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恩替卡韦联合苦参素治疗慢性乙型肝炎疗效及对患者外周血免疫球蛋白、TNF-α和IL-6的影响

Effects of Entecavir Combined with Kushenin on Chronic Hepatitis B and its Effect on Peripheral Blood Immunoglobulin, TNF-α and IL-6

DOI：

中文关键词: 慢性乙型肝炎恩替卡韦苦参素外周血免疫球蛋白肿瘤坏死因子 α 白细胞介素6

英文关键词:Chronic hepatitis B Entecavir Kushenin Peripheral blood immunoglobulin TNF α IL 6

基金项目:

作者	单位
吴颖王峰金玺	南通市中医院消化内科江苏南通 226000

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中文摘要:

摘要目的：观察恩替卡韦联合苦参素治疗慢性乙型肝炎的疗效，及对患者外周血免疫球蛋白、肿瘤坏死因子 α（TNF α）和白细胞介素6（IL 6）水平的影响。方法：采用随机双盲对照试验方法，70例慢性乙型肝炎患者随机分为观察组35与对照组各35例。对照组给予恩替卡韦分散片0.5 mg，po，qd；观察组在此基础上加用苦参素胶囊0.2 g，po，tid。两组疗程均为12个月。观察并记录两组患者治疗前后血清HBV DNA及ALT水平、外周血免疫球蛋白（IgM、IgA、IgG）及血清TNF α、IL 6水平变化，比较两组治疗后ALT复常率、HBV DNA阴转率、HBeAg/HBeAb转换率、HBeAg阴转率。结果：治疗后，两组患者ALT水平均较治疗前明显下降（P<0.01），但两组间比较差异无统计学意义（P>0.05）；两组患者HBV DNA水平也较治疗前明显下降（P<0.01），且观察组明显低于对照组（P<0.01）。观察组ALT复常率、HBV DNA阴转率、HBeAg/HBeAb转换率、HBeAg阴转率均显著低于对照组（P<0.05）。治疗后，观察组外周血IgM、IgA、IgG含量，以及血清TNF α、IL 6水平较治疗前显著增加（P<0.01或P<0.05），且均明显高于对照组（P<0.05）。结论：恩替卡韦联合苦参素抗HBV疗效显著，并且能显著提高外周血免疫球蛋白含量，增强免疫应答水平、降低血清TNF α、IL 6含量，控制肝内炎症发展，值得在临床应用中推广。

英文摘要:

ABSTRACT Objective:To investigate the effects of entecavir combined with kushenin on chronic hepatitis B and its effect on peripheral blood immunoglobulin, TNF α and IL 6. Methods: In this study, 70 hospitalized patients in our hospital from March 2015 to September 2016 were divided into observation group (n=35) and control group (n=35) according to double blind method. Control group was given entecavir 0.5 mg orally, once a day; The observation group was given kushenin 0.2 g orally, 3 times/day on the basis of therapeutic schedule of control group, both tid for 12 months. The changes of serum levels (HBV DNA, alanine aminotransferase, ALT normalization rate), the serum virology indices (Hbeag negative rate, HBeag/HBeAb seroconversion rate, HBsAg loss rate), the peripheral blood immunoglobulin (IgM, IgA, IgG) and the tumor necrosis factors (TNF α, IL 6) were observed and recorded. Results: The HBV DNA levels decreased after treatment in both groups, but the decrease level was more significant in the observation group than in the control group (P<0.01); The ALT levels decreased after treatment in both groups, but no significant difference between groups was found (P>0.05); The recovery rate of ALT in observation group was significantly higher than that in control group (94.28% vs. 74.29%, P<0.05); The Hbeag negative rate, HBeag/HBeAb seroconversion rate, HBsAg loss rate were 88.57%, 48.57%, 62.85% respectively, which were significantly higher than those of the control group (65.71%, 22.85%, 31.43%, P<0.05); After treatment, the level of peripheral blood immunoglobulin (IgM, IgA and IgG) increased, but the increase level in the observation group was more significant than that in the control group (P<0.05); The tumor necrosis factors (TNF α, IL 6) levels decreased after treatment (P<0.05), the decrease was more obvious in the observation group than in the control group (P<0.05). Conclusion: The entecavir combined with kushenin was an effective to ameliorate the content of immunoglobulin in peripheral blood and immune response level. It reduced the content of serum TNF α and IL 6, control the intrahepatic inflammation development, which was worthy of clinical application.

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