清温并用法对HBV-ACLF非阳黄证患者Treg/Th17型细胞因子表达的影响

Effects of clearing and warming method on the expression of Treg/Th17 cytokine in HBV-ACLF patients with non-syndrome of yang jaundice

目的:观察清温并用法对乙型肝炎慢加急性肝衰竭(HBV-ACLF)非阳黄证患者外周血清Treg/Th17型细胞因子表达的影响。方法:采用两中心、随机、对照设计方法,根据中央随机系统将36例非阳黄证的HBVACLF患者随机分为试验组和对照组,试验组20例,对照组16例,试验组为西医内科综合治疗基础上联合清温并用法,对照组为西医内科综合治疗,两组均治疗8周,应用ELISA法检测两组患者第0周及第8周时外周血清标本转化生长因子(TGF-β)、白介素(IL-10、IL-17、IL-23)的表达水平。结果:(1)治疗后,试验组在8周累计生存率高于对照组,但差异无统计学意义,而黄疸总体有效率,两组差异有统计学意义(P<0.05);在降低总胆红素(TBIL)、国际化标准比值(INR)、提高凝血酶原活动度(PTA),试验组明显优于对照组,差异有统计学意义(P<0.05);(2)治疗后两组患者外周血清IL-10、TGF-β、IL-17、IL-23水平均明显下降,差异有统计学意义(P<0.01);治疗后试验组较对照组仅在降低IL-17、IL-10水平方面,差异有统计学意义(P<0.05)。结论:清温并用法治疗HBV-ACLF非阳黄证患者能促进黄疸消退、改善凝血功能,或与其调节Treg/Th17型细胞因子减轻炎症反应有关。

Objective:To observe the effects of clearing and warming method on the expression of Treg/Th17 cytokine in serum of HBV-ACLF patients with non-syndrome of yang jaundice.Methods:Adopting double center,randomized controlled clinical design,36 cases of HBV-ACLF patients with non-syndrome of yang jaundice were divided randomly into trial group (20 cases)and control group (16 cases)by central randomization system.The trial group was treated by clearing and warming method based on Western medicine comprehensive treatment and the contol group was treated with Western medicine comprehensive treatment.All were treated for 8 weeks.The expression level of cytokines TGF-α,IL-10,IL-17and IL-23 in peripheral serum samples from the two groups at week 0 and week 8 were detected by ELISA.Results:①After 8 weeks treatment,the cumulative survival rate of the trial group at 8 weeks was higher than that of the control group,but the difference was not statistically significant,while the overall efficiency of janndice had statistically significant (P<0.05).The levels of TBIL,INR and PTA in the treatment group were superior to the control group (P<0.05).②)After treatment,the levels of serum IL-10,TGF-β,IL-17 and IL-23 in the two groups were significantly decreased,and the difference was statistically significant (P<0.01).After treatment, the trial group only decreased the levels of IL-17 and IL-10,and the difference was statistically significant (P<0.05).Conclusion: Clearing and warming method was applied in treatment of HBV-ACLF patients with non-syndrome of yang jaundice could promote jaundice subsided and improve coagulation function by possibly regulating Treg/Th17 cytokines to reduce inflammation.