复方甘草酸苷联合替诺福韦酯对活动性乙肝肝硬化的炎症因子及外周血T细胞的影响

Effects of compound glycyrrhizin combined with tenofovir on inflammatory cytokines and peripheral blood T cells in the patients with active hepatitis B cirrhosis

目的探究复方甘草酸苷片联合替诺福韦酯对活动性乙肝肝硬化的炎症因子及外周血T细胞的影响。方法选取南京市第二医院2019年1月至2021年6月收治的126例活动性乙肝肝硬化患者作为研究对象,以随机数字表法将其分为3组,每组42例。空白对照组予以安慰剂治疗,对照组予以替诺福韦酯治疗,观察组在对照组基础上联合复方甘草酸苷治疗。给药6个月后评估临床疗效。比较乙肝病毒e抗原(HBeAg)转阴率及乙型肝炎病毒(HBV)DNA复制水平、肝功能指标、炎症因子水平、免疫因子水平及药物不良反应发生率。结果治疗后,观察组患者HBeAg转阴率高于对照组及空白对照组(P<0.05),HBV DNA复制水平低于对照组及空白对照组。对照组患者HBV DNA复制水平低于空白对照组(P<0.05)。观察组患者临床疗效优于对照组及空白对照组(P<0.05)。观察组和对照组患者丙氨酸转氨酶(ALT)、总胆红素(TBIL)水平均低于治疗前,血白蛋白(ALB)水平高于治疗前。观察组患者ALT、TBIL水平低于对照组及空白对照组,ALB水平高于对照组及空白对照组。对照组患者ALT、TBIL水平低于空白对照组,ALB水平高于空白对照组(P<0.05)。观察组及对照组患者的白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平较治疗前均降低,观察组IL-6、TNF-α水平均低于对照组及空白对照组,对照组IL-6、TNF-α水平低于空白对照组(P<0.05)。观察组及对照组患者的CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)水平较治疗前均升高,观察组CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)水平均高于对照组及空白对照组,对照组CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)水平均高于空白对照组(P<0.05)。3组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论复方甘草酸苷联合替诺福韦酯应用于活动性乙肝肝硬化患者治疗中,能够有效地降低肝区炎症反应,促进免疫功能恢复,提升临床疗效且安全性良好。

Objective To investigate the effects of compound glycyrrhizin combined with tenofovir on inflammatory cytokines and peripheral blood T cells in the patients with active hepatitis B cirrhosis.Methods 126 patients with active hepatitis B cirrhosis treated in the Second Hospital of Nanjing from January 2019 to June 2021 were selected as research subjects,and were randomly and equally divided into 3 groups(n=42).The blank control group was treated with placebo,the control group was treated with tenofovir dipivoxil,and the observation group received compound glycyrrhizin on the basis of the control group.Clinical efficacy of the three groups was evaluated 6 months after medication,and the HBeAg negative conversion rate,HBV DNA replication level,liver function index,inflammatory factor level,immune factor level and the rate of adverse drug reactions were compared between the 3 groups.Results After treatment,the HBeAg negative rate in the observation group was higher than that in the control group and the blank control group(P<0.05),the HBV DNA replication level was lower than that in the control group and the blank control group,and the HBV DNA replication level in the control group was lower than that in the blank control group(P<0.05).The clinical efficacy of the observation group was superior to that of the control group and the blank control group(P<0.05).The levels of alanine transaminase(ALT)and total bilirubin(TBIL)in the observation group and the control group were lower than those before treatment,but the level of hemoglobin(Alb)was higher than that before treatment.The ALT and TBIL levels in the observation group were lower than those in the control group and the blank control group,and the ALB level was higher than that in the control group and the blank control group.The ALT and TBIL levels in the control group were lower than those in the blank control group,and the ALB level was higher than that in the blank control group(P<0.05).IL‐6 and TNF in the observation group and the control group all decrease as compared with those before treatment.The levels of IL‐6 and TNF‐αin the observation group were lower than those in the control group and the blank control group(P<0.05).The levels of IL‐6 and TNF‐αin the control group were lower than those in the blank control group(P<0.05).After treatment,the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in the observation group and the control group all increased as compared with those before treatment.The levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in the observation group were all higher than those in the control group and the blank control group,and the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in the control group were all higher than those in the blank control group(P<0.05).There was no statistical significance in the rate of adverse reactions,when comparisons were made between the 3 groups(P>0.05).Conclusion Compound glycyrrhizin combined with tenofovir in treatment of active hepatitis B cirrhosis could effectively reduce the inflammatory reactions in the hepatic region,promote recovery of immune function and improve clinical efficacy and safety.