The Study Of The Curative Effect Observation Of Traditional Chinese Medicine Treatment Of Refractory Chronic Hepatitis C And Its Relationship Between TCM Syndrome Type And T Lymphocyte Subsets

Chronic hepatitis c(HCV) is a public health problem whichcause serious damage to the human health. According to the WHO global HCV infection rate was3%, about170million people, thereare35000new hepatitis c patients every year. According to thelatest published by the state ministry of health in September，2010,the results of epidemiological investigation anti HCV positive ratewas0.43%in our country, probably the HCV infected more than5million.Nature of HCV infection history is long, a rate ofchronic at50%to85%. Liver cirrhosis and liver cancer is theleading cause of death among patients with chronic hepatitis c, theinfection of30%to40%will develop cirrhosis after5-10years,5%to7%after10-20years for the development of liver cancer. Oneof the most infectious diseases become the serious harm people’shealth. Although modern medicine in the treatment of chronichepatitis c made some breakthrough in the triple therapy as genotype1b，etc.some lastest scheme of refractory hepatitis c. But someunable to antiviral and virological breakthrough in the treatment,partial response, invalid response or no response, the side effectsof drugs, relapse after the drug was stopped, genotype1or4typeof HCV infection,a high viral load,merging other virus infection,orwith other such as diabetes, thyroid dysfunction Hemophilia organtransplant kidney disease and hemodialysis related diseases suchas autoimmune dysfunction,and the existence of the problems suchas cirrhosis of the liver decompensation period, makes thehepatitis c treatment is still a clinical problem, namely so-calledrefractory chronic hepatitis c. At present,caused by infection ofHCV genotype1chronic hepatitis c in China accounts for about78%,high viral load of chronic hepatitis c accounts for about69%,sothe vast majority of chronic hepatitis c in China belong to the refractory hepatitisc.refractory hepatitis c be formed complex,Andso its clinical manifestations are diverse. Through the11thfive-year plan for CHC symptoms of TCM syndrome classification’study shows：zheng xu xie lian、liver depression and spleendeficiency、kidney Yin deficiency type three accounts for more than73%of all kind of this syndrome，So the factors of the clinicalmanifestations of intermingled deficiency and excess are the maincharacteristics of CHC， If people do not implement clinicalintervention, let it to further development,it will be formed theintractable liver disease such as cirrhosis，The poor prognosis，which would be a great threat to The life of the patients, and poseda great challenge to treat. There is no special effective methodin terms of RHC therapies. Polyethylene glycol (peg) a interferon(P E G a IF N a) plus ribavirin optimized treatment or standardsolutions combined with protease inhibitors for the treatment ofgenotype1is still the first choice. But because of interferon、ribavirin and protease inhibitors are difficult to adapt to the sideeffects of the refractory hepatitis c treatment more confused.Therefore, further to seek immune pathogenesis of refractoryhepatitis c and further to find effective scheme for the treatmentof refractory hepatitis c is the urgent need of medical and clinicaltraditional Chinese medicine for its unique advantages, in theprevention and treatment of chronic viral hepatitis c hasaccumulated rich experience. From the traditional treatment basedon syndrome differentiation, ZhuanBing specially designed medicine,acupuncture, medicine, folk prescription, development to combinetraditional Chinese and western medicine treatment, has thecontribution of Chinese medicine. Years of research also confirmed that the traditional Chinese medicine in the prevention andtreatment of chronic hepatitis c is liver enzyme and antiviraleffect, to turn the early suppression of liver fibrosis has beenrecognized, to reduce the rate of chronic, chemical medicine sideeffects to improve compliance, improve immunity, improvingsymptoms and quality of life, prolong the survival period, reducethe mortality and the incidence of major events is more obviousadvantages.Purpose：This study on the basis of the "11th five-year plan" Thestudy of Chronic hepatitis c syndrome regularity and the treatmentprescription with the method of intergrated traditional andwestern medicine, relying on the national “12th five-year”refractory hepatitis c treatment of traditional Chinese medicine,in traditional Chinese medicine (TCM) syndrome (yiqi jiedu party,liver, spleen, kidney and liver) to treat refractory hepatitis c,and observe its clinical curative effect, transaminase and HCV RNAturn rate and falling rate drops2log (HCV RNA), and the immunefunction and transaminase, viral load and TCM syndrome type and Tlymphocyte subsets, HCV RNA and other correlation is studied, usingthe computer statistical software for data processing andcomprehensive analysis, to explore the clinical curative effect ofChinese medicine syndrome differentiation on refractory hepatitisc and RCHC viral load, liver inflammation, immune regulationmechanism and the correlation between TCM syndrome types, in orderto further improve the level of clinical treatment of refractorychronic viral hepatitis c.Methods: the experiment divided into three partsThe first part: the syndrome differentiation of traditional Chinese medicine clinical observation on treatment of refractorychronic hepatitis c54patients with refractory chronic hepatitis c were randomized,compared,28cases were divided into test group and control groupin26cases. Experimental group were given Chinese medicinesyndrome differentiation: yiqi jiedu, liver spleen, kidney andliver treatment, control group given a placebo treatment.,24,36,4812weeks after treatment to observe and compare the two groups ofblood HCV RNA Yin turn rate and falling rate, liver function andtwo groups of traditional Chinese medicine symptom integralchanges.The second part: the peripheral blood T cell subsets in patientswith refractory chronic hepatitis c correlation research and viralload153cases of intractable chronic HCV infection in1b gene,recurrence and liver cirrhosis after antiviral treatment Yin turninto three groups, respectively, by using flow cytometry andfluorescence quantitative PCR detection respectively in theperipheral blood T lymphocyte subsets (CD3+T，CD4+T，CD8+T，CD4+T/CD8+T) and HCV RNA loads. Alternate year healthy physicalexamination,150people in the peripheral blood T lymphocytesubgroup as control group.The third part: refractory of TCM syndrome types of chronichepatitis c and T lymphocyte subgroup and HCV RNA loads such ascorrelation studiesTCM syndrome types was studied for the153patients, using flowcytometry to test which patients and150normal healthy controlsperipheral blood T lymphocyte subsets changes, fluorescence quantitative PCR detection RCHC RNA content, genotyping, andpatients with liver function test, to observe the liver function,serum RCHC RNA loads and T lymphocyte subgroup indicators and therelationship between the TCM syndrome type.Results:the first part: the syndrome differentiation of traditionalChinese medicine clinical observation on treatment of refractorychronic hepatitis cTraditional Chinese medicine (TCM) syndrome compared with controlsparty (yiqi jiedu, liver, kidney and liver, spleen and party party)group can obviously reduce transaminase level, improve the HCV RNAYin turn rate and falling rate (P＜0.05) in the second part:peripheral blood T cell subsets in patients with refractory chronichepatitis c correlation research and viral load.1RHC patients compared with the control group of CD3+T，CD4+Tdecline was statistically significant (P＜0.05), while CD8+T, CD4+T/CD8+T no statistical significance (P>0.05).2A group of patients with high viral load compared with thecontrol group CD3+T, CD4+T decline was statistically significant (P<0.05), and CD8+T, CD4+T/CD8+T change there was no significantdifference (P>0.05), a group of patients with low viral load CD8+Tdecline was statistically significant compared with controls (P <0.05). RCHC group of patients with high viral load and low viralload in patients with T lymphocyte subsets, there was nostatistically significant difference (P>0.05).3After antiviral treatment turn Yin relapse group and controlgroup comparison of CD3+T, CD4+T, CD8+T decreased significantly, thedifference was statistically significant (P <0.05). 4liver cirrhosis group and control group comparison of CD3+T,CD8+T decreased significantly, and CD4+T/CD8+T increasesignificantly， the difference was statistically significant (P <0.05).5Gene1b group compared with control group, CD4+T, CD8+Tdecreased significantly, the difference was statisticallysignificant (P <0.05).6Treatment Yin turn recurrence, no statistical significancebetween the groups with and cirrhosis of the liver, compared withgenotype1b CD3+T, CD8+T decreased significantly, the differencewas statistically significant (P <0.05).7Cirrhosis group compared with genotype1b group of CD3+T,CD8+T decreased significantly, and CD4+T/CD8+T increasesignificantly，the difference was statistically significant (P <0.05).The third part: refractory of TCM syndrome types of chronichepatitis c and T lymphocyte subgroup and HCV RNA loads such ascorrelation studies.1Refractory common TCM syndrome types of chronic hepatitisc in the order is empty and, to change, liver and gallbladder dampand hot, blood stasis resistance winding, liver and kidney Yindeficiency and spleen kidney Yang deficiency and so on six type.2ALT level and based on the relationship between TCM syndrometype：which is the ALT from high to low in sequence for each cardtype：humid heat to hinder type，spleen and kidney Yang deficiencytype，liver-kidney Yin deficiency type，blood stasis resistancetype， change the type is empty and type, including humid heat tohinder type compared with other syndrome types ALT increased significantly, the difference was statistically significant(P<0.05); AST level and based on the relationship between TCM syndrometypes: which is the AST from high to low in sequence for each cardtype：spleen kidney Yang deficiency type, humid heat to hinder type,blood stasis resistance type, liver-kidney Yin deficiency type,change the type is empty and type, the spleen and kidney Yangdeficiency type and compared with other types increasedsignificantly, the difference was statistically significant(P<0.05); Propagated and based on the relationship between TCMsyndrome types: spleen kidney Yang deficiency type A significantlylower with other types of traditional Chinese medicine, thedifference was statistically significant(P <0.05).3RHC RNA levels and TCM syndrome types have a certain regularity,namely courage humid heat to hinder type> is empty and>liver-kidney Yin deficiency type> blood stasis resistance type>change the type> spleen kidney Yang deficiency type.The damp andhot resistance type and blood stasis resistance type compared thespleen kidney Yang deficiency type,RHC RNA increasedsignificantly,the difference was statistically significant(P<0.05).4Index of T lymphocyte subsets (CD3+T, CD4+T, CD4+T/CD8+T) oftraditional Chinese medicine and have a certain correlation,compared with normal control group humid heat to hinder type CD8+T significantly increased (P<0.01), CD4+T/CD8+T decreasedobviously (P <0.05); Spleen and kidney Yang deficiency type andchange the type compared with normal control group T CD3+T, CD4+TT cells decreased obviously (P <0.01), and CD8+T significantlydecreased (P<0.05); Is virtual love evil, blood stasis resistance compared with the normal control group, liver and kidney Yindeficiency type (CD3+T, CD4+T, CD4+T/CD8+T) has no statisticalsignificance(P＞0.05).5In each type of spleen kidney Yang deficiency syndromecompared T lymphocyte count declined obviously, and is empty andtype, humid heat to hinder type, blood stasis resistance type，liver and kidney Yin deficiency syndrome, type difference wasstatistically significant(P <0.05); Change the type of Tlymphocyte count drops obviously, and humid heat to hinder type,kidney Yin deficiency type difference was statisticallysignificant(P<0.05); Liver syndrome T lymphocyte count increasedsignificantly, compared with the blood stasis resistance type,spleen and kidney Yang deficiency type difference was statisticallysignificant(P <0.05)； CD4+T/CD8+T significantly decreased,compared with blood stasis type resistance difference wasstatistically significant(P <0.05).Conclusion:1Chinese medicine syndrome differentiation can improverefractory chronic viral hepatitis c liver inflammation, and hascertain antiviral effect.2long-term chronic HCV infection can cause low organismcellular immunity function and immune dysfunction, may be thegenotype1b and antiviral treatment after turn Yin recurrence andliver cirrhosis formed one of the leading causes of refractory, RCHCpatients with high viral load, active viral replication, liverinflammation disease, weakened immune system and the immune levelof turbulence gradually aggravated with HCV higher loads.3TCM syndrome type of RHC in turn is empty and type, change the type, liver and gallbladder damp and hot resistance type, bloodstasis resistance type, liver and kidney Yin deficiency type andspleen kidney Yang deficiency type and so on six type.4RHC transaminase, viral load and T lymphocyte subsets andTCM syndrome types have certain relevance.