本文選題：HBeAg陽(yáng)性慢性HBV攜帶者 + 腎虛型　； 參考：《浙江大學(xué)》2016年碩士論文

【摘要】：背景:乙型肝炎病毒(Hepatitis B virus,HBV)感染呈全球流行,據(jù)世界衛(wèi)生組織統(tǒng)計(jì),全球慢性HBV感染者約有2.4億人,每年約有65萬(wàn)人死于HBV感染所致的肝功能衰竭、肝硬化等疾病。慢性HBV攜帶者(ASC)常常進(jìn)展為慢性乙型肝炎,肝硬化,甚至肝癌,是全球目前較為關(guān)注的話題。目前用于抗病毒治療的藥物主要有普通干擾素、聚乙二醇干擾素和核苷類似物。西醫(yī)的抗病毒藥物可以通過(guò)長(zhǎng)期持續(xù)地抑制病毒復(fù)制,減輕肝臟炎癥,具有確切的臨床療效以及可重復(fù)性的優(yōu)點(diǎn),但是也有其局限性。中醫(yī)對(duì)慢性HBV攜帶者的認(rèn)識(shí)目前主要集中在"腎虛濕熱毒邪內(nèi)伏肝血"的理論,中醫(yī)治療較西醫(yī)將會(huì)產(chǎn)生"治本"的效應(yīng)。能否通過(guò)中醫(yī)藥干預(yù)來(lái)改善慢性HBV攜帶者免疫功能將成為中醫(yī)治療HBV感染者的新的研究方向。補(bǔ)腎清透方能否改善慢性HBV攜帶者的免疫功能還有待于進(jìn)一步研究和探討。方法:為了解慢性HBV攜帶者的中醫(yī)體質(zhì),我們進(jìn)行了相關(guān)的流行病學(xué)分析。我們采用ASC證候規(guī)律研究病例報(bào)告表(CRF),醫(yī)生現(xiàn)場(chǎng)問(wèn)卷調(diào)查、慢性HBV攜帶者自填問(wèn)卷調(diào)查、中醫(yī)專家醫(yī)院檢查及實(shí)驗(yàn)室檢測(cè)相結(jié)合的方式,對(duì)中醫(yī)證侯和中醫(yī)體質(zhì)進(jìn)行調(diào)查和分析。本研究將200例HBeAg陽(yáng)性的慢性HBV攜帶者,按中醫(yī)理論進(jìn)行辨證分型及體質(zhì)分類,選取"腎虛證"的HBeAg陽(yáng)性的慢性HBV攜帶者予以中藥"補(bǔ)腎清透方"干預(yù)。為了評(píng)估慢性HBV攜帶者在補(bǔ)腎清透方干預(yù)后免疫功能是否有所改善,我們通過(guò)ELISA檢測(cè)Th1/Th2型細(xì)胞因子IL-2、IL-10、TNF-α和IFN-γ分泌情況,并觀察HBV-DNA載量,評(píng)估"補(bǔ)腎清透方"在調(diào)節(jié)慢性HBV攜帶者免疫功能方面的作用,了解抗病毒療效,為中醫(yī)藥及時(shí)有效干預(yù)提供理論依據(jù)。結(jié)果:本研究發(fā)現(xiàn),流行病學(xué)分析涉及的中醫(yī)證候有13個(gè),有證可辨中主要集中在腎陽(yáng)虛、肝氣郁結(jié)、腎陰虛、腎氣虛、脾氣虛等12個(gè)證型,其中以腎虛證為主,占68.9%(82/119)。200例HBeAg陽(yáng)性的HBV攜帶者的中醫(yī)體質(zhì)類型根據(jù)量化評(píng)定表分為10種,出現(xiàn)頻率最高的為平和質(zhì),其中以合并腎虛質(zhì)為主(24.5%,49/200)。干預(yù)48周后,干預(yù)組血清IL-2、TNF-α、IFN-γ水平升高的程度高于對(duì)照組,兩組比較均有統(tǒng)計(jì)學(xué)差異(P0.01);干預(yù)組IL-10水平降低的程度也高于對(duì)照組,兩組比較有統(tǒng)計(jì)學(xué)差異(P0.01);干預(yù)組血清HBV-DNA下降1 log10、21og10、3log10的例數(shù)明顯多于對(duì)照組,干預(yù)組療效明顯優(yōu)于對(duì)照組,兩組比較有統(tǒng)計(jì)學(xué)意義。干預(yù)結(jié)束后復(fù)查兩組的血常規(guī)、大便常規(guī)、尿常規(guī)、腎功能、肝功能、心電圖、腹部B超均無(wú)明顯異常,顯示補(bǔ)腎清透方具有較好的安全性。結(jié)論:本研究發(fā)現(xiàn),慢性HBV攜帶者以"腎虛型"為主;中藥"補(bǔ)腎清透方"治療腎虛型慢性HBV攜帶者,可改善相關(guān)免疫功能指標(biāo),降低HBV載量,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- 偽 and IFN- 緯 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- 偽 IFN- 緯 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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259

【參考文獻(xiàn)】

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1 王貴強(qiáng);王福生;成軍;任紅;莊輝;孫劍;李蘭娟;李杰;孟慶華;趙景民;段鐘平;侯金林;賈繼東;唐紅;盛吉芳;彭R，

本文編號(hào)：1982650