舒肝解郁胶囊治疗慢性乙型肝炎伴轻中度抑郁的临床效果及其对外周血淋巴细胞亚群的影响研究

Effect of Shuganjieyu Capsule on Peripheral Blood Lymphocyte Subsets in Patients with Chronic Hepatitis B Combined with Mild to Moderate Depression

目的研究舒肝解郁胶囊治疗慢性乙型肝炎伴轻中度抑郁的临床效果及其对外周血淋巴细胞亚群的影响,以为临床提供参考。方法选择2015年1月—2016年1月于河北省人民医院门诊就诊及住院的慢性乙型肝炎患者70例,根据汉密尔顿抑郁量表(HAMD,24项)评分(HAMD评分8~35分为轻中度抑郁)将患者分为慢性乙型肝炎伴轻中度抑郁组40例、慢性乙型肝炎组30例;比较两组患者CD_3^+、CD_4^+、CD_8^+T淋巴细胞百分数及CD_4^+/CD_8^+、CD^+_(19)B淋巴细胞百分数、HAMD评分,并分析慢性乙型肝炎伴轻中度抑郁组患者淋巴细胞亚群与HAMD评分的相关性。采用随机数字表法将慢性乙型肝炎伴轻中度抑郁组分为研究亚组(舒肝解郁胶囊+常规保肝药治疗)20例,对照亚组(常规保肝药治疗)20例,均治疗4周;比较治疗前后对照亚组和研究亚组患者外周血淋巴细胞亚群和HAMD评分。结果慢性乙型肝炎组患者CD_3^+、CD_4^+、CD_8^+T淋巴细胞百分数及CD_(19)^+B淋巴细胞百分数高于慢性乙型肝炎伴轻中度抑郁组(P<0.05)。慢性乙型肝炎伴轻中度抑郁组CD_8^+T淋巴细胞百分数与HAMD评分呈负相关(r=-0.353,P<0.05),CD_4^+/CD_8^+与HAMD评分呈正相关(r=0.371,P<0.05),CD_3^+、CD_4^+T淋巴细胞百分数及CD_(19)^+B淋巴细胞百分数与HAMD评分无直线相关关系(r值分别为-0.121、-0.127、0.069,P均>0.05)。治疗前研究亚组与对照亚组CD_3^+、CD_4^+、CD_8^+T淋巴细胞百分数及CD_4^+/CD_8^+、CD_(19)^+B淋巴细胞百分数、HAMD评分比较,差异无统计学意义(P>0.05)。治疗后研究亚组CD_3^+、CD_4^+、CD_8^+T淋巴细胞百分数均高于对照亚组,HAMD评分低于对照亚组(P<0.05)。治疗后研究亚组CD_3^+、CD_4^+、CD_8^+T淋巴细胞百分数均高于治疗前,HAMD评分低于治疗前(P<0.05)。结论慢性乙型肝炎伴发轻中度抑郁患者存在细胞和体液免疫功能紊乱,HAMD评分与淋巴细胞亚群之间有相关性。推测抑郁可影响慢性乙型肝炎的病情及预后,而舒肝解郁胶囊能够改善患者的抑郁状态,同时提高患者免疫功能。

Objective To explore the effect of Shuganjieyu capsule on the peripheral blood lymphocyte subsets in patients with chronic hepatitis B(CHB)combined with mild-moderate depression,hoping to provide a reference for clinical treatment.Methods We enrolled 70 outpatients and inpatients with CHB from Hebei General Hospital from January 2015 to January 2016 and assigned 40 cases of them to the CHB with mild-moderate depression group(Hamilton depression scores ranged 8-35)and other 30 cases to the CHB group(CHB without depression)based on the assessment results of 24-item Hamilton Depression Rating Scale(HAMD-24).We compared CD3+,CD4+and CD8+T lymphocyte percentages as well as the CD4+/CD8+value,CD19+B-lymphocyte percentage and HAMD scores between these two groups and analyzed the correlations between the cell percentage of the peripheral blood lymphocyte subsets and the HAMD score for CHB with mild-moderate depression group.The CHB with mild-moderate depression group were further randomly divided into the experimental subgroup(20 cases treated with Shuganjieyu capsule plus conventional liver-protecting drugs),and the control subgroup(20 cases treated with conventional liver-protecting drugs).Treatment for both subgroups lasted for 4 weeks.Comparisons were made between the two subgroups in the HAMD scores and the peripheral blood lymphocyte subsets before and after treatment.Results The CD3+,CD4+and CD8+T lymphocyte percentages as well as the CD19+B-lymphocyte percentage in CHB with mild-moderate depression group were lower than the CHB group(P<0.05).There was a negative correlation between CD8+T lymphocyte percentage and HAMD score in CHB with mild-moderate depression group(r=-0.353,P<0.05)and a positive correlation between CD4+/CD8+and HAMD score(r=0.371,P<0.05),but there was no linear correlation between HAMD score and CD3+,CD4+T lymphocyte percentages or CD19+B-lymphocyte percentage(r=-0.121,-0.127,0.069,respectively,all P>0.05).Before treatment,there were no significant differences between the experimental subgroup and control subgroup in CD3+,CD4+and CD8+T lymphocyte percentages as well as CD4+/CD8+,CD19+B-lymphocyte percentage and HAMD score(P>0.05).After treatment,CD3+,CD4+and CD8+T lymphocyte percentages of the experimental subgroup were higher,while HAMD scores were lower compared with the control subgroup(P<0.05).Compared with before treatment,the experimental subgroup had higher CD3+,CD4+and CD8+T lymphocyte percentages and lower HAMD scores after treatment(P<0.05).Conclusion In CHB patients with mild-moderate depression,cell and humoral immune disorders can be found,and the HAMD score correlates with the lymphocyte subsets.It is inferred that depression may deteriorate the conditions and prognosis of CHB,and Shuganjieyu capsule can improve the depression as well as the immune function of the patients.