疏肝化瘀方治疗慢性乙型病毒性肝炎相关性肝纤维化的疗效及对血清Treg/Th17的影响

Efficacy of Shugan Huayu Decoction on chronic hepatitis B related liver fibrosis and its influence on serum Treg/Th17

目的探究疏肝化瘀方治疗慢性乙型病毒性肝炎肝纤维化的临床疗效及对血清Treg/Th17的影响。方法回顾性分析2017年12月—2018年11月黑龙江省中医药科学院肝胆脾胃一科门诊收治的90例慢性乙型病毒性肝炎合并肝纤维化患者资料,其中ETV组给予恩替卡韦治疗,联合组在ETV组的基础上联合疏肝化瘀方治疗,2组疗程均为26周。观察2组患者治疗前后肝功能指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBil)]、肝纤维化指标[层黏连蛋白(LN)、透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C)]、肝纤维化无创诊断指标(LSM、FIB-4)、血清Th17和Treg表达率及Th17/Treg比值,并评估其临床疗效。结果治疗后2组患者ALT、AST、TBil、HA、Ⅳ-C、PCⅢ、LN、LSM、FIB-4均较治疗前显著下降(P均<0.05),联合组均显著低于ETV组(P均<0.05);治疗后2组患者Th17、Treg表达率及Th17/Treg比值均较治疗前下降(P均<0.05),且联合组较ETV组下降更为显著(P均<0.05)。联合组治疗后总有效率为91.1%(41/45),ETV组治疗后总有效率为75.6%(34/45),联合组总有效率明显高于ETV组(P<0.05)。结论疏肝化瘀方联合恩替卡韦治疗慢性乙型病毒性肝炎肝纤维化临床疗效显著,不仅能够改善肝功能,抑制肝纤维化,还可以调节免疫平衡。

Objective It is to explore the clinical efficacy of Shugan Huayu Decoction in treating chronic hepatitis B with liver fibrosis and its effect on serum Treg/Th17.Methods A retrospective analysis of the data of 90 patients with chronic hepatitis B with liver fibrosis admitted to the Outpatient Department of Hepatobiliary and Spleen and Stomach Department of Heilongjiang Academy of Chinese Medicine from December 2017 to November 2018 was performed.The ETV group was treated with entecavir,and the combination group was treated with Shugan Huayu Decoction on the basis of the ETV group,the treatment course of the two groups was 26 weeks.The liver function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil)],liver fibrosis indexes[laminin(LN),hyaluronic acid(HA),typeⅢprocollagen(PCⅢ),typeⅣcollagen(Ⅳ-C)],liver fibrosis non-invasive diagnostic indicators(LSM,FIB-4),serum Th17 and Treg expression rate and Th17/Treg ratio before and after treatment were observed in the two groups,and the clinical curative effects were evaluated.Results After treatment,the levels of ALT,AST,TBil,HA,IV-C,PCⅢ,LN,LSM,and FIB-4 in the two groups were significantly lower than those before treatment(all P<0.05),and these indexes in the combination group were significantly lower than those in the ETV group(all P<0.05);the Th17,Treg expression rate and Th17/Treg ratio of the two groups were decreased after treatment compared with before treatment(all P<0.05),and the decrease in the combination group was more significant than that in the ETV group(all P<0.05).The total effective rate after treatment in the combined group was 91.1%(41/45),and that in the ETV group was 75.6%(34/45),the total effective rate in the combination group was significantly higher than that in the ETV group(P<0.05).Conclusion The combination of Shugan Huayu Decoction and entecavir has a significant clinical effect in the treatment of chronic hepatitis B with liver fibrosis.It can not only improve liver function,inhibit liver fibrosis,but also regulate immune balance.