胞介素(IL)-2、IL-10、IL-17、转化生长因子β1(TGF-β1)]的变化,评价治疗前后终末期肝病模型(MELD)评分和慢性肝衰竭联盟-慢加急性肝衰竭预后(CLIF-CACLF)评分。结果(1)治疗后,两组患者T淋巴细胞CD4^(+)、Treg细胞水平和CD4^(+)/CD8^(+)比值升高(P<0.05),CD8^(+)、Th17水平和Th17/Treg比值降低(P<0.05),且治疗后观察组CD4^(+)、Treg细胞水平和CD4^(+)/CD8^(+)比值高于对照组,CD8^(+)、Th17水平和Th17/Treg比值低于对照组(P<0.05)。(2)治疗后,两组患者IL-2、IL-17和TGF-β1水平降低,IL-10水平升高(P<0.01);且治疗后观察组IL-2、IL-17和TGF-β1低于对照组,IL-10水平高于对照组(P<0.01)。(3)治疗后,两组患者MELD和CLIF-CACLF评分均降低(P<0.01),且治疗后观察组MELD和CLIF-CACLF评分均低于对照组(P<0.01)。(4)观察组临床总有效率为90.20%(46/51),高于对照组的75.00%(39/52)(χ^(2)=4.125,P<0.05)。结论解毒化瘀Ⅱ方联合西医综合治疗可调节ACLF患者免疫功能,促进免疫重建,减轻病情严重程度,临床疗效优于单纯西医治疗。Objective To evaluate the clinical efficacy of Jiedu Huayu FormulaⅡin the treatment of chronic-onset acute liver failure(ACLF)and its influence on immune reconstitution.Methods The one hundred and twelve patients were randomly divided into control group and observation group,with 56 cases in each group.Patients in the control group adopted comprehensive western medicine treatment measures.On the basis of the control group,patients in the observation group took Jiedu Huayu FormulaⅡ.The treatment course was 8 weeks for both groups.The cellular immunity including levels of T lymphocyte subsets(CD4^(+),CD8^(+)),regulatory T cells(Treg cells),helper T cell 17(Th17),and the related inflammatory factors Interleukin(IL)-2,IL-10,IL-17 and transforming growth factorβ1(TGF-β1)of two groups were compared.The end-stage liver disease model(MELD)score and the chronic liver failure combined-chronic plus acute liver failure prognosis(CLIF-CACLF)score before and after therapy were also evaluated.Results (1)After treatment,the levels of CD4^(+),Treg cells and the ratios of CD4^(+)/CD8^(+)increased(P<0.05),while the levels of CD8^(+),Th17,and the ratios of Th17/Treg decreased(P<0.05)in both groups.Moreover,the CD4^(+),Treg cell levels and CD4^(+)/CD8^(+)ratio of the observation group were higher than those of the control group,and the CD8^(+),Th17 levels and Th17/Treg ratio were lower than those of the control group after treatment(P<0.05).(2)After treatment,the levels of IL-2,IL-17 and TGF-β1 in the two groups decreased,and the level of IL-10increased(P<0.01).The IL-2,IL-17 and TGF-β1 of the observation group were lower than those of the control group,while the level of IL-10 was higher than that of the control group after therapy(P<0.01).(3)After treatment,the MELD and CLIF-CACLF scores of patients in two groups decreased on averages(P<0.01),and the MELD and CLIF-CACLF scores of the observation group after treatment were lower than those of the control group(P<0.01).(4)The total effective rate of clinical curative effect i

关 键 词：慢加急性肝衰竭 解毒化瘀Ⅱ方 体液免疫 细胞免疫 炎症因子 预后 临床观察 

分 类 号：K285.6[历史地理—历史学]