两种药物治疗乙肝肝硬化的疗效及其对肝纤维化程度、炎症反应及免疫相关指标的影响

Yinzhi Ganfu granules combined with entecavir for treatment of hepatitis B cirrhosis: Efficacy and impact on liver fibrosis, inflammatory response, and immune related indicators

目的探讨茵芪肝复颗粒联合恩替卡韦治疗乙肝肝硬化的疗效及其对肝纤维化程度、炎症反应及免疫相关指标的影响。方法选取浙江省中西医结合医院自2016-04/2017-04期间收治的86例慢性乙型肝炎肝硬化患者作为观察对象,按照随机数表法分为对照组、研究组,分别43例。对照组给予恩替卡韦治疗,研究组给予茵芪肝复颗粒联合恩替卡韦治疗,对比两组中医证候积分、肝脏超声、肝纤维化指标、炎症反应指标、免疫功能指标的变化。结果治疗后,两组患者的中医证候积分、脾脏厚度均显著低于治疗前(P<0.05)。且观察组治疗后中医证候积分、脾脏厚度显著低于对照组同期(P<0.05)。治疗后,两组ALB水平均高于治疗前(P<0.05),其中,研究组治疗后显著高于对照组同期(P<0.05)。治疗前,两组肝纤维化指标采用酶联免疫法测定层黏连蛋白(laminin,LN)、透明质酸(hyaluronic acid, HA)、Ⅳ型胶原(typeⅣcollagen,Ⅳ-C)和Ⅲ型前胶原(typeⅢprocollagen,PC-Ⅲ)比较差异无统计学意义(P>0.05)。治疗后,两组LN、HA、Ⅳ-C和PC-Ⅲ均显著低于治疗前(P<0.05)。且研究组治疗后LN、HA、Ⅳ-C和PC-Ⅲ均低于对照组同期(P<0.05)。治疗前,两组免疫指标CD_3^+、CD_4^+、CD_8^+指标比较差异无统计学意义(P>0.05)。治疗后,两组CD_3^+、CD_4^+水平均高于治疗, CD_8^+低于治疗前(P<0.05)。其中,研究组治疗后CD_3^+、CD_4^+均高于对照组同期, CD_8^+低于对照组同期,比较差异有统计学意义(P<0.05)。治疗前,两组炎症反应指标IL-15、IL-16、TGF-β1比较差异无统计学意义(P>0.05)。治疗后,两组IL-15、IL-16、TGF-β1水平显著低于治疗前(P<0.05)。且研究组治疗后IL-15、IL-16、TGF-β1水平均低于对照组(P<0.05)。治疗后两组肝纤维化程度分级均改善,研究组自身比较(P<0.05),对照组自身比较(P<0.05),治疗后两组比较差异不明显(P>0.05)。结论茵芪肝复颗粒联合恩替卡韦治疗可延缓慢性乙型肝炎后肝纤维化进程,减轻炎症反应,提高患者的免疫功能,具有较高推广应用价值。

AIM To evaluate the efficacy of Yinzhi Ganfu granules combined with entecavir in the treatment of hepatitis B cirrhosis and the effect on liver fibrosis,inflammatory response,and immune related indicators.METHODS Eighty-six patients with chronic hepatitis B cirrhosis admitted to Zhejiang Provincial Hospital of Integrated Traditional Chinese and Western Medicine from April 2016 to April 2017 were included and randomly divided into either a control group or a study group,with 43 cases in each group.The control group was treated with entecavir alone,and the study group was treated with Yinzhi Ganfu granules and entecavir.The changes of traditional Chinese medicine(TCM)syndrome score,liver ultrasound findings,liver fibrosis indexes,inflammatory response indexes,and immune function indexes were compared between the two groups.RESULTS After treatment,the TCM syndrome scores and spleen thickness of the two groups were significantly lower than those before treatment(P<0.05).The scores of TCM syndrome and spleen thickness in the observation group were significantly lower than those in the control group(P<0.05).After treatment,ALB levels in the two groups were significantly higher than those before treatment(P<0.05),and the level in the study group was significantly higher than that of the control group(P<0.05).Before treatment,there was no significant difference in liver fibrosis markers LN,HA,Ⅳ-C and PC-Ⅲ between the two groups(P>0.05).After treatment,these indexes were significantly lower than those before treatment(P<0.05),and were significantly lower in the study group than in the control group(P<0.05).Before treatment,there was no significant difference in CD3+,CD4+ or CD8+ lymphocytes between the two groups(P>0.05).After treatment,the levels of CD3+ and CD4+ lymphocytes were significantly higher and that of CD8+ lymphocytes was significantly lower in the two groups than those before treatment(P<0.05).The levels of CD3+ and CD4+ lymphocytes were significantly higher and that of CD8+ lymphocytes was significantly lower in the study group than in the control group(P<0.05).Before treatment,there was no significant difference in IL-15,IL-16,or TGF-β1 between the two groups(P>0.05).After treatment,the levels of IL-15,IL-16,and TGF-β1 in the two groups were significantly lower than those before treatment(P<0.05).The levels of IL-15,IL-16,and TGF-β1 in the study group were significantly lower than those in the control group(P<0.05).After treatment,liver fibrosis was significantly improved in both groups(P<0.05),but there was no significant difference between the two groups(P>0.05).CONCLUSION Yinzhi Ganfu granules combined with entecavir can delay the progression of hepatic fibrosis,reduce inflammation,and improve immune function in patients with chronic hepatitis B.