异甘草酸镁治疗慢性乙型肝炎重度患者外周血TregTh17细胞及其相关细胞因子水平变化

Therapeutic effect of isoglycyrrhizic acid magnesium in treatment of patients with hepatitis B and dynamic changes of Treg 17 cells and related cytokines

目的探讨应用异甘草酸镁治疗慢性乙型肝炎(CHB)重度患者疗效及其外周血调节性T淋巴细胞和辅助性T细胞Th17(Treg/Th17)的变化。方法2017年10月~2018年9月我科诊治的CHB重度患者80例,被分为观察组(n=50)和对照组(n=30),给予对照组护肝和抗病毒治疗,观察组则加用异甘草酸镁治疗,两组均治疗30天。结果在治疗30天末,观察组血清AST为(124.2±10.2)U/L,显著低于对照组[(179.3±13.5)U/L,P<0.05],ALT为(105.1±10.8)U/L,显著低于对照组[(135.6±14.8)U/L),P<0.05],TBIL为(34.8±4.8)μmol/L,显著低于对照组[(45.0±5.2)μmol/L,P<0.05];观察组血清TNF-α为(10.2±2.8)ng/L,显著低于对照组[(13.5±2.5)ng/L,P<0.05],IL-4为(49.1±7.2)ng/L,显著低于对照组[(62.2±6.2)ng/L,P<0.05],IL-10为(13.6±2.8)ng/L,显著低于对照组[(19.3±3.2)ng/L,P<0.05],而IL-2为(168.2±15.8)ng/L,显著高于对照组[(142.2±14.0)ng/L,P<0.05];观察组外周血Treg细胞为(3.1±0.4)%,显著低于对照组[(5.9±0.5)%,P<0.05],Th17细胞百分比为(3.2±0.4)%,显著低于对照组[(4.9±0.5)%,P<0.05],Treg/Th17细胞比值为(0.9±0.1)%,显著低于对照组[(1.2±0.3)%,P<0.05];观察组血CD4^+为(42.2±4.3)%,显著高于对照组[(38.2±3.9)%,P<0.05],CD8^+为(21.2±2.9)%,显著低于对照组[(26.2±2.2)%,P<0.05],CD4^+/CD8^+比值为(1.8±0.2),显著高于对照组[(1.6±0.5),P<0.05];观察组有45例(90.0%)患者病情好转,显著高于对照组的21例(70.0%),差异有统计学意义(P<0.05)。结论应用异甘草酸镁治疗慢性乙型肝炎重度患者效果明显,促进了肝功能恢复,改善了机体免疫功能紊乱,减轻了机体炎症反应。

Objective The aim of this study was to investigate the therapeutic effect of isoglycyrrhizic acid magnesium in the treatment of patients with severe chronic hepatitis B(CHB)and the changes of peripheral blood regulatory T lymphocytes(Treg)and helper T cell 17(Th17).Methods 80 patients with CHB of severe degree in our hospital from October 2017 through September 2018,and were divided into observation(n=50)and control group(n=30).They were given liver protection and antiviral treatment,and those in the observation group were treated withisoglycyrrhizic acid magnesium at base of treatment in the control.The regimen lasted for 30 days.Results At the end of 30 days of treatment,serum AST in the observation group was(124.2±10.2)U/L,significantly lower than[(179.3±13.5)U/L,P<0.05],serum ALT was(105.1±10.8)U/L,significantly lower than[(135.6±14.8)U/L,P<0.05],serum bilirubin level was(34.8±4.8)μmol/L,significantly lower than[(45.0±5.2)μmol/L,P<0.05]in the control;serum TNF-αin the observation group was(10.2±2.8)ng/L,which was significantly lower than[(13.5±2.5)ng/L,P<0.05],and the IL-4 was(49.1±7.2)ng/L,significantly lower than[(62.2±6.2)ng/L,P<0.05],serum IL-10 was(13.6±2.8)ng/L,significantly lower than[(19.3±3.2)ng/L,P<0.05]],while serum IL-2 was(168.2±15.8)ng/L,which was significantly higher than[(142.2±14.0)ng/L,P<0.05]in the control;in the observation group,the percentage of peripheral blood Treg cells were(3.1±0.4)%,which was significantly lower than[(5.9±0.5)%,P<0.05],and the percentage of Th17 cells was(3.2±0.4)%,which was significantly lower than[(4.9±0.5)%,P<0.05],and the ratio of Treg/Th17 cells was(0.9±0.1)%,significantly lower than[(1.2±0.3)%,P<0.05]in the control;the peripheral blood CD4^+cells in the observation group was(42.2±4.3)%,significantly higher than[(38.2±3.9)%,P<0.05],the CD8^+was(21.2±2.9)%,significantly lower than[(26.2±2.2)%,P<0.05],and the CD4^+/CD8^+cell ratio was(1.8±0.2),significantly higher than[(1.6±0.5),P<0.05]in the control;90.0%of patients in the observation group improved,which was significantly higher than 70.0%in the control group(P<0.05).Conclusion The application of isoglycyrrhizic acid magnesium in patients with severe chronic hepatitis B has obvious curative effects,which might promote liver function recovery and correct immune dysfunction.