阿德福韦酯联合九味肝泰治疗对儿童慢性乙型肝炎患者T细胞亚群及肝纤维化指标的影响

Effects of adefovir dipivoxil tablets combined with Jiuwei Gantai capsules on T lymphocyte subsets and liver fibrosis indicators in children with chronic hepatitis B

目的探讨阿德福韦酯联合九味肝泰治疗对儿童慢性乙型肝炎(CHB)患者T细胞亚群及肝纤维化指标的影响。方法选取2015年8月至2016年7月收治的儿童CHB患者74例为研究对象,依据随机数字表法分为观察组和对照组,每组各37例。对照组患者在保肝、降酶基础上,口服阿德福韦酯,观察组患者在对照组的基础上,口服九味肝泰胶囊,两组患者均治疗6个月,治疗期间,定期检查肝、肾功能。采集治疗前后清晨空腹外周静脉血,比较两组患者治疗前后肝功能相关指标[总胆红素(TBIL)、总胆汁酸(TBA)、天氨酸转氨酶(AST)、谷氨酰转移酶(GGT)、丙氨酸转氨酶(ALT)];T细胞亚群水平[CD3+、CD4+、CD8+,计算CD4+/CD8+];肝纤维化各项指标[血清透明质酸(HA)、Ⅳ型胶原(ⅣC)、层黏蛋白(LN)、Ⅲ型前胶原N末端肽(PⅢNP),转化生长因子-β1(TGF-β1)]的变化。结果治疗后,观察组患者TBIL、TBA、AST、GGT、ALT水平低于对照组;CD3+、CD4+、CD4+/CD8+高于对照组,CD8+低于对照组;HA、ⅣC、LN、PⅢNP、TGF-β1低于对照组,上述指标差异均有统计学意义(P<0.01)。结论阿德福韦酯联合九味肝泰可有效调节儿童CHB患者免疫功能,改善肝功能,并具有良好的抗纤维化作用。

Objective To explore the effects of adefovir dipivoxil tablets combined with Jiuwei Gantai capsules on T lymphocyte subsets and liver fibrosis indicators in those children with chronic hepatitis B（ CHB）. Methods A total of 74 children with CHB ever treated in our hospital between Aug 2015 and Jul 2016 were collected as the study objectives,and then were divided into the study group and the control group by means of random number table,37 cases in each group. Besides oral administration of adefovir dipivoxil tablets to patients in the control group on basis of regimens of liver protection and enzyme activities reduction,those patients in the study group were orally given additional Jiuwei Gantai capsules. Both groups were treated for 6 months,and their liver and renal function indicators were regularly examined during the process. The fasting peripheral venous blood was collected at early morning before and after treatment,and the blood levels of TBIL,TBA,AST,GGT and ALT were detected via automatic biochemical analyzer. The CD3 ＋,CD4^＋.and CD8^＋.levels were tested via flow cytometer,with the CD4^＋./CD8^＋.ratio being calculated. Furthermore,radioimmunoassay was used to detect the serum levels of HA,IVC,LN and PIIINP,and ELISA was used to measure the TGF-β1 levels. Results After treatment,the TBIL,TBA,AST,GGT and ALT levels in the study group were significantly lower than those in the control group,and results of CD3^＋.,CD4^＋.and CD4^＋./CD8^＋.in the study group were significantly higher,whereas CD8^＋.being significantly lower than those in the control group（ all P〈0. 01）. The HA,IVC,LN,PIIINP and TGF-β1 levels after treatment in the study group were lower than those in the control group,also with statistically significant differences（ P〈0. 01）. Conclusion Administration of adefovir dipivoxil tablets combined with Jiuwei Gantai capsules could effectively regulate immune function and improve liver function in those CHB children,with further favorable anti-fibrosis effects.