| Antiviral therapy and immune regulation therapy are the main means of modern medical treatment of chronic hepatitis B,and the dialectical treatment is the main characteristics of TCM in treating chronic hepatitis B.The thesis intends to combine the advantages of modern medicine and traditional Chinese medicine to treat chronic hepatitis B,to study the relativity between TCM syndromes and cellular immune status of chronic hepatitis B and to evaluate the curative effect of entecavir antiviral therapy on TCM syndromes and its mechanism,There were three Parts in the thesis: 1.Study on the correlation between TCM syndromes of chronic hepatitis B and somatic cell immune status;2.Study on curative effect evaluation of entecavir antiviral by TCM syndrome type of chronic hepatitis B;3.The effect of the combination of entecavir and the Gnpitiaobu Fang on the cellular immune function of chronic hepatitis B in patients with liver-stagnation and spleen-deficiency syndrome.Part one The relationship between Traditional Chinese Medicine syndromes and cellular immune status of chronic hepatitis BObjective: To study the relationship between TCM syndromes and T lymphocyte subsets,NK cells,regulatory T cells,IL-12 and IL-10.Methods: 100 patients of CHB were divided into five groups,Which were liver-stagnation and spleen-Deficiency syndrome,the damp-heat in middle-Jiao syndrome,blood stasis syndrome,liver and kidney-yin deficiency syndrome,spleen and kidney-yang deficiency syndrome in 20 cases;and detection of peripheral blood T lymphocyte subsets and NK cells,regulatory T cells,IL-12 and IL-10.Result:1.Liver function damage is the lowest in liver depression and spleen deficiency syndrome,and dampness heat is the most serious.The difference between the three groups of liver qi stagnation and spleen deficiency syndrome,damp heat resistance syndrome and blood stasis obstructing collaterals was statistically significant,there were no significant differences between the two groups of liver kidney yin deficiency syndrome and spleen and kidney yang deficiency syndrome.2.The level of CD4+T lymphocyte was the highest in damp heat syndrome,the level of CD8+T lymphocyte in spleen and kidney yang deficiency was higher,CD4+/CD8+ level was higher in liver depression and spleen deficiency syndrome.3.NK cells were the highest in damp heat syndrome,and blood stasis blocking collateral syndrome was the lowest.The difference between damp heat syndrome and blood stasis blockage syndrome,spleen kidney yang deficiency syndrome and liver kidney yin deficiency syndrome type three was statistically significant.The longer the course of disease,the lower the level of NK cells.4.The regulatory T cells were the highest in blood stasis blocking syndrome,the lowest in liver depression and spleen asthenia syndrome.The difference between the syndrome of liver qi stagnation and spleen deficiency and blood stasis obstruction syndrome,spleen kidney yang deficiency syndrome and liver kidney yin deficiency syndrome is statistically significant,the longer the course of disease is,the higher the regulatory T cell level is.5.IL-12 expression was the highest in damp heat syndrome,lowest in liver depression and spleen asthenia syndrome.The expression of IL-10 was the highest in liver stagnation and spleen deficiency syndrome,and the lowest in damp heat syndrome.Conclusion:1.CD4+T lymphocyte subsets were the highest in damp heat syndrome and the lowest in spleen and kidney yang deficiency syndrome.CD8+T lymphocyte subsets were the highest in spleen and kidney yang deficiency syndrome,the lowest in damp heat syndrome and CD4+/CD8+ in liver qi stagnation and spleen deficiency syndrome.2.The level of NK cells is: Damp heat syndrome,liver depression,spleen deficiency syndrome,liver kidney yin deficiency syndrome,spleen kidney yang deficiency syndrome,blood stasis blocking syndrome.3.The level of regulatory T cells in turn is: blood stasis obstructing collaterals syndrome> spleen kidney yang deficiency syndrome> liver kidney yin deficiency syndrome> damp heat obstructing syndrome > liver stagnation and spleen deficiency syndrome.4.The levels of IL-12 were: Damp heat obstructing syndrome > blood stasis blocking syndrome > liver kidney yin deficiency > spleen kidney yang deficiency > liver stagnation and spleen deficiency syndrome.5.The levels of IL-10 were: liver depression spleen deficiency syndrome>liver kidney yin deficiency syndrome>spleen kidney yang deficiency syndrome>blood stasis obstruction syndrome>damp heat syndrome.Part two Evaluation of the efficacy of entecavir in the treatment of chronic hepatitis B by TCM syndrome typeObjective: To study the correlation between TCM Syndromes of CHB patients and entecavir antiviral efficacy.Methods: 100 cases of CHB were included in TCM syndrome differentiation,including liver depression and spleen deficiency syndrome,damp heat resistance syndrome,stagnation of blood stasis syndrome,liver kidney yin deficiency syndrome and spleen kidney yang deficiency syndrome in 20 cases.Entecavir(Run Zhong)was treated with antiviral therapy.Hepatitis B virus markers,HBs Ag quantification,HBV-DNA quantification,liver function and liver color Doppler were checked before treatment.The hepatitis B virus markers,HBs Ag quantitative,HBV-DNA quantitative,liver function,T lymphocyte subsets,regulatory T cells,NK cells,IL-10 and IL-12 were detected for Twelfth weeks,24 weeks and 48 weeks respectively,and the time of observation was 48 weeks.The changes of ALT repetition rate,HBV-DNA negative conversion rate,HBs Ag quantification,T lymphocyte subsets,regulatory T cells,NK cells,IL-12 and IL-10 levels were observed.Results:1.Baseline HBs Ag value was the highest in damp heat syndrome,and the difference was statistically significant compared with the other 4 types.2.Baseline HBV-DNA values were: Damp heat resistance syndrome >liver depression and spleen deficiency syndrome > blood stasis blocking syndrome > spleen kidney yang deficiency > liver kidney yin deficiency syndrome.3.The baseline ALT,AST value: in the order of damp heat resistance syndrome > liver depression and spleen deficiency syndrome > stagnation of blood stasis syndrome > liver kidney yin deficiency syndrome > spleen kidney yang deficiency syndrome,damp heat resistance syndrome and other 4 types,the difference is statistically significant.4.The baseline TBIL value: in the order of damp heat resistance syndrome,spleen kidney yang deficiency syndrome,blood stasis obstructing collaterals > liver kidney yin deficiency syndrome > liver depression and spleen deficiency syndrome,damp heat resistance syndrome and other 4 types,the difference is statistically significant.5.The recurrence rate of ALT,AST and TBIL: the highest resistance type and the fastest speed in the damp heat,compared with the other 4 groups,the difference was statistically significant,and the lowest rate of the yin deficiency of the liver and kidney was the lowest.6.The negative conversion rate of HBV-DNA: the total negative rate of HBV-DNA was 81%,of which 12,24 and 48 weeks were treated,and the syndrome of dampness and heat was 65%,80%,90%,and the syndrome of liver depression and spleen deficiency were 55%,75%,85%,respectively,and spleen and kidney yang deficiency syndrome were 45%,65% and 80%,respectively.7.HBs Ag titer: HBs Ag titers of all types showed a downward trend,but there was no statistical significance.HBs Ag titer of patients with damp heat syndrome was significantly lower than that of the other 4 groups,the difference was statistically significant.8.CD4+T lymphocyte count changes: the spleen and kidney yang deficiency syndrome increased significantly,and compared with the treatment of 12 weeks,the difference was statistically significant,the other types have increased,and no statistical significance before treatment.9.NK cell change: dampness and heat resistance is the highest,and the other four groups have statistical significance,spleen and kidney yang deficiency syndrome increased significantly,and compared with the treatment of 12 weeks,the difference is statistically significant,other types have increased,and no statistical significance before treatment.10.Regulatory T cell changes: Damp heat syndrome is the lowest,and the other four groups have statistical significance,liver depression and spleen deficiency syndrome is obvious,and compared with the treatment of 12 weeks,the difference is statistically significant,the other types are down,and there is no statistical significance before treatment.11.IL-12 and IL-10 changes: Damp heat syndrome IL-12 is the highest,and liver qi stagnation and spleen deficiency syndrome,liver kidney yin deficiency syndrome,spleen kidney yang deficiency syndrome comparison,the difference is statistically significant;the damp and heat resistance syndrome IL-10 is the lowest,among which the liver depression and spleen deficiency syndrome,spleen kidney yang deficiency syndrome IL-10 down significantly,48 weeks and 12 weeks treatment,the difference has statistical significance.Conclusion: The ALT recurrence rate and the negative rate of HBV-DNA were the highest in the damp heat resistance syndrome,the order was the same,in turn: Damp heat resistance syndrome > liver depression and spleen deficiency > spleen kidney yang deficiency syndrome > stagnation of blood stasis syndrome > liver kidney yin deficiency syndrome;and entecavir can up regulate liver depression and spleen deficiency syndrome,damp heat syndrome,liver kidney yin deficiency syndrome,spleen kidney yang deficiency syndrome CD4+T lymphocyte count and NK The cell count and IL-12 level,among which the spleen and kidney yang deficiency syndrome is the highest,the Treg cell count and IL-10 of the 5 types of syndromes have the downregulation effect,among which the liver depression and spleen deficiency syndrome are the strongest.Part three Effect of combination of entecavir with Ganpitiaobu Fang on the cellular immune function of chronic hepatitis B in patients with liver stagnation and spleen deficiency syndromeObjective: To observe the effect of "liver spleen regulating prescription" combined with entecavir on CHB patients with liver depression and spleen deficiency syndrome and its effect on cellular immune function.Methods: 20 cases of chronic hepatitis B with liver-stagnation and spleen-deficiency syndrome were treated by the combination of Ganpitiaobu Fang plus entecavir.Before treatment,hepatitis B virus markers,HBs Ag quantification,HBV-DNA quantification,liver function and liver color Doppler were performed at baseline.The HBV markers,HBs Ag quantification,HBV-DNA quantification,liver function,T lymphocyte subsets,regulatory T cells,NK cells,IL-10 and IL-12 were detected at twelfth weeks,24 weeks and48 weeks respectively.The observation time was 48 weeks.Objective To observe the effects of the combination of Ganpitiaobu Fang and entecavir on ALT recurrence rate,HBV-DNA negative conversion rate,HBs Ag quantification,T lymphocyte subsets,regulatory T cells,NK cells,IL-10 and IL-12 in chronic hepatitis B patients with liver-stagnation and spleen-Deficiency syndrome.Results:1.ALT recurrence rate comparison: the combined treatment group was better than the entecavir group at 12 weeks,24 weeks and 48 weeks,the difference was statistically significant.2.HBs Ag value comparison: the combined treatment group was better than the single entecavir group at 48 weeks,and the difference was statistically significant.The negative conversion rate of the two groups in the two groups was higher than that of the single entecavir group at 12,24 and 48 weeks,but the difference was not statistically significant because of the small sample size.3.CD4+T lymphocyte comparison: the two groups were upregulated,the combined treatment group was better than the entecavir group at 12 weeks,24 weeks and 48 weeks,the difference was statistically significant.4.NK cell comparison: in the 12 week,the 24 week and the 48 week,the two groups were upregulated.The combined treatment group was better than the entecavir group at 24 weeks and 48 weeks,the difference was statistically significant.5.Treg cell comparison: the two groups were reduced in 12 weeks,24 weeks and 48 weeks.The combined treatment group was lower than the single entecavir group in 24 weeks and 48 weeks.The difference was statistically significant.6.IL-12 comparison: the two groups increased at 12 weeks,24 weeks and 48 weeks.The combined treatment group was better than the entecavir group at 24 weeks and 48 weeks,the difference was statistically significant.7.IL-10 comparison: the two groups were decreased at 12 weeks,24 weeks and 48 weeks,and the difference was not statistically significant.Conclusion:1.The combination of liver and spleen regulating formula and entecavir in the treatment of CHB can increase the biochemical response rate and virological response rate.2.he liver and spleen tonifying prescription combined with entecavir in the treatment of CHB patients could increase the CD4+T lymphocyte count,NK cell count,and cytokine IL-12,down the Treg cell count and IL-10 level. |
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