补肾法和清肝法对慢性乙型肝炎患者细胞免疫调控作用的比较研究

Immunoregulatory effects of supplementing kidney method and clearing liver method on chronic hepatitis B:a comparative study

目的比较补肾法和清肝法治疗轻中度慢性乙型肝炎患者的疗效及其对细胞免疫功能的调控作用。方法采用随机、对照方法将40例患者分为补肾组和清肝组,各20例;补肾组给予巴菟补肾益肝颗粒,清肝组给予双虎清肝颗粒,疗程12周。观察治疗前后中医证候积分、肝功能、T淋巴细胞亚群和IL-2、IL-6、IL-8、IL-10、IFN-γ等细胞因子变化。结果补肾组总有效率为95.0%,对照组为90.0%;两组临床疗效比较,差异有统计学意义(P<0.01)。治疗后两组中医证候积分均显著降低(P<0.01),且补肾组积分降低幅度较清肝组显著(P<0.05)。治疗后,两组主要症状积分较治疗前均显著降低(P<0.01),补肾组腰膝酸软、耳鸣等症状积分显著低于清肝组(P<0.05)。两组肝功能指标有不同程度改善(P<0.05,P<0.01),但两组之间无显著性差异(P>0.05)。补肾组CD3+、CD4+、CD4+/CD8+T淋巴细胞比例显著提高(P<0.05),而清肝组治疗前后T淋巴细胞亚群均无统计学差异(P>0.05);两组间比较,各T淋巴细胞亚群均无统计学差异(P>0.05)。补肾组IL-2、IFN-γ水平显著增加(P<0.05),IL-6、IL-8水平降低(P<0.05),清肝组IL-6水平降低(P<0.05);两组间比较,IL-2、IL-6、IL-8、IFN-γ均有显著差异(P<0.05)。结论补肾法和清肝法均能显著改善慢性乙型肝炎患者的临床症状和肝功能,但补肾法免疫调控作用显著优于清肝法。

Objective To compared the clinical efficacy of supplementing kidney method and cleating liver method on chronic hepatitis B and its regulatbry effect in cellular immune function. Methods Forty cases were divided into supplementing kidney group and cleating liver group by randomized controlled trial, with 20 cases in each group. The supplementing kidney group was treated with ＂ Batu Bushen Yigan Granule＂, and cleating liver group was treated with ＂ Shuanghu Qinggan Granule＂, with the course of 12 weeks. The TCM syndrome score, liver function, T-lymphocyte subsets and changes of IL-2, IL-6, IL-8, IL-10 and IFN-γ were observed. Results The total effective rate was 95.0% in supplementing kidney group and 90.0% in the control group, with a difference between the two groups （P 〈 0.01 ）. After treatment, the TCM syndrome scores were reduced in both groups （P 〈 0.01 ）, and the reduction of TCM syndrome score in supplementing kidney group was much more than that of the cleating liver group （ P 〈 0.05 ）. The main symptoms scores in both groups were reduced markedly （ P 〈 0. O1 ）, and scores of aching and weakness of waist and knees, scores of tinnitus in supplementing kidney group were lower than that of the cleating liver group （ P 〈 0.05 ）. The liver function indexes in both groups were improved （ P 〈 0.05, P 〈 0.01 ） , without significant difference between the two groups （ P 〉 0.05 ）. The CD3 ＋ , CD4＋and CD4＋/CD8＋ in supplementing kidney group were increased markedly （ P 〈 0.05 ） , and no statistical difference was found in T-lymphocyte subsets in cleating liver group （ P 〉 0.05 ） ; without significant difference in T-lymphocyte subsets between the two groups （ P 〉 0.05 ）. In supplementing kidney group, the levels of IL- 2 and IFN-γ were increased markedly （ P 〈 0.05 ）, the levels of IL： 6 and IL- 8 were reduced （ P 〈 0.05 ）. In clearing liver group, the IL-6 level was reduced （P 〈 0.05） , with significant differences in IL-2, IL-6, IL-8 and IFN-γ between the two groups （ P 〈 0.05 ）. Conclusion Supplementing kidney method and cleating liver method can improve the clinical symptoms and liver function in patients with chro＇nic hepatitis B. While, the immunoregulatory effect of supplementing kidney method is better than that of the clearing liver method.