大黄蛰虫胶囊联合恩替卡韦对乙肝肝硬化患者肝纤维化及T细胞亚群的影响

The effect of Dahuang Shuchong capsules combined with entecavir on hepatic fibrosis and T-cell subsets in patients with hepatitis B liver cirrhosis

目的观察大黄蛰虫胶囊联合恩替卡韦治疗慢性乙型肝炎(CHB)肝硬化患者临床疗效,探讨其对肝纤维化及T细胞亚群的影响。方法选取住院及门诊CHB肝硬化患者64例,随机分为对照组和观察组,各32例。对照组单纯予以恩替卡韦分散片口服治疗,1片/次,1次/d;在此基础上,观察组加用大黄蛰虫胶囊口服治疗,4粒/次,2次/d,两组均连续治疗24周。比较两组治疗前后临床疗效、肝功能水平、影像学指标、肝纤维化指标及T细胞亚群表达。结果观察组总有效率为84.4%明显高于对照组的62.5%(P<0.01);治疗后观察组肝功能天门氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)及总胆红素(total bilirubin,TBil)、乙型肝炎病毒(HBV)-DNA载量明显低于对照组(P<0.05);观察组肝纤维化指标透明质酸(hyaluronic acid,HA)、层粘连蛋白(laminin,LN)、Ⅳ型胶原(collage typeⅣ,Ⅳ-Co)及Ⅲ型前胶原(procollagen-Ⅲ,PCⅢ)均明显低于对照组(P<0.05);治疗后观察组肝门静脉内径、脾脏厚度、肝脏硬度数值显著低于对照组(P<0.05);观察组T细胞亚群CD3^+、CD4^+及CD4^+/CD8^+水平明显高于对照组,差异有统计学意义(t=6.360、8.262、4.232,P=0.000、0.000、0.000),CD8+明显低于对照组,差异有统计学意义(P<0.01)。结论大黄蛰虫胶囊联合恩替卡韦用药治疗CHB肝硬化患者疗效显著,可降低HBV-DNA载量,改善肝纤维化,调节T淋巴细胞亚群,提高机体免疫状态。

Objective To observe the clinical efficacy of Dahuang Shuchong capsules combined with Entecavir on liver fibrosis and T-cell subsets in the patients with hepatitis B liver cirrhosis.Methods Sixty-four patients with hepatitis B cirrhosis were selected from November 2017 to November 2018,and were randomly divided into control group and treatment group(n=32).The control group was treated by simple oral treatment of Entecavir tablets,while the treatment group received additional Dahuang Shuchong capsules for 24 weeks.The clinical efficacy,liver function,imaging index,liver fibrosis index and T-cell subsets expression were compared between the two groups.Results The total effective rate of treatment group(84.4%)was significantly higher than the control group(62.5%,P<0.01).The levels of liver function AST,ALT,TBil,HBV-DNA,the liver fibrosis indexes of AHA,LN,IV-Co,PCIII,the value of hepatic portal vein diameter,spleen thickness and liver hardness in treatment group were all significantly lower than the control group(P<0.01).The immune function of CD3^+,CD4^+and CD4^+/CD8^+in the treatment group were significantly higher than the control group(P=0.000).CD8+in control group was significantly lower than that the control group(P<0.01).Conclusion The treatment of CHB patients with Dahuang Shuchong capsules combined with Entecavir has significant efficacy,which can reduce HBV-DNA,improve liver fibrosis,regulate T-cell subsets and improve body immunity.