中西医结合治疗婴儿巨细胞病毒肝炎对机体Th1/Th2免疫功能的影响

Effects on serum Th1/Th2 cytokines immunity functions of infant cytomegalovirus (CMV) hepatitis treated by traditional Chinese medicine combined with western medicine

目的:评价中西医结合治疗对巨细胞病毒(CMV)肝炎患儿机体Th1/Th2免疫功能的影响。方法:36例患儿随机分为治疗组19例、对照组17例。两组均采用更昔洛韦诱导期治疗:每次5mg/kg,每12h静点1次,连用2周;3-8周为每周静点5d,剂量为每次5mg/kg,1次/d,同时给予维生素C、能量合剂、葡醛内酯片保肝对症,治疗组在此基础上加用中药:黄疸期予利胆退黄方,黄疸消退转氨酶升高期予益肝降酶方,两组总疗程均为8周。检测治疗前及治疗8周后两组患儿总胆红素(TBIL)、直接胆红素(DBIL)水平、谷丙转氨酶(ALT)水平及细胞因子白介素-10(IL-10),干扰素-γ(IFN-γ)水平变化。结果:两组均能有效减轻患儿黄疸水平并改善肝功能(P<0.01),两组均可提升机体受抑制的IFN-γ水平(P<0.01),仅治疗组可降低机体较亢进的IL-10水平(P<0.01),而对照组对机体IL-10的影响无显著变化。治疗组未见明显不良反应。结论:应用更昔洛韦联合中药辨证分期治疗婴儿CMV肝炎,不仅可以促进临床症状缓解,而且对机体的Th1/Th2免疫调节作用也优于单纯应用更昔洛韦治疗。

Objective： To evaluate the efficacy of treating infant cytomegalovirus （CMV） hepatitis with intergrated traditional Chinese medicine and western medicine and impact on cytokines of Thl/Th2. Methods： 36 infants with CMV hepatitis were randomly divided into treatment group （19） and control group （17）. Treatment group： the patients who were at the stage of jaundice took orally liver-clearing and cholagogue soup. When the jaundice faded away but the transaminase was still high, took the soup which can reinforce liver and drop enzyme. Meanwhile, Ganciclovir was given through intravenous drip （5mg/kg each time, ql2h for the first two weeks and 5mg/kg each time, qd, five days every week for the 3 to 8 weeks）. Control group： Ganciclovirwas given through intravenous drip the same as the treatment group and took orally Glucurolactone （50mg each time, tid）. Before and after treatment for 8weeks, the total bilirubin （TBIL）, direct bilirubin （DBIL） levels, cereal third transaminase （ALT） levels and cytokine 1L-10, IFN-7 level were determined. Results： Both of two groups could decline the jaundice （P〈0.01）, improve liver functions （P〈0.01） and could increase the IFN-~t levels （P〈0.01）. But only the treatment group could decrease the IL-10 level （P〈0.01） while there was no influence on IL-10 of control group. And there was no adverse reaction in treatment group. Conclusion： The stage treatment of traditional Chinese medicine syndrome differentiation combined with ganciclovir could not only significantly improve clinical symptoms, but is superior to application of ganciclovir only about Thl/Th2 immune regulating effect.