【摘要】：目的:探討柴胡疏肝散、甘草酸二銨腸溶膠囊對(duì)α-干擾素(interferon-alpha,IFN-α)治療慢性乙型肝炎(chronic hepatitis B,CHB)療效的觀察及對(duì)腫瘤壞死因子-α(tumor necrosis factorα,TNF-α)、白細(xì)胞介素-6(interleukin-6,IL-6)水平的影響。方法:524例慢性乙型肝炎,按隨機(jī)數(shù)字表法隨機(jī)分為單藥治療組174例,聯(lián)合中藥治療組174例,聯(lián)合西藥治療組176例。單藥治療組采用IFN-α治療24周;聯(lián)合中藥治療組在IFN-α治療基礎(chǔ)上,采用柴胡疏肝散口服,每日1劑,療程24周;聯(lián)合西藥治療組在IFN-α治療基礎(chǔ)上,采用甘草酸二銨腸溶膠囊150-mg tid口服,療程24周。觀察3組治療前后的癥狀積分改變情況、中醫(yī)癥狀療效、ALT水平、HBV DNA定量、抗病毒治療應(yīng)答及治療前、治療8周、治療24周的TNF-α、IL-6水平的變化。結(jié)果:治療24周后,聯(lián)合中藥治療組癥狀積分改善程度最明顯、中醫(yī)癥狀療效總有效率最高,聯(lián)合西藥治療組次之,而單藥治療組最低(P0.01,P0.05)。完成IFN-α24周治療后,聯(lián)合中藥治療組ALT改善程度、HBV DNA定量下降程度及完全應(yīng)答率最高,無(wú)應(yīng)答率最低,單藥治療組次之,而聯(lián)合西藥治療組最低(P0.05);治療8周后聯(lián)合中藥治療組及單藥治療組TNF-α、IL-6水平較治療前升高(P0.05),聯(lián)合西藥治療組TNF-α、IL-6水平較治療前下降(P0.01),治療24周后聯(lián)合中藥治療組及單藥治療組TNF-α、IL-6水平較治療8周明顯下降(P0.01),聯(lián)合西藥治療組TNF-α、IL-6水平較治療8周時(shí)無(wú)明顯下降(P0.05)。結(jié)論:INF-α聯(lián)合柴胡疏肝散治療慢性乙型肝炎可改善患者癥狀,增加INF-α抗病毒療效,值得推薦聯(lián)用,而聯(lián)合甘草酸二銨腸溶膠囊治療可降低INF-α抗病毒療效,不推薦聯(lián)合使用,INF-α及柴胡疏肝散均可以通過(guò)上調(diào)TNF-α、IL-6水平通過(guò)免疫激活來(lái)清除病毒,二者聯(lián)用可起到協(xié)同作用。
[Abstract]:Objective: to investigate the therapeutic effect of Chaihu Shugan San and diammonium glycyrrhizinate enteric-coated capsule on interferon-偽 (interferon-alpha,IFN- 偽) in the treatment of chronic hepatitis B (chronic hepatitis-B, CHB) and the treatment of tumor necrosis factor-偽 (tumor necrosis factor 偽 (TNF- 偽). 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- 偽 for 24 weeks, combined with traditional Chinese medicine treatment group, on the basis of IFN- 偽 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- 偽 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- 偽 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- 偽, 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- 偽 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- 偽 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- 偽 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- 偽 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- 偽 combined with Bupleurum bupleurum Shugan Powder can improve the symptoms of patients with chronic hepatitis B and increase the antiviral effect of INF- 偽. Combined with diammonium glycyrrhizinate enteric-coated capsule can reduce the antiviral effect of INF- 偽. It is not recommended that INF- 偽 and Bupleurum Shugan Powder can eliminate virus by up-regulating the level of TNF- 偽 and IL-6 through immune activation, and the combination of them can play a synergistic role.
【作者單位】： 廈門大學(xué)醫(yī)學(xué)院;廈門市中醫(yī)院肝病中心;
【基金】：國(guó)家自然科學(xué)基金(No.81503529,NO.81673660) 福建省衛(wèi)生廳中醫(yī)藥項(xiàng)目(No.wzpw201308) 福建省自然科學(xué)基金面上資助項(xiàng)目(No.2014J01374) 福建省科技計(jì)劃引導(dǎo)性項(xiàng)目(No.2016D012) 廈門市科技計(jì)劃項(xiàng)目(3502Z20134020)
【分類號(hào)】：R512.62
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本文編號(hào)：2446339