Network meta-analysis of the compensatory effect of different Chinese herbal compounds combined with Entecavir in the treatment of hepatitis B cirrhosis

Objective:To evaluate the efficacy and safety of different Chinese herbal compounds combined with Entecavir in the treatment of hepatitis B cirrhosis during the compensatory period by using mesh meta-analysis.Methods:PubMed,CNKI,Wanfang and VIP databases were searched by computer,and the retrieval time was from the establishment of each database to October 5,2022.According to inclusion and exclusion criteria,literature search was conducted independently by two researchers.RevMan5.4.1 software provided by Cochrane was used for evaluation,and Stata16.0 software was used for statistical analysis.Results:A total of 34 RCTs were included,involving 16 TCM compounds and 1543 patients.The results of network meta-analysis showed that ALT indexes of liver function were listed as Yiqi Jiedu Tongluo Method>Luoshugan Tablet>Anluo Huaxian Wan>Qishenrugan Capsule>Qingganhuaji Decoction>Ganshuang Granules>Compound Biejia Rugan Tablet>Rougan Sanjie Decoction>Shugan Jianpi Decoction>Shenqi Fuzheng Huayu Decoction>Peituhua Decoction>Shugan Jianpi Huoxu prescription>Rhubarb Zhezhan Capsule combined with Entecavir treatment respectively;The order of HA index of liver fibrosis was Heluo Shugan Tablet>Shugan Jianpi Huoxui prescription>Anluo Huaxian Wan>Compound Biejia Ruangan Tablet>Rougan Sanjie Decoction>Ganshuang Granules>Danji Huoxui Decoction>Yiqi Jiedu Tongluo Method>Rhubarb Zhezhe Capsule>Fuzheng Huayu Table>Shugan Jianpi Decoction>Rougan Huayu Decoction>Peitu Huayu Decoction>Qingganhuaji Prescription>Shenqi Fuzheng Huayu prescription combined with Entecavir respectively;In order of adverse reactions from best to worst,Shuganjianpi Decoction,Qishenrugangan Capsule,Ganshuang Granules,Peituhuazhi Decoction,compound Biejiruganpian,and He Shugan Pian combined with entecavir,respectively;The effective rate of treatment was listed as Ganshuang Granules>Compound Biejia Ruangan Tablets>uoshugan Tablets>Rougansanjie Decoction>Rhubarb Zhezhe Capsules>Yiqi Jiedu Tongluo Method>Qingganhuaji prescription>Anluo Huaxia Wan>Shugan Jianpi Decoction>Fuzheng Huayu tablets>Peituhuazhi Decoction>Shenqi Fuzheng Huayu prescription combined with Entecavir respectively.Conclusion:Entecavir combined with supplementing qi and detoxifying and dredging collages is the best method to recover ALT index of liver function during the compensation period for hepatitis B cirrhosis;Entecavir combination and Luoshugan tablet were the best treatment for HA index of hepatic fibrosis;Entecavir combined with Shuganjianpi Decoction was the best treatment for adverse reactions;The best treatment efficiency was Entecavir combined with Ganshuang granules.

Clinical efficacy and safety of TCM prescriptions combined with nucleoside(acid)analogues in treating chronic hepatitis B:a meta-analysis

Objective There are many clinical reports on traditional Chinese medicine(TCM)combined with nucleoside(acid)analogues(NAs)for the treatment of chronic hepatitis B(CHB),but its efficacy and safety are not completely clear.This meta-analysis aims to evaluate the clinical efficacy and safety thus providing evidence for clinical applications.Methods We searched Chinese databases the China National Knowledge Infrastructure(CNKI),Wanfang Data,and China Science and Technology Journal Database(VIP),as well as English databases Pub Med and Cochrane Library,from time of establishment to April 14,2021.Literature quality was evaluated according to the bias risk assessment criteria of Cochrane Collaboration network.Rev Man 5.3 and Stata 12.0 software were used to perform this research.Results A total of 23 articles,3282 patients,and 25 TCM prescriptions were included in this study.NAs plus TCM remarkably improved the clinical total effective rate[Odds ratio(OR)=3.92,P<0.00001],TCM syndrome score(Mean difference=-3.73,P<0.00001),hepatitis B virus(HBV)DNA negative conversion rate(OR=1.49,P=0.0001),hepatitis Be antigen(HBe Ag)negative conversion rate(OR=2.03,P<0.00001),alanine aminotransferase levels[Std mean difference(SMD)=-0.95,P<0.00001],and aspartate aminotransferase levels(SMD=-0.70,P=0.0004).Adverse reaction rates did not increase in the combined treatment group(OR=0.97,P=0.84).A comprehensive analysis of the 25 TCM prescriptions suggested that the combination of spleen-strengthening prescriptions with NAs showed better effects than other prescriptions.Conclusion TCM in combination with NAs,demonstrated better clinical efficacy against CHB than NAs alone.In addition,the combination of spleen-strengthening prescriptions and NAs was identified as the best therapeutic strategy.However,more randomized controlled trials of high quality are needed to provide more reliable clinical basis for the application of TCM.

Clinical Study of Dahuang Zhechong Pill (大黄■虫丸) in Treating Posthepatitis B Hepatic Fibrosis

Hepatic fibrosis is the only way for all kinds of chronic hepatic diseases to develop into liver cirrhosis. How to block and reverse hepatic fibrosis is the key issue for treatment of all kinds of chronic hepatic disease. After many years’ arduous effort in treating hepatic fibrosis, no satisfactory results in western medical treatment have been obtained. Though hepatic fibrosis could be definitely re-

Correlation analysis of TCM syndrome types with T lymphocytes and biochemical indices in patients with HBV-related primary liver cancer

Objective:To investigate the correlation between T lymphocytes and biochemical indices in patients with Primary liver cancer(PLC)associated with hepatitis B virus(HBV)and TCM syndrome differentiation.Methods:263 HBV-related PLC patients who were admitted to the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2018 to December 2019 were retrospectively collected.There were 127 cases of liver depression and spleen deficiency syndrome(48.3%),48 cases of spleen deficiency and dampness syndrome(18.3%),31 cases of liver and gallbladder dampness and heat syndrome(11.8%),35 cases of liver and blood stasis syndrome(13.3%),and 22 cases of liver and kidney Yin deficiency syndrome(8.4%).The general data,T cell subsets,oncology and virology indicators,oncology characteristics,biochemical indicators and other data were counted.Epidata and Excel were used to collect and summarize the data,and SPSS26.0 software was used for statistical analysis.Results:There was no significant difference in gender and age distribution among the five syndrome types(χ^(2)=5.462,F=1.979,ALL P>0.05).The differences among T lymphocyte count(χ^(2)=57.785,P<0.001),CD4(+)T cell count(χ^(2)=47.103,P<0.001)and CD8(+)T lymphocyte count(F=12.760,P<0.001)were statistically significant.The T lymphocyte count,CD4(+)T lymphocyte count and CD8(+)T lymphocyte explicit count in patients with liver and kidney Yin deficiency syndrome were significantly lower than those in the other four syndrome types.AFP(χ^(2)=89.986,P<0.001),CEA(χ^(2)=95.501,P<0.001),CA199(χ^(2)=30.044,P<0.001)of the five syndrome types increased successively from the syndrome of liver depression and spleen deficiency to the syndrome of liver and kidney Yin deficiency,and the difference was statistically significant.There were statistically significant differences in the inner diameter of main portal vein,portal vein cancer thrombin and extrahepatic metastasis among the five syndrome types(ALL P<0.001).The main symptoms of portal vein cancer thrombin and extrahepatic metastasis were liver-gallbladder dampness-heat syndrome and liver-blood stasis syndrome.The differences among PLT(χ^(2)=39.234,P<0.001),Alb(χ^(2)=75.171,P<0.001),TBil(χ^(2)=51.140,P<0.001),AST(χ^(2)=55.881,P<0.001),PT(χ^(2)=21.515,P<0.001)were statistically significant.PLT and Alb decreased successively from the syndrome of liver depression and spleen deficiency to the syndrome of liver and kidney Yin deficiency.PLT and Alb of the syndrome of liver depression and spleen deficiency were significantly higher than those of the other four groups,and TBil and AST of the syndrome of liver and gallbladder dampness and heat were significantly higher than those of the other four groups.PT of liver and kidney Yin deficiency was significantly higher than that of the other four groups.The lymphocyte count,CD4(+) lymphocyte count and CD8(+) lymphocyte count were negatively correlated with AFP,PT and TBil(ALL P<0.05),and positively correlated with PLT(P<0.05).T lymphocyte count was positively correlated with AIb(P<0.05).Conclusion:This study found that patients with liver depression and spleen deficiency syndrome have better cellular immune function,liver function and prognosis.Patients with liver and kidney Yin deficiency have lower cellular immunity,worse liver function,and worse prognosis.Portal vein carcinoma embolus and extrahepatic metastasis were mainly characterized by dampness and heat of liver and gallbladder and blood stasis of liver.Patients with lower lymphocyte counts have poorer blood clotting,worse the liver reserve,and the higher the risk of further cancer.

Influence of TCM Therapy for Supplementing Pi(脾) and Nourishing Shen(肾) on Dendritic Cell Function in Patients with Chronic Hepatitis B Treated by Lamivudine

Objective:To observe the influence of traditional Chinese medicine(TCM) therapy for supplementing Pi(脾) and nourishing Shen(肾,SPNS) on dendritic cell function in patients with chronic hepatitis B (CHB) treated by lamivudine.Methods:Sixty CHB patients with positive HBeAg were equally randomized by digital table into two groups:the observation group and the control group.Patients in the control group were treated with lamivudine only,while patients in the observation group were treated with lamivudine combine...

中西医结合治疗HBV相关慢加急性肝衰竭合并肝性脑病的效果分析

目的探讨中西医结合治疗HBV相关慢加急性肝衰竭(ACLF)合并肝性脑病(HE)患者8周病死率情况,分析影响其预后的独立危险因素。方法选取2012年1月-2015年2月18家医院收治的HBV-ACLF患者,采用随机对照设计分为试验组和对照组,分别给予中西医结合治疗和单纯西医综合治疗,纳入所有0周合并HE的患者125例。观察2组8周病死率情况。计量资料2组间比较采用t检验或Mann-Whitney U检验,计数资料2组间比较采用χ2检验,生存分析采用Kaplan-Meier方法及logrank检验,危险因素分析采用Cox比例风险回归模型。结果试验组及对照组8周病死率分别为27.5%、50.0%(χ~2=5.630,P=0.018),8周内中位生存时间分别为41.2 d、28.4 d,累积生存概率分别为60.4%、32.5%(χ~2=6.187,P=0.013);Cox回归分析结果显示与对照组相比,试验组是HBV-ACLF合并HE患者预后的保护因素[风险比(HR)=0.424,P=0.018,95%可信区间(95%CI):0.208~0.864],高TBil(HR=1.063,P=0.042,95%CI:1.002~1.128)、低PTA(HR=0.942,P=0.044,95%CI:0.890~0.998)、ACLF分期晚期(HR=2.737,P=0.009,95%CI:1.287~5.818)、合并消化道出血(HR=5.291,P=0.003,95%CI:1.736~16.126)是8周死亡的独立危险因素。结论中医药治疗可显著降低HBV-ACLF合并HE患者的8周病死率,提高8周生存概率,延长生存时间。TBil、PTA、疾病分期、消化道出血是该组患者的独立预后影响因素。

HBV前C区基因变异与中医证候的相关性研究

研究慢性乙型肝炎患者HBV前C区基因变异的变化规律与中医证候的相关机制。基因芯片检测慢性乙型肝炎不同证候的HBV前C区基因变异。不同位点变异率(%)与证候相关,肝肾阴虚1764(38%),1896(68%),1899(38%);瘀血阻络1762(93%),1764(90%),1899(50%)。不同证候变异株信号强度差异显著,1762、1764;瘀血阻络>肝肾阴虚>肝郁脾虚;1862:肝肾阴虚>肝郁脾虚;>1896:肝肾阴虚>瘀血阻络>湿热中阻>肝郁脾虚;1899:瘀血阻络>肝肾阴虚>湿热中阻>肝郁脾虚。慢性乙型肝炎HBV前C区基因变异与中医证候相关,为分子证候辨证提供了一定实验依据和研究基础。

慢性HBV感染相关疾病患者的中医体质分布规律研究

目的基于文献调研,总结慢性HBV感染相关疾病患者的中医体质分布规律。方法检索近10年来有关慢性HBV感染相关疾病患者中医体质学研究的文献,采用文献计量学及系统综述的方法,按照制定的标准提取相关的中医体质分布资料,按照疾病类别进行不同体质类型的频数汇总,对不同疾病患者的中医体质分布情况进行分析比较。结果 HBV携带者中,平和质占52.79%,气虚质占8.42%,湿热质占6.94%,阳虚质占6.59%,气郁质占6.12%,其余体质类型占19.15%;慢性乙型肝炎患者中,湿热质占26.68%,气虚质占20.75%,气郁质占11.93%,阴虚质占10.69%,其余体质类型占29.95%;乙型肝炎肝硬化(纤维化)患者者中,阴虚质占33.96%,平和质占29.25%,气虚质占28.30%,其他体质占8.49%;HBV相关的原发性肝癌患者中,平和质占18.92%,阳虚质占17.94%,气虚质占14.74%,瘀血质占13.76%,湿热质占13.02%,其余体质类型占21.62%。结论慢性HBV感染不同相关疾病患者有着特定的中医体质分布规律:HBV携带者中平和质最多见,但有一定的偏颇;慢性乙型肝炎患者主要表现为湿热质、气虚质、气郁质、阴虚质;乙型肝炎肝硬化(纤维化)患者主要表现为阴虚质、气虚质等偏颇体质;HBV相关的原发性肝癌患者主要表现为阳虚质、气虚质、瘀血质、湿热质等偏颇体质。

慢性乙型肝炎患者外周血单个核细胞内HBV-DNA与中医证型关系的研究

目的探讨慢性乙型肝炎患者血清乙肝病毒脱氧核糖核酸(HBV-DNA)及外周血单个核细胞(PBMCs)中HBV-DNA感染与中医证型的关系。方法220例慢性乙型肝炎患者进行乙肝标志物检查、血清HBV-DNA(定量)及PBMCs中HBV-DNA检测(PCR方法),经中医辨证确定205例患者的中医证型。结果研究发现各中医证型血清HBV-DNA(定量)≥1.0×105拷贝/mL(高病毒载量)患者比例由小到大排列依次为:湿热中阻证<瘀血阻络证<肝肾阴虚证<脾肾阳虚证<肝郁脾虚证。肝郁脾虚证组血清HBV-DNA(定量)≥1.0×105拷贝/mL患者比例最高(占82.5%),与湿热中阻证组(占55.2%)差异有显著性(P<0.01)。各中医证型PBMCs中HBV-DNA感染患者比例由小到大排列依次为:肝肾阴虚证<湿热中阻证<脾肾阳虚证<瘀血阻络证<肝郁脾虚证。肝郁脾虚证组PBMCs中HBV-DNA感染患者比例最高(占77.2%),与肝肾阴虚证(占27.3%)、湿热中阻证(占34.3%)、瘀血阻络证(占53.1%)比较,差异均有显著性(P<0.01)。结论血清HBV-DNA(定量)及PBMCs中HBV-DNA感染与中医证型之间有一定关系,肝郁脾虚证组血清HBV-DNA(定量)≥1.0×105拷贝/mL患者比例及PBMCs中HBV-DNA感染患者比例最高,治疗应注重扶正祛邪。

HBeAg阴性慢性乙型肝炎中医证型分布及与HBVDNA、肝纤四项关系的研究

目的探讨HBeAg阴性慢性乙型肝炎中医证型分布规律及各证型与实验室指标的关系。方法采用临床流行病学回顾性研究方法，从2008年1月-2009年5月就诊于广东省中医院门诊及住院患者中选取合格研究对象329例，观察其肝功能、HBVDNA、肝纤四项等实验室指标。结果各证型的分布为：肝郁脾虚〉湿热中阻〉肝肾阴虚〉瘀血阻络〉脾肾阳虚。湿热中阻证的血清丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）水平明显高于其他证型（P〈0．05）。当HBVDNA〈10^4 copies／mL时，湿热中阻证的频数明显高于其他证型（P〈0．05）；而当10^4≤HBVDNA〈10^7 copies／mL时则相反。湿热中阻证三型前胶原（PCIII）的异常率明显高于肝郁脾虚、肝肾阴虚证，肝肾阴虚证层粘连蛋白（LN）、透明质酸（HA）的异常率及瘀血阻络证HA的异常率均明显高于肝郁脾虚、湿热中阻证（P〈0．05）；而肝郁脾虚证IV型胶原（CIV）的异常率与湿热中阻证差异没有统计学意义（P〉0．05）。结论HBeAg阴性慢性乙型肝炎的中医证型分布具有一定的规律；各证型与转氨酶、HBVDNA、肝纤四项等实验室指标之间有一定的内在关系。

194例HBeAg阳性HBV携带者中医证候及体质分布规律观察

目的:观察194例HBe Ag阳性的HBV携带者中医证候及体质的分布规律,探讨病机,为中医药干预提供理论依据。方法:选择194例HBe Ag阳性HBV携带者,中医证候采用问卷调查结合高级中医师辨证进行分型,中医体质根据王琦中医体质分类法进行分类,部分患者行肝脏穿刺病理检查,将证候及体质、病理结果进行统计分析。结果:194例HBe Ag阳性的HBV携带者在症状方面以困倦乏力、尿黄、腰腿酸痛、腰腿酸软、健忘等症状显现频率较高,有证可辨者以肾虚证为主(68.4%),异常体质者中也以肾虚体质为主(22.6%),肝穿病理检查结果提示部分患者(60.5%)存在不同程度的炎症及纤维化。结论:肾虚是慢性乙型肝炎(CHB)致病的重要病机。

慢性乙型肝炎患者中医证型与ALT、HBV DNA及肝组织病理的关系

目的:探讨慢性乙型肝炎(CHB)患者中医证型与肝功能、血清病毒学、免疫组化HBs Ag、HBc Ag检出率及肝组织病理之间的关系及对CHB的诊断意义。方法:选择2013年6月至2016年8月在我科住院的58例CHB患者,比较不同中医证型与肝功能、HBVDNA水平、免疫组化HBs Ag、HBc Ag检出率及肝组织病理的关系。结果:1)中医辨证分型:肝郁脾虚证(26/58,31%)和湿热中阻证(15/58,30%)出现频次最高,其他依次为肝肾阴虚证(7/58,15%),脾肾阳虚证(6/58,12%)和瘀血阻络证(4/58,12%);2)不同中医证型和ALT有明显相关性,各证型之间比较有统计学意义,P<0.05;不同中医证型和AST、TBIL无明显相关性,差异无统计学意义,P>0.05;3)不同中医证型和HBV DNA有明显相关性,各证型之间比较有统计学意义,P<0.05;不同中医证型和HBs Ag、HBe Ag无明显相关性,差异无统计学意义,P>0.05;4)不同中医证型与免疫组化HBc Ag检出率有明显相关性,各组间比较有统计学意义,P<0.05;不同中医证型与免疫组化HBs Ag检出率无相关性,P>0.05;5)CHB患者肝脏炎性反应G及纤维化程度S存在高度相关性,r=0.758,P<0.01;不同中医证型和肝脏炎性反应G有明显相关性,P<0.05;不同中医证型和纤维化程度S有明显相关性,P<0.01。结论:CHB患者ALT、HBV DNA、免疫组化HBc Ag检出率及肝脏炎性反应G及纤维化程度S检测与中医证型间有显著相关性,对指导CHB患者临床诊断治疗有重要指导意义。

补肾清透方对HBeAg阳性慢性HBV携带者细胞因子的影响研究

目的:评估补肾清透方对HBe Ag阳性HBV携带者细胞因子的影响、抗病毒疗效及安全性。方法:选取60例符合肾虚证的HBe Ag阳性慢性乙肝病毒携带者,随机分为治疗组(40例)和对照组(20例),治疗组予以中药补肾清透干预,对照组予以安慰剂干预,疗程均为48周。治疗前及治疗后第48周检测所有入组患者外周血的IL-2、IL-10、TNF-α、IFN-γ、HBe Ag、HBe Ab及HBV-DNA。结果:治疗48周后,治疗组升高血清IL-2、TNF-α、IFN-γ水平的程度高于对照组,两组比较均有统计学差异(P<0.01);治疗组降低IL-10水平的程度也高于对照组,两组比较有统计学差异(P<0.01);治疗组HBe Ag阴转率及HBe Ag/HBe Ab血清转换率均高于对照组,两组比较均有统计学差异(P<0.01);治疗组血清HBV-DNA下降>1 log10、>2 logl0、>3 log10及HBVDNA阴转的例数明显多于对照组,两组比较均有统计学差异(P<0.01)。结论:补肾清透方可改善ASC患者的免疫功能,且有一定抑制HBV的作用,可能与改善T细胞功能有关,安全性良好。

小柴胡汤体外抗HBV及其组方机理的实验研究

目的 :通过小柴胡汤抗HBV的作用 ,探讨其“扶正祛邪”的组方机理及其抑制HBV的疗效差异。方法 :将中药小柴胡汤分成全方组、半方组和柴胡单味组 ,观察 3组药物在 2 2 15细胞培养中抗HBV的不同作用。结果 :3组药物对 2 2 15细胞上清中HBsAg和HBeAg分泌均有一定抑制作用 ,全方组对HBsAg和HBeAg的治疗指数 (TI)分别可达 5 15和 3 0 0 ,半方组对HBeAg的TI为 4 13,而单味组TI较低 ,抑制作用不明显。结论

补肾健脾方对HBeAg阳性乙肝病毒携带者的抗病毒疗效

目的:评价补肾健脾方对HBeAg阳性HBV携带者的抗病毒疗效及安全性。方法:采用多中心、随机、双盲、安慰剂对照的临床研究方法。300例e-抗原阳性乙肝病毒携带者随机双盲分入两个试验组,其中治疗组200例,对照100例。52周的双盲治疗期间,治疗组患者给予补肾健脾方治疗,对照组患者给予安慰剂治疗,以上药物均为颗粒冲剂,用法均为1剂/d,分两次开水冲服。治疗过程中检测患者血清HBV DNA定量及乙肝两对半定量并观察不良反应的发生。结果:治疗52周时治疗组患者血清HBV DNA水平明显下降,与0周及安慰剂对照组比较,差异有显著性意义;其中治疗组下降>1 lg及>2 lg的比例为45.98%、21.84%,明显多于对照组的11.83%、5.38%。治疗过程中,治疗组患者HBeAg均值、HBsAg均值均呈持续下降趋势。52周时,治疗组患者HBeAg均值、HBsAg均值下降均显著优于安慰剂对照组,差异有显著性意义;而HBsAg下降>0.5 lg的百分率治疗组、对照组分别为22.99%、7.53%,差异有显著性意义。52周时,两组患者血清HBV DNA水平下降>3 lg及阴转比例,HBeAg阴转率以及HBeAg血清转换比例,HBsAg下降>1 lg、>2 lg及阴转比例相似,差异均无显著性意义。研究过程中,各组均未发生任何严重不良事件。结论:补肾健脾方有一定的抑制HBV的作用,作用呈时间依赖趋势。

PCR检测HBV DNA与舌象的关系

研究探讨聚合酶链反应检测乙型肝炎病毒ＤＮＡ与中医舌象之间的关系。运用ＰＣＲ检测１１６例ＨＢＶＤＮＡ，并与中医舌象观察结果进行比较。结果，病理舌色较正常舌色ＰＣＲ－ＨＢＶ－ＤＮＡ阳性可能性大（Ｐ＜０．０１），但病理舌色患者并非一定ＰＣＲ－ＨＢＶ－ＤＮＡ阳性；舌形反映ＰＣＲ－ＨＢＶ－ＤＮＡ阳性结果的程度依次为胖大（齿痕）舌、嫩舌、芒刺舌、裂纹舌、老舌、正常舌形；苔色结果依次为苔厚黄、苔厚白、苔薄黄、苔薄白、灰黑苔组。苔质结果依次为腐腻组、燥组和剥脱组。在一定程度上，中医舌象可以反映ＰＣＲ检测ＨＢＶＤＮＡ结果情况。

慢性HBV携带者的中西医诊治概况

通过分析近年来有关慢性HBV携带者的中医病因病机、证候与体质辨识、中医药治疗的研究概况,发现以HBVDNA高水平复制、ALT正常或低水平为特点的HBV免疫耐受状态的患者具有高度传染性,且存在向肝硬化和肝癌进展的较大风险。因公认有效的抗HBV药物对慢性HBV携带者不适用,现代医学建议随访观察,不进行治疗。结合现代医学,中医对慢性HBV携带者的病因病机及证候规律认识逐渐深入,并采用中医体质辨识解决辨证困局,运用中医药治疗取得了一定疗效。由此可见,中医药治疗是具有前景的治疗途径。

慢性HBV感染者不同免疫状态证候虚实分类与T、B及NK细胞亚群的相关性研究

目的了解慢性乙型肝炎病毒(HBV)感染者不同免疫状态证候虚实分类与T、B细胞亚群及自然杀伤(NK)细胞之间的相互关系。方法将3种不同免疫状态的慢性HBV感染者分为虚证组、实证组,检测其外周血淋巴细胞亚群和NK细胞,并对上述各组指标进行比较分析。结果在3种不同免疫状态中,所有虚实两组患者的CD4+T细胞百分比均较对照组(健康献血员)低(P<0.05),其中在免疫耐受状态中实证组CD4+T细胞低于虚证组(P<0.05);在免疫清除状态中,CD8+T细胞百分比由高至低依次为实证组、对照组、虚证组(P<0.05)。3种不同免疫状态中,实证组CD4+/CD8+比值均显著低于虚证组或对照组,在免疫清除状态中虚实两组的B淋巴细胞百分比高于对照组,NK细胞低于对照组(P<0.05)。结论慢性HBV感染者存在着免疫功能紊乱;HBV感染不同免疫状态证候虚实分类与T、B细胞亚群及NK细胞之间存在一定相关性,免疫功能检测对于虚实证型的判定具有一定的临床应用价值。

基于高通量测序分析凉血解毒方对HBV相关慢加急性肝衰竭患者肠道菌群的影响

目的观察凉血解毒方对HBV相关慢加急性肝衰竭(HBV-ACLF)患者肠道菌群的影响。方法选取2018年10月—2019年10月于北京地坛医院住院诊断为HBV-ACLF的患者,招募同期正常健康人群作为对照(HP组),通过高通量测序的方法筛选出HBV-ACLF患者与正常健康人群的菌群多样性和菌种的差异,从门、属水平筛选出两组的差异菌;利用体外模拟发酵实验,HBV-ACLF患者给予不同浓度(0、10%、50%、100%)凉血解毒方培养基培养24 h,从属分类水平比较分析HBV-ACLF用药组、HBV-ACLF未用药组及HP组菌群变化。正态分布的计量资料两组间比较采用t检验;非正态分布的计量资料两组间比较采用Mann-Whitney U检验。结果共纳入HBV-ACLF患者10例,其中HBV-ACLF用药组5例,未用药组5例;HP组15例。HBV-ACLF未用药组较HP组肠道菌群多样性及丰度下降。在门分类水平,HP组每个样本均以拟杆菌门和厚壁菌门为主;HBV-ACLF未用药组拟杆菌门明显减少,梭杆菌门、变形菌门、纤维杆菌门增多。在属分类水平上,HBV-ACLF未用药组瘤胃菌、布劳特菌属、真杆菌属较HP组明显减少,而副杆菌属、乳酸杆菌、梭杆菌、链球菌较HP组增多。体外模拟发酵实验结果显示,HBV-ACLF用药组瘤胃菌、毛螺菌属、拟杆菌、氏菌属相对丰度值较HBV-ACLF未用药组显著升高,而梭杆菌、变形菌较未用药组显著减少(P值均<0.05)。结论凉血解毒方能够调节肠道菌群紊乱,恢复肠道菌群多样性,增加优势菌,减少致病菌,这可能是其治疗HBV-ACLF重要的作用机制之一。

肝脏硬度与慢性乙型肝炎中医证型的关系及联合APRI、FIB-4、GP对肝纤维化的诊断价值

目的:探索瞬时弹性成像检测肝脏硬度值(LSM)与慢性乙型肝炎中医证型的关系以及联合血清模型APRI、FIB-4、GP是否提高慢性乙型肝炎患者肝纤维化的诊断率。方法:回顾收集2015年10月至2018年9月就诊于广西中医药大学附属瑞康医院肝病科的慢性乙型肝炎患者521例,并分析患者的中医证型、血清值指标值、肝脏硬度值、肝组织穿刺病理结果。结果:521例患者的中医证型分布为肝郁脾虚证占48.2%,湿热中阻证占27.1%,瘀血阻络证占15.4%,肝肾阴虚证占6.3%,脾肾阳虚证占3.1%。各组中医证型LSM值由低到高依次为:肝郁脾虚证、湿热中阻证、肝肾阴虚证、脾肾阳虚证、瘀血阻络证,各中医证型间LSM差异有统计学意义(P﹤0.01)。与肝组织穿刺病理结果对照,LSM联合纤维化指数(FIB-4)、天门冬氨酸氨基转移酶(AST)/血小板(PLT)比值(APRI指数)或球蛋白/血小板(GP)诊断轻微肝纤维化的AUROC分别为0.801、0.773、0.756;LSM联合APRI或FIB-4或GP与LSM单独诊断轻微肝纤维化的AUROC差异无统计学意义(P>0.05)。结论:LSM值在慢性乙型肝炎患者不同中医证型间存在差异,LSM值可能有助于慢性乙型肝炎的中医辨证。LSM值单独存在有诊断肝纤维化的价值,联合其他指标不能提高肝纤维化的诊断率。