HBeAg阳性慢性HBV携带者的证候规律及补肾清透方对肾虚型慢性HBV携带者的影响研究

发布时间：2018-06-05 16:36

本文选题：HBeAg阳性慢性HBV携带者 + 肾虚型　；参考：《浙江大学》2016年硕士论文

【摘要】：背景:乙型肝炎病毒(Hepatitis B virus,HBV)感染呈全球流行,据世界卫生组织统计,全球慢性HBV感染者约有2.4亿人,每年约有65万人死于HBV感染所致的肝功能衰竭、肝硬化等疾病。慢性HBV携带者(ASC)常常进展为慢性乙型肝炎,肝硬化,甚至肝癌,是全球目前较为关注的话题。目前用于抗病毒治疗的药物主要有普通干扰素、聚乙二醇干扰素和核苷类似物。西医的抗病毒药物可以通过长期持续地抑制病毒复制,减轻肝脏炎症,具有确切的临床疗效以及可重复性的优点,但是也有其局限性。中医对慢性HBV携带者的认识目前主要集中在"肾虚湿热毒邪内伏肝血"的理论,中医治疗较西医将会产生"治本"的效应。能否通过中医药干预来改善慢性HBV携带者免疫功能将成为中医治疗HBV感染者的新的研究方向。补肾清透方能否改善慢性HBV携带者的免疫功能还有待于进一步研究和探讨。方法:为了解慢性HBV携带者的中医体质,我们进行了相关的流行病学分析。我们采用ASC证候规律研究病例报告表(CRF),医生现场问卷调查、慢性HBV携带者自填问卷调查、中医专家医院检查及实验室检测相结合的方式,对中医证侯和中医体质进行调查和分析。本研究将200例HBeAg阳性的慢性HBV携带者,按中医理论进行辨证分型及体质分类,选取"肾虚证"的HBeAg阳性的慢性HBV携带者予以中药"补肾清透方"干预。为了评估慢性HBV携带者在补肾清透方干预后免疫功能是否有所改善,我们通过ELISA检测Th1/Th2型细胞因子IL-2、IL-10、TNF-α和IFN-γ分泌情况,并观察HBV-DNA载量,评估"补肾清透方"在调节慢性HBV携带者免疫功能方面的作用,了解抗病毒疗效,为中医药及时有效干预提供理论依据。结果:本研究发现,流行病学分析涉及的中医证候有13个,有证可辨中主要集中在肾阳虚、肝气郁结、肾阴虚、肾气虚、脾气虚等12个证型,其中以肾虚证为主,占68.9%(82/119)。200例HBeAg阳性的HBV携带者的中医体质类型根据量化评定表分为10种,出现频率最高的为平和质,其中以合并肾虚质为主(24.5%,49/200)。干预48周后,干预组血清IL-2、TNF-α、IFN-γ水平升高的程度高于对照组,两组比较均有统计学差异(P0.01);干预组IL-10水平降低的程度也高于对照组,两组比较有统计学差异(P0.01);干预组血清HBV-DNA下降1 log10、21og10、3log10的例数明显多于对照组,干预组疗效明显优于对照组,两组比较有统计学意义。干预结束后复查两组的血常规、大便常规、尿常规、肾功能、肝功能、心电图、腹部B超均无明显异常,显示补肾清透方具有较好的安全性。结论:本研究发现,慢性HBV携带者以"肾虚型"为主;中药"补肾清透方"治疗肾虚型慢性HBV携带者,可改善相关免疫功能指标,降低HBV载量,安全性良好。
[Abstract]:Background: hepatitis B virus (HBV) infection is prevalent all over the world. According to the statistics of the World Health Organization, there are about 240 million people living with chronic HBV infection in the world, and about 650000 people die of liver failure and cirrhosis caused by HBV infection every year. Chronic hepatitis B, liver cirrhosis and even liver cancer are the most important topics in the world. At present, the main antiviral drugs are interferon, polyethylene glycol interferon and nucleoside analogues. Western antiviral drugs can reduce liver inflammation by inhibiting viral replication for a long time. It has definite clinical efficacy and reproducibility, but it also has its limitations. The knowledge of chronic HBV carriers in TCM is mainly focused on the theory of "kidney deficiency, dampness, heat, toxin, internal accumulation of liver and blood", and TCM treatment will have the effect of "treating the root cause" compared with western medicine. Whether the immune function of chronic HBV carriers can be improved through TCM intervention will become a new research direction of TCM in treating HBV infected persons. Whether Bushen Qingdu recipe can improve the immune function of chronic HBV carriers remains to be further studied and discussed. Methods: in order to understand the TCM constitution of chronic HBV carriers, we carried out epidemiological analysis. We used the ASC syndrome study case report form CRF, the doctor field questionnaire, the chronic HBV carrier self-filling questionnaire, the traditional Chinese medicine expert hospital examination and the laboratory examination. Investigation and analysis of TCM syndromes and TCM constitution. In this study, 200 HBeAg-positive chronic HBV carriers were divided into two groups according to TCM theory, and the HBeAg-positive chronic HBV carriers with "Kidney deficiency Syndrome" were selected to intervene with the traditional Chinese medicine "Bushen Qingdu recipe". In order to evaluate whether the immune function of chronic HBV carriers improved after the intervention of Bushen Qing Qing Fang, we detected the secretion of Th1 / Th2 cytokines IL-10 TNF- 伪 and IFN- 纬 by Elisa, and observed the HBV-DNA load. To evaluate the effect of "Bushen Qingdu recipe" on regulating the immune function of chronic HBV carriers, to understand the antiviral effect and to provide theoretical basis for timely and effective intervention of TCM. Results: this study found that there were 13 TCM syndromes involved in epidemiological analysis, in which there were mainly 12 syndrome types, including deficiency of kidney yang, stagnation of liver qi, deficiency of kidney yin, deficiency of kidney qi, deficiency of spleen qi, and so on. The TCM physique types of 200 HBV carriers with HBeAg positive were divided into 10 types according to the quantitative evaluation table. The most frequent ones were calmness and quality, of which 24.549 / 200 were associated with kidney deficiency. After 48 weeks of intervention, the level of serum IL-2TNF- 伪 IFN- 纬 in the intervention group was higher than that in the control group (P 0.01), and the level of IL-10 in the intervention group was also higher than that in the control group. The serum HBV-DNA in the intervention group was significantly lower than that in the control group, and the curative effect in the intervention group was significantly better than that in the control group, and there was statistical significance between the two groups. After the intervention, the blood routine, stool routine, urine routine, renal function, liver function, electrocardiogram, abdominal B ultrasound were not significantly abnormal. Conclusion: in this study, we found that the main type of chronic HBV carriers was "kidney deficiency", and the treatment of chronic HBV carriers with kidney deficiency by "Bushen Qingshen prescription" could improve the related immune function indexes, reduce the amount of HBV load, and have good safety.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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