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黄连温胆汤治疗慢性乙型肝炎肝纤维化肝胆湿热证的效果观察
Clinical effect of Huanglian Wendan decoction in treatment of chronic hepatitis B liver fibrosis patients with liver-gallbladder damp-heat syndrome
文章发布日期:2020年06月08日  来源:  作者:谢爱泽,毛德文,石清兰,等  点击次数:287次  下载次数:34次

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【摘要】:目的 探讨黄连温胆汤治疗慢性乙型肝炎肝纤维化肝胆湿热证患者的效果及对辅助性T淋巴细胞17(Th17)/IL-17炎症轴的调控作用。方法 收集2016年1月-2018年12月在广西中医药大学第一附属医院肝病科诊治的128例肝胆湿热证的慢性乙型肝炎肝纤维化患者的临床资料。以随机数字表法分为治疗组(n=64)和对照组(n=64),2组均给予核苷类药物恩替卡韦分散片治疗,对照组给予中药安慰剂,治疗组采取黄连温胆汤内服。2组疗程均为24周。比较2组患者肝胆湿热证症状评分、肝功能、肝纤维化血清指标、肝硬度值(LSM)以及外周血IL-17和Th17细胞水平。计量资料2组间比较采用t检验;同一组内不同时间段比较采用单因素方差分析,进一步两两比较采用LSD-t检验;计数资料2组间比较采用χ2检验。结果 与同组治疗前比较,对照组和治疗组治疗12、24周后肝胆湿热证症状(胁肋胀痛、身目黄染、小便黄赤、口干苦、舌苔黄腻)评分均显著降低(P值均<0.01);2组间治疗12、24 周后比较,肝胆湿热证症状评分差异均有统计学意义(P值均<0.01)。与同组治疗前比较,对照组和治疗组治疗12、24周后肝功能指标(AST、ALT、TBil、GGT)均显著降低(P值均<0.01);2组间治疗12、24 周后比较,肝功能指标差异均有统计学意义(P值均<0.01)。与同组治疗前比较,对照组和治疗组治疗12、24周后肝纤维化血清指标(透明质酸、Ⅲ型前胶原、Ⅳ型胶原、层粘连蛋白)和LSM均显著降低(P值均<0.01);2组间治疗12、24 周后肝纤维化血清指标和LSM比较差异均有统计学意义(P值均<0.01)。治疗24周后与治疗前比较,治疗组患者的外周血Th17细胞、IL-17显著降低(t值分别为2.79、2.60,P值均<0.01),对照组患者的外周血Th17细胞显著降低(t=2.47,P<0.01);治疗组治疗24周后外周血Th17细胞、IL-17明显低于对照组治疗24周后(P值均<0.01)。对照组总有效率76.56%,治疗组总有效率90.63%,2组间比较差异有统计学意义(χ2=4.61,P<0.05)。结论 在西医核苷类药物抗病毒治疗的基础上,黄连温胆汤治疗慢性乙型肝炎肝纤维化肝胆湿热证疗效显著,调节Th17/IL-17炎症轴可能是其作用途径之一。
【Abstract】:Objective To investigate the clinical effect of Huanglian Wendan decoction in the treatment of chronic hepatitis B liver fibrosis patients with liver-gallbladder damp-heat syndrome and its regulatory effect on T helper 17 (Th17) cells/interleukin-17 (IL-17) inflammatory axis. Methods A total of 128 chronic hepatitis B liver fibrosis patients with liver-gallbladder damp-heat syndrome who were diagnosed and treated in The First Affiliated Hospital of Guangxi University of Chinese Medicine from January 2016 to December 2018 were enrolled and divided into treatment group and control group using a random number table, with 64 patients in each group. In addition to the treatment with the nucleoside drug entecavir dispersible tablets, the patients in the control group were given the traditional Chinese medicine (TCM) placebo, and those in the treatment group were given oral administration of Huanglian Wendan decoction. The course of treatment was 24 weeks for both groups. The two groups were compared in terms of symptom score of liver-gallbladder damp-heat syndrome, liver function, serological parameters for liver fibrosis, liver stiffness measurement (LSM), and levels of IL-17 and Th17 cells in peripheral blood. The t-test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison within each group at different time points, and the least significant difference t-test was used for further comparison between two time points. The chi-square test was used for comparison of categorical data between two groups. Results After 12 and 24 weeks of treatment, both groups had significant reductions in the scores of the symptoms of liver-gallbladder damp-heat syndrome (distending pain in the hypochondrium, jaundice of the skin and eyes, deep-colored urine, dry mouth and bitter taste, and slimy yellow tongue fur) (all P<0.01), and there were significant differences in the scores of the symptoms of liver-gallbladder damp-heat syndrome between the two groups (all P<0.01). After 12 and 24 weeks of treatment, both groups had significant reductions in the liver function parameters aspartate aminotransferase, alanine aminotransferase, total bilirubin, and gamma-glutamyl transpeptidase (all P<0.01), and there were significant differences in these liver function parameters between the two groups (all P<0.01). After 12 and 24 weeks of treatment, both groups had significant reductions in serological parameters for liver fibrosis (hyaluronic acid, procollagen type Ⅲ, type Ⅳ collagen, and laminin) and LSM (all P<0.01), and there were significant differences in these serological parameters for liver fibrosis and LSM between the two groups (both P<0.01). After 24 weeks of treatment, the treatment group had significant reductions in the count of Th17 cells and the level of IL-17 in peripheral blood (t=2.79 and 2.60, both P<0.01), and the control group had a significant reduction in the count of Th17 cells in peripheral blood (t=2.47, P<0.01); after 24 weeks of treatment, the treatment grop had significantly lower count of Th17 cells and level of IL-17 in peripheral blood than the control group (both P<0.01). There was a significant difference in overall response rate between the control group and the treatment group (76.56% vs 90.63%, χ2=4.61, P<0.05). Conclusion On the basis of antiviral therapy with nucleosides in Western medicine, Huanglian Wendan decoction has a marked clinical effect in the treatment of chronic hepatitis B liver fibrosis patients with liver-gallbladder damp-heat syndrome, possibly by regulating the Th17/IL-17 inflammatory axis.
【关键字】:乙型肝炎,慢性; 肝硬化; 黄连温胆汤; 肝胆湿热
【Key words】:hepatitis B chronic; liver cirrhosis; Huanglian Wendan Decoction; liver gallblad damp heat
【引证本文】:XIE AZ, MAO DW, SHI QL, et al. Clinical effect of Huanglian Wendan decoction in treatment of chronic hepatitis B liver fibrosis patients with liver-gallbladder damp-heat syndrome[J]. J Clin Hepatol, 2020, 36(7): 1502-1507. (in Chinese)
谢爱泽, 毛德文, 石清兰, 等. 黄连温胆汤治疗慢性乙型肝炎肝纤维化肝胆湿热证的效果观察[J]. 临床肝胆病杂志, 2020, 36(7): 1502-1507.

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