| 引用本文:黄风雷1，张国梁2，李永生1.中西医结合治疗对乙型肝炎肝硬化失代偿期患者外周血Th/Treg平衡及淋巴细胞的影响研究[J].世界中医药,2019,(06):. |
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| 中西医结合治疗对乙型肝炎肝硬化失代偿期患者外周血Th/Treg平衡及淋巴细胞的影响研究 |
| Effects of Integrated Traditional Chinese and Western Medicine on Th/Treg Balance and Lymphocyte in Peripheral Blood of Patients with Decompensated Hepatitis B Cirrhosis |
| 投稿时间：2018-11-28 |
| DOI：10.3969/j.issn.1673-7202.2019.06.020 |
| 中文关键词: 中西医结合 乙型肝炎肝硬化 失代偿期 外周血Th/Treg平衡 淋巴细胞 肝功能 肝纤维化 安全性 |
| English Keywords:Integrated traditional Chinese and western medicine Hepatitis B cirrhosis Decompensated phase Th/Treg balance in peripheral blood Lymphocyte Liver function Liver fibrosis Safety |
| 基金项目:2016年度安徽省卫生计生委中医药科研课题(2016zy123) |
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| 中文摘要: |
| 目的:探究中西医结合治疗对乙型肝炎肝硬化失代偿期患者外周血Th/Treg平衡及淋巴细胞影响性,以期提高疗效,丰富治疗方法。方法:选取2017年2月至2018年8月安徽省淮北市中医医院收治符合纳入条件乙型肝炎肝硬化失代偿期患者80例作为研究对象,按照就诊顺序编号随机分为对照组与观察组,每组40例。对照组给予常规西医治疗予一般治疗、药物治疗、补充白蛋白和血浆、放腹水、积极防治各种并发症治疗,观察组加用中药汤剂治疗,每日1剂,均治疗4周。观察2组患者治疗前、完成治疗后淋巴细胞指标CD3+、CD4+、CD8+、CD4+/CD8+、CD19、自然杀伤细胞(NK细胞)变化并比较;观察2组患者治疗前、完成治疗后在辅助性T细胞(Th17)/调节性T细胞(Treg)平衡指标白细胞介素-17(IL-17)、IL-6和转化生长因子(TGF)-β变化并比较;观察2组患者治疗前、完成治疗后在肝功能、肝纤维化指标、谷丙转氨酶(ALT)、白蛋白(ALB)、白球比(A/G)、γ-谷氨酰转肽酶(γ-GT)、透明质酸(HA)、Ⅳ型胶原、层黏蛋白(LN)变化并比较;治疗过程中进行不良反应监测,并及时治疗,治疗结束后进行统计比较。结果:1)2组患者治疗前CD3+、CD4+、CD8+、CD4+/CD8+、CD19、NK细胞比较，差异无统计学意义(P>005),完成治疗后2组患者CD3+、CD4+、CD4+/CD8+、CD19、NK细胞较治疗前均显著上升,CD8+则显著下降(P<005),完成治疗后观察组患者CD3+、CD4+、CD4+/CD8+、CD19、NK细胞显著高于对照组,CD8+显著低于对照组(P<005)。2)2组患者治疗前Th17、IL-17、IL-6、Treg、TGF-β比较，差异无统计学意义(P>005),完成治疗后2组患者Th17、IL-17、IL-6较治疗前显著下降,Treg、TGF-β显著升高(P<005),完成治疗后观察组Th17、IL-17、IL-6显著低于对照组、Treg、TGF-β显著高于对照组(P<005)。3)2组患者治疗前ALT、ALB、A/G、γ-GT、HA、Ⅳ型胶原、LN比较，差异无统计学意义(P>005),完成治疗后2组患者ALT、ALB、γ-GT、HA、Ⅳ型胶原、LN较治疗前均显著下降、A/G较治疗前显著升高(P<005),完成治疗后观察组A/G显著高于对照组,余指标显著低于对照组(P<005)。4)观察组疲乏无力发生率显著低于对照组(P<005),而在恶心呕吐、肝功能异常比率比较，差异无统计学意义(P>005)。结论:中西医结合治疗能改善乙型肝炎肝硬化失代偿期患者外周血Th/Treg平衡,提供淋巴细胞水平,改善功能,从而提高疗效。 |
| English Summary: |
| To explore the effects of integrated traditional Chinese and western medicine on Th/Treg balance and lymphocyte in peripheral blood of patients with decompensated hepatitis B cirrhosis，so as to improve the curative effect and enrich the treatment methods.Methods:A total of 80 patients with decompensated hepatitis B cirrhosis admitted to Huaibei Hospital of Traditional Chinese Medicine from February 2017 to August 2018 were randomly divided into a control group(40 cases)and an observation group(40 cases).The control group was treated with routine western medicine，including general treatment，drug treatment，supplementation of albumin and plasma，ascites release，active prevention and treatment of various complications.The observation group was treated with Chinese herbal decoction，one dose a day，for 4 weeks.The changes of lymphocyte indexes CD3+，CD4+，CD8+，CD4+/CD8+，CD19 and natural killer cells(NK cells)were observed and compared before and after treatment in the 2 groups.The changes of balance indexes of helper T cells(Th17)/regulatory T cells(Treg)，interleukin-17(IL-17)，interleukin-6(IL-6)and transformational growth factor(TGF)were observed before and after treatment in the 2 groups were observed and compared before and after treatment.The changes of liver function，liver fibrosis index，alanine aminotransferase(ALT)，albumin(ALB)，albumin ratio(A/G)，gamma-glutamyltransferase(gamma-GT)，hyaluronic acid(HA)，type IV collagen and laminin(LN)were compared.During the process，adverse reactions were monitored and treated in time.Statistical comparisons were performed after treatment.Results:1)There was no significant difference in CD3+，CD4+，CD8+，CD4+/CD8+，CD19 and NK cells between the 2 groups before treatment(P>005).After treatment，CD3+，CD4+，CD4+/CD8+，CD19 and NK cells in the 2 groups increased significantly，while CD8+ decreased significantly(P<005).After treatment，CD3+，CD4+，CD4+/CD8+，CD19 and NK cells in the observation group were significantly higher than those in the control group，and CD8+ was significantly lower than that in the control group(P<005).2)There was no significant difference in Th17，IL-17，IL-6，Treg and TGF-β between the 2 groups before treatment(P>005).After treatment，Th17，IL-17 and IL-6 in the 2 groups decreased significantly，and Treg and TGF-β increased significantly(P<005).After treatment，Th17，IL-17 and IL-6 in the observation group were significantly lower than those in the control group，and Treg and TGF-β were significantly higher than those in the control group.Treg and TGF-β were significantly higher than those in the control group(P<005).3)There was no significant difference in ALT，ALB，A/G，γ-GT，HA，collagen IV and LN between the 2 groups before treatment(P>005).After treatment，ALT，ALB，γ-GT，HA，collagen IV and LN in the 2 groups decreased significantly compared with before treatment，and A/G increased significantly compared with before treatment(P<005).After treatment，A/G in the observation group was significantly higher than that in the control group(P<005).The remaining index was significantly lower than that in the control group(P<005).4)The incidence of fatigue and weakness in the observation group was significantly lower than that in the control group(P<005)，but there was no significant difference in the ratio of nausea，vomiting and abnormal liver function(P>005).Conclusion:Combination of traditional Chinese and western medicine can improve the balance of Th/Treg in peripheral blood of patients with decompensated hepatitis B cirrhosis，provide the level of lymphocyte and improve the function，so as to improve the curative effect. |
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