α-干扰素联合柴胡疏肝散治疗慢性乙型肝炎的临床观察及对TNF-α、IL-6的影响
发布时间：2019-03-24 12:41
【摘要】：目的:探讨柴胡疏肝散、甘草酸二铵肠溶胶囊对α-干扰素(interferon-alpha,IFN-α)治疗慢性乙型肝炎(chronic hepatitis B,CHB)疗效的观察及对肿瘤坏死因子-α(tumor necrosis factorα,TNF-α)、白细胞介素-6(interleukin-6,IL-6)水平的影响。方法:524例慢性乙型肝炎,按随机数字表法随机分为单药治疗组174例,联合中药治疗组174例,联合西药治疗组176例。单药治疗组采用IFN-α治疗24周;联合中药治疗组在IFN-α治疗基础上,采用柴胡疏肝散口服,每日1剂,疗程24周;联合西药治疗组在IFN-α治疗基础上,采用甘草酸二铵肠溶胶囊150-mg tid口服,疗程24周。观察3组治疗前后的症状积分改变情况、中医症状疗效、ALT水平、HBV DNA定量、抗病毒治疗应答及治疗前、治疗8周、治疗24周的TNF-α、IL-6水平的变化。结果:治疗24周后,联合中药治疗组症状积分改善程度最明显、中医症状疗效总有效率最高,联合西药治疗组次之,而单药治疗组最低(P0.01,P0.05)。完成IFN-α24周治疗后,联合中药治疗组ALT改善程度、HBV DNA定量下降程度及完全应答率最高,无应答率最低,单药治疗组次之,而联合西药治疗组最低(P0.05);治疗8周后联合中药治疗组及单药治疗组TNF-α、IL-6水平较治疗前升高(P0.05),联合西药治疗组TNF-α、IL-6水平较治疗前下降(P0.01),治疗24周后联合中药治疗组及单药治疗组TNF-α、IL-6水平较治疗8周明显下降(P0.01),联合西药治疗组TNF-α、IL-6水平较治疗8周时无明显下降(P0.05)。结论:INF-α联合柴胡疏肝散治疗慢性乙型肝炎可改善患者症状,增加INF-α抗病毒疗效,值得推荐联用,而联合甘草酸二铵肠溶胶囊治疗可降低INF-α抗病毒疗效,不推荐联合使用,INF-α及柴胡疏肝散均可以通过上调TNF-α、IL-6水平通过免疫激活来清除病毒,二者联用可起到协同作用。
[Abstract]:Objective: to investigate the therapeutic effect of Chaihu Shugan San and diammonium glycyrrhizinate enteric-coated capsule on interferon-伪 (interferon-alpha,IFN- 伪) in the treatment of chronic hepatitis B (chronic hepatitis-B, CHB) and the treatment of tumor necrosis factor-伪 (tumor necrosis factor 伪 (TNF- 伪). Effect of interleukin-6 (interleukin-6,IL-6) level. Methods: 524 cases of chronic hepatitis B were randomly divided into single drug treatment group (174 cases), combined traditional Chinese medicine treatment group (174 cases) and western medicine treatment group (176 cases). The single drug treatment group was treated with IFN- 伪 for 24 weeks, combined with traditional Chinese medicine treatment group, on the basis of IFN- 伪 treatment, Bupleurum Shugan Powder was given orally for 24 weeks, and the treatment course was 24 weeks. Combined with western medicine treatment group, based on IFN- 伪 treatment, diammonium glycyrrhizinate enteric-coated capsule 150-mg tid was given orally for 24 weeks. The changes of symptom score before and after treatment, the therapeutic effect of traditional Chinese medicine (TCM), the quantitative, HBV DNA of ALT level, the changes of TNF- 伪 and IL-6 levels before and after antiviral therapy, 8 weeks and 24 weeks after treatment were observed. Results: after 24 weeks of treatment, the improvement degree of symptom score was the most obvious in the combined traditional Chinese medicine treatment group, and the total effective rate was the highest in the traditional Chinese medicine treatment group, followed by the combination western medicine treatment group, and the lowest in the single medicine treatment group (P 0.01, P0.05). After 24-week treatment of IFN- 伪, the improvement degree of ALT and complete response rate were the highest in the combined traditional Chinese medicine treatment group, the lowest in the non-response rate, the second in the single drug treatment group, and the lowest in the western medicine treatment group (P0.05). After 8 weeks of treatment, the levels of TNF- 伪 and IL-6 in the combined Chinese medicine treatment group and the single drug treatment group were higher than those before the treatment (P0.05), and the levels of TNF- 伪 and IL-6 in the combination western medicine treatment group were lower than those before the treatment (P0.01). After 24 weeks of treatment, the levels of TNF- 伪 and IL-6 in the combined Chinese medicine treatment group and the single drug treatment group were significantly lower than those in the 8 week treatment group (P0.01), while the levels of TNF- 伪 and IL-6 in the combination western medicine treatment group were not significantly lower than those in the 8 week treatment group (P0.05). Conclusion: INF- 伪 combined with Bupleurum bupleurum Shugan Powder can improve the symptoms of patients with chronic hepatitis B and increase the antiviral effect of INF- 伪. Combined with diammonium glycyrrhizinate enteric-coated capsule can reduce the antiviral effect of INF- 伪. It is not recommended that INF- 伪 and Bupleurum Shugan Powder can eliminate virus by up-regulating the level of TNF- 伪 and IL-6 through immune activation, and the combination of them can play a synergistic role.
【作者单位】： 厦门大学医学院;厦门市中医院肝病中心;
【基金】：国家自然科学基金(No.81503529,NO.81673660) 福建省卫生厅中医药项目(No.wzpw201308) 福建省自然科学基金面上资助项目(No.2014J01374) 福建省科技计划引导性项目(No.2016D012) 厦门市科技计划项目(3502Z20134020)
【分类号】：R512.62
，
本文编号：2446339
[Abstract]:Objective: to investigate the therapeutic effect of Chaihu Shugan San and diammonium glycyrrhizinate enteric-coated capsule on interferon-伪 (interferon-alpha,IFN- 伪) in the treatment of chronic hepatitis B (chronic hepatitis-B, CHB) and the treatment of tumor necrosis factor-伪 (tumor necrosis factor 伪 (TNF- 伪). Effect of interleukin-6 (interleukin-6,IL-6) level. Methods: 524 cases of chronic hepatitis B were randomly divided into single drug treatment group (174 cases), combined traditional Chinese medicine treatment group (174 cases) and western medicine treatment group (176 cases). The single drug treatment group was treated with IFN- 伪 for 24 weeks, combined with traditional Chinese medicine treatment group, on the basis of IFN- 伪 treatment, Bupleurum Shugan Powder was given orally for 24 weeks, and the treatment course was 24 weeks. Combined with western medicine treatment group, based on IFN- 伪 treatment, diammonium glycyrrhizinate enteric-coated capsule 150-mg tid was given orally for 24 weeks. The changes of symptom score before and after treatment, the therapeutic effect of traditional Chinese medicine (TCM), the quantitative, HBV DNA of ALT level, the changes of TNF- 伪 and IL-6 levels before and after antiviral therapy, 8 weeks and 24 weeks after treatment were observed. Results: after 24 weeks of treatment, the improvement degree of symptom score was the most obvious in the combined traditional Chinese medicine treatment group, and the total effective rate was the highest in the traditional Chinese medicine treatment group, followed by the combination western medicine treatment group, and the lowest in the single medicine treatment group (P 0.01, P0.05). After 24-week treatment of IFN- 伪, the improvement degree of ALT and complete response rate were the highest in the combined traditional Chinese medicine treatment group, the lowest in the non-response rate, the second in the single drug treatment group, and the lowest in the western medicine treatment group (P0.05). After 8 weeks of treatment, the levels of TNF- 伪 and IL-6 in the combined Chinese medicine treatment group and the single drug treatment group were higher than those before the treatment (P0.05), and the levels of TNF- 伪 and IL-6 in the combination western medicine treatment group were lower than those before the treatment (P0.01). After 24 weeks of treatment, the levels of TNF- 伪 and IL-6 in the combined Chinese medicine treatment group and the single drug treatment group were significantly lower than those in the 8 week treatment group (P0.01), while the levels of TNF- 伪 and IL-6 in the combination western medicine treatment group were not significantly lower than those in the 8 week treatment group (P0.05). Conclusion: INF- 伪 combined with Bupleurum bupleurum Shugan Powder can improve the symptoms of patients with chronic hepatitis B and increase the antiviral effect of INF- 伪. Combined with diammonium glycyrrhizinate enteric-coated capsule can reduce the antiviral effect of INF- 伪. It is not recommended that INF- 伪 and Bupleurum Shugan Powder can eliminate virus by up-regulating the level of TNF- 伪 and IL-6 through immune activation, and the combination of them can play a synergistic role.
【作者单位】： 厦门大学医学院;厦门市中医院肝病中心;
【基金】：国家自然科学基金(No.81503529,NO.81673660) 福建省卫生厅中医药项目(No.wzpw201308) 福建省自然科学基金面上资助项目(No.2014J01374) 福建省科技计划引导性项目(No.2016D012) 厦门市科技计划项目(3502Z20134020)
【分类号】：R512.62
，
本文编号：2446339
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