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目的探讨苦参素治疗HBe Ag阳性慢性乙型肝炎(CHB)的疗效及对患者免疫功能的影响,为CHB的治疗提供依据。方法选择2015年1月至2016年6月鹤壁市传染病医院诊治的229例HBe Ag阳性CHB患者作为研究对象,随机分为联合治疗组(112例)和对照组(117例)。对照组采用重组人干扰素α-2b(IFN-α-2b)肌内注射治疗,疗程6个月;联合治疗组在对照组基础上采用苦参素注射液静脉滴注治疗3个月,苦参素片口服治疗3个月。治疗6个月后,观察两组患者治疗前后肝功能和肝脏纤维化指标改善情况以及患者免疫功能改善情况。用SPSS 17.0软件进行数据的统计处理,组间比较用t检验、χ2检验。结果治疗6个月后,联合治疗组患者血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)和总胆红素(TBIL)水平[分别为(45.5±7.6)IU/L、(48.3±13.6)IU/L和(15.0±3.9)μmol/L]均较对照组明显下降[分别为(82.4±8.3)IU/L、(68.3±13.1)IU/L和(16.2±3.2)μmol/L],差异均有统计学意义(P<0.05);联合治疗组患者HBe Ag和HBV-DNA转阴率及HBe Ag/HBe Ab血清转换率(分别为39.29%、52.68%和33.93%)均明显高于对照组(23.93%、37.61%和19.66%),差异均有统计学意义(P<0.05)。治疗后,联合治疗组患者肝纤维化指标血清透明质酸(HA)、Ⅲ型前胶原N端肽(PⅢP)、Ⅳ型胶原(Ⅳ-C)和层黏连蛋白(LN)水平[分别为(127.6±18.4)ng/ml、(43.7±17.4)pg/ml、(36.5±16.4)ng/ml和(44.2±13.7)ng/ml]均明显低于对照组[(167.8±19.7)ng/ml、(60.3±17.8)pg/ml、(46.7±17.6)ng/ml和(53.7±12.7)ng/ml],差异均有统计学意义(P<0.05)。治疗后,联合治疗组患者外周血CD4~+T细胞、CD4~+/CD8~+比值、IFN-γ和白细胞介素(IL)-2表达水平[分别为39.4%±4.5%、1.6±0.5、(65.4±8.5)pg/ml和(206.4±29.6)pg/ml]均较对照组[35.8%±5.7%、1.4±0.3、(47.9±8.7)pg/ml和(134.3±26.5)pg/ml]明显升高,差异均有统计学意义(P<0.05);联合治疗组患者外周血CD8~+T细胞、IL-4和IL-10表达水平[分别为25.3%±5.4%、(19.7±5.7)pg/ml和(137.6±27.3)pg/ml]均较对照组[分别为28.8%±6.8%、(23.5±6.2)pg/ml和(154.4±30.6)pg/ml]明显下降,差异均有统计学意义(P<0.05)。结论苦参素辅助治疗CHB,可明显改善患者的肝功能,减轻肝脏纤维化,增强患者1型辅助T淋巴细胞(Th1)型细胞免疫应答,有利于HBV的清除。
Objective To investigate the curative effect of oxymatrine on HBeAg-positive chronic hepatitis B (CHB) and its effect on immune function in patients with CHB. Methods 229 HBe Ag positive CHB patients diagnosed and treated in Hebi City Infectious Disease Hospital from January 2015 to June 2016 were randomly divided into combined treatment group (112 cases) and control group (117 cases). The control group received intramuscular injection of recombinant human interferon α-2b (IFN-α-2b) for 6 months. The combination therapy group was treated with oxymatrine injection for 3 months on the basis of the control group, Ginseng tablets oral treatment for 3 months. After 6 months of treatment, the improvement of liver function and liver fibrosis index and the improvement of immune function in both groups before and after treatment were observed. SPSS 17.0 software for statistical analysis of data between groups using t test, χ2 test. Results After six months of treatment, the levels of serum ALT, AST and TBIL in the combined treatment group were (45.5 ± 7.6) IU / L, ( 48.3 ± 13.6 IU / L and 15.0 ± 3.9 μmol / L, respectively] were significantly lower than those in the control group (82.4 ± 8.3 IU / L, 68.3 ± 13.1 IU / L and 16.2 ± 3.2 μmolol / / L], the difference was statistically significant (P <0.05). The HBeAg and HBV-DNA negative rates and HBe Ag / HBe Ab seroconversion rate in the combined treatment group were 39.29%, 52.68% and 33.93%, respectively Were significantly higher than the control group (23.93%, 37.61% and 19.66%), the differences were statistically significant (P <0.05). After treatment, the levels of serum HA, PⅢP, Ⅳ-C and LN were significantly higher in the combined treatment group [ (127.6 ± 18.4) ng / ml, (43.7 ± 17.4) pg / ml, (36.5 ± 16.4) ng / ml and (44.2 ± 13.7) ng / ml] ml, (60.3 ± 17.8) pg / ml, (46.7 ± 17.6) ng / ml and (53.7 ± 12.7) ng / ml respectively). The difference was statistically significant (P <0.05). After treatment, the levels of CD4 ~ + T cells, CD4 ~ + / CD8 ~ +, IFN-γ and IL-2 in the peripheral blood of the combination group were 39.4% ± 4.5% and 1.6 ± 0.5 (35.8% ± 5.7%, 1.4 ± 0.3, (47.9 ± 8.7) pg / ml and (134.3 ± 26.5) pg / ml) were significantly higher than those in the control group (65.4 ± 8.5 pg / ml and 206.4 ± 29.6 pg / (P <0.05). The levels of CD8 + T cells, IL-4 and IL-10 in the peripheral blood of the combination therapy group were 25.3% ± 5.4% and 19.7 ± 5.7) pg / ml and (137.6 ± 27.3) pg / ml] were significantly lower than those in the control group [28.8% ± 6.8%, (23.5 ± 6.2) pg / ml and (154.4 ± 30.6) pg / ml] The differences were statistically significant (P <0.05). Conclusion Oxymatrine is an effective adjuvant treatment of CHB, which can significantly improve liver function, reduce liver fibrosis and enhance type 1 T helper lymphocyte (Th1) -type cellular immune response, which is good for the clearance of HBV.