温阳化浊退黄汤治疗HBV感染相关慢加急性肝衰竭的效果及对PD-1/PD-L1表达的影响  

Effect of Wenyang Huazhuo Tuihuang decoction on treatment of HBV infection-associated acute-on-chronic liver failure and impact on expressions of PD-1/PD-L1

作　　者：何丽杰 车启富 李明友 HELi-jie;CHE Qi-fu;LI Ming-you(Jiamusi Traditional Chinese Medicine Hospital,Jiamusi,Heilongjiang 154002,China;不详)

机构地区：[1]佳木斯市中医医院消化科,黑龙江佳木斯154002 [2]佳木斯市中医医院呼吸循环内科,黑龙江佳木斯154002 [3]佳木斯市传染病院肝病中心,黑龙江佳木斯154007

出　　处：《中华医院感染学杂志》2024年第2期215-219,共5页Chinese Journal of Nosocomiology

基　　金：黑龙江省卫生计生委科研课题(2018203)。

摘　　要：目的分析温阳化浊退黄汤治疗乙型肝炎病毒(HBV)感染相关慢加急性肝衰竭(ACLF)的效果及对肝功能指标、程序性死亡因子-1/程序性死亡因子配体-1(PD-1/PD-L1)表达水平的影响。方法采用随机数字表法将86例HBV感染相关ACLF患者分为A组和B组,每组43例,A组给予常规治疗,在A组患者治疗的基础上,B组患者辅以温阳化浊退黄汤进行治疗,均连续治疗8周,比较两组临床疗效、肝功能指标、PD-1/PD-L1、终末期肝病模型(MELD)评分及安全性。结果治疗8周后,B组总有效率高于A组(76.74%vs.44.19%)(P<0.05);两组血清谷草转氨酶(GOT)、直接胆红素(DBIL)、外周血CD_(4)^(+)PD-1^(+)、CD_(4)^(+)PD-L1^(+)、CD_8~+PD-1^(+)、CD_8~+PD-L1^(+)水平较治疗前降低(P<0.05),且B组降低值大于A组(P<0.05);两组血清白蛋白(ALB)、胆碱酯酶(CHE)水平较治疗前升高(P<0.05),且B组升高值大于A组(P<0.05);治疗4、8周后,两组MELD评分均低于治疗前(P<0.05),治疗8周后MELD评分低于治疗4周后(P<0.05),与A组比较,B组MELD评分较低(P<0.05);治疗期间,两组均未出现严重不良反应。结论温阳化浊退黄汤可有效降低HBV感染相关ACLF患者MELD评分,提高患者肝功能,并降低PD-1/PD-L1的表达,进而有效提高临床疗效,且安全性良好。OBJECTIVE To observe the effect of Wenyang Huazhuo Tuihuang decoction on treatment of hepatitis B virus(HBV)infection-associated acute-on-chronic liver failure(ACLF)and analyze the impact on liver function indexes and expression levels of programmed death factor-1/programmed death factor ligand-1(PD-1/PD-L1).METHODS A total of 86 patients with HBV infection-associated ACLF were randomly divided into the group A and the group B,with 43 cases in each group.The group A was given conventional therapy,the group B was trea-ted with Wenyang Huazhuo Tuihuang decoction on basis of the therapy of the group A.Both groups were treated for 8 consecutive weeks.The clinical therapeutic effects,liver function indexes,PD-1/PD-L1,model for end-stage liver disease(MELD)score and safety were observed and compared between the two groups.RESULTS After the treatment for 8 weeks,the total effective rate of the group B was 76.74%,higher than 44.19%of the group B(P<0.05).The levels of serum glutamic oxaloacetic transaminase(GOT),direct bilirubin(DBIL),peripheral blood CD_(4)^(+)PD-1^(+),CD_(4)^(+)PD-L1^(+),CD8+PD-1^(+)and CD8+PD-L1^(+)of the two groups were lower after the treat-ment than before the treatment(P<0.05),and the levels of the above indexes of the group B were lower than those of the group A(P<0.05).The levels of serum albumin(ALB)and cholinesterase(CHE)of the two groups were higher after the treatment than before the treatment(P<0.05),and the levels of the above indexes of the group were higher than those of the group A(P<0.05).The MELD score of the two groups was lower after the treatment for 4 and 8 weeks than before the treatment(P<0.05),the MELD score was lower after the treat-ment for 8 weeks than after the treatment for 4 weeks(P<0.05),and the MELD score of the group B was lower than that of the group A(P<0.05).There were no severe adverse reactions in both groups during the treatment.CONCLUSION Wenyang Huazhuo Tuihuang decoction can effectively reduce the MELD score of the patients with HBV infection-associated ACLF,bo

关 键 词：乙型肝炎病毒 慢加急性肝衰竭 温阳化浊退黄汤 肝功能 程序性死亡因子-1 程序性死亡因子配体-1 

分 类 号：R243[医药卫生—中医临床基础]