肠源性内毒素血症对急性病毒性肝炎患者免疫功能的影响

The Intestinal Endotoxemia's effects on cellular immunity in acute hepatitis patients

目的 观察急性甲型病毒性肝炎患者内毒素对细胞免疫功能的影响及中药双利肝的临床疗效。方法 2 6例急性甲型病毒性肝炎患者 ,正常组 10例为健康人 ,肝功能正常 ,各型肝炎病毒标志物均为阴性。分三组 :正常组、对照组 (一般用药组 )、治疗组 (一般用药 +双利肝组 )。检测以下指标 :血浆内毒素 (ET)、肿瘤坏死因子 -α(TNF -α)、白细胞介素 -6 (IL -6 )、T细胞亚群和肝功能。结果 急性甲型病毒性肝炎患者 ,治疗前血浆ET、TNF -α、IL -6及ALT水平明显升高 ,治疗后明显下降 ;治疗前T淋巴细胞亚群CD+ 3 、CD+ 4下降 ,CD+ 8上升 ,CD+ 4/CD+ 8下降 ,治疗后CD+ 3 与CD+ 4升高 ,CD+ 8下降 ,CD+ 4/CD+ 8升高。对照组与治疗组ET、CD+ 3 、CD+ 4及CD+ 8治疗前后差值比较均有明显差异 (P <0 0 5 )。血浆中ET水平与CD+ 3 、CD+ 4、CD+ 4/CD+ 8呈显著负相关 ,相关系数分别为 -0 6 38(P <0 0 5 )、 -0 6 76 (P <0 0 5 )、 -0 6 12 (P <0 0 5 )。结论 急性甲型病毒性肝炎患者血浆内毒素水平明显升高 ,且与免疫功能的变化密切相关。双利肝通过降低内毒素水平 ,可调整机体免疫功能 ,达到治疗目的。

Objective To study the intestinal endotoxemia's effects on Acute Hepatitis A cellular immunity function and the therapeutic role of Chinese Medicine DD in acute hepatitis patients. Methods We selected 26 acute hepatitis A patients and 10 healthy subjects.The plasma was collected for the measurement of ET,TNF-α,IL-6 and peripheral blood T lymphocyte subset etc. Results (1)Plasma ET,TNF-α,IL-6 contents in patients with acute hepatitis A were significantly higher than that of normal group.(2)CD + 3?CD + 4 T cell and CD + 4/CD + 8 in patients were lower than that of normal group.CD + 8 in patients was higher than that of normal group.(3)There were negative correlation between ET and CD + 3,ET and CD + 4,ET and CD + 4/CD + 8(r=-0.638,-0.676,-0.612,P<0.05)?(4)ET,CD + 8 of control+DD group were lower than that of control group.CD + 3,CD + 4 and CD + 4/CD + 8 of control+DD group were higher than that of control group. Conclusion Endotoxemia is closely related to the status of cellular immunoresponse in patients with acute hepatitis A.This study suggests that DD treatment may ameliorate the cellular immunoresponses in acute hepatitis patients by reduce ET content.