| Objective:To provide the basis for further exploring combination of clearing method with warming method controling the inflammatory response against liver failure through regulating Treg/Th17 cells by observing the efficacy and safety of combination of clearing method with warming method in the treatment of Hepatitis B virus related acute-on-chronic liver failure(HBV-ACLF)patients with negative Yang Huang Sysndrome and further analyzing the arranging of Th17/Treg cytokines,lipopolysaccharide(Lippolysaccharide,LPS),c-reactive Protein,(C-Reactive Protein,CRP),calcitonin(Procalcitonin,PCT).Methods:Adopting double center,randomized controlled clinical design,a total of 36 cases of HBV-ACLF patients with the negative Yang Huang Sy sndrome were randomly assigned to trial group(20 cases)and control group(16 cases).Patients in the contol group were treated with comprehesnive Western therapy,while those in trial group were treated with comprehesnive Western ther-apy and combination of clearing method with warming method.All were treated for 8 weeks.The survival rates of two groups 8 weeks after treatment,liver function,blood coagulation routine change and drug safety were compa-red to evaluating the clincal effect and safety.Treg/Th17 cytokines(IL-17,IL-23,TNF-α,IL-10,TGF-β),LPS,CRP and PCT in peripheral serum samples ob-tained from the two groups of patients at week 0 and week 8 were detected by ELISA(enzyme-linked immunosorbent method).Results:1.After 8-week-treatment,there was statistical difference in the overall effective rate between trial group and control group(75.00% vs 43.75%,P<0.05),while the differences of 8 weeks survival rate between the two groups was not statistically significant(80.00%vs68.75%,P>0.05).No one obvious case of adverse drug reaction and severe adverse eve nt was reported in the course of 8 weeks treatment.2.The ALT,AST,TBIL,PTA and INR level at 8 week compared withth ose at 0 week significantly decreased,whose significant difference was statistically significant(P<0.05),while there was no statistically signifi cant difference in incresing ALB(P>0.05);In reducing TBIL,INRand s ublimating PTA at 8 week,the trial group was better than control gr oup with the statistically significant difference(P<0.05);3.The serum inflammatory cytokines IL-17,IL-23,TNF-α,IL-10,LPS an d CRP level at 0 week were significantly higher in nunsurvival group than survival group,the difference was statistically significant(P<0.05),while the TGF-β,PCT were slightly higher with no statistical different significance(P>0.05);In a linear regression model,LPS levels were signifcntanly possitive correlated with serum IL-17,IL-23,TNF-α,IL-10,PCT(P<0.05),while the relationship of between TGF-β,CRP and LPS w as not showed(P>0.05);4.After 8 week treatment,the inflammatory cytokines IL-17,IL-23,TNF-α,TGF-β,IL-10,PCT,CRP,and LPS levels significantly reduced relative to 0 week in the trial group and control group,separately;Only in IL-17,IL-23,TNF-α,IL-10,PCT and LPS at 8 week did significantly decreased beween the trial group and control group,the difference was statistically significant(P<0.01).Conclusion:1.In inproving liver function(promoting the jaundice subsided)and bl ood coagulation,the comprehesnive Western therapy combination TCM clearing method and warming method was significtly better than the c omprehesnive Western therapy.2.Expressed highly levels of IL-17,IL-23,TNF-α,IL-10,LPS,CRP in patients with HBV-ACLF of the negative Yang Huang Sysndrome was associated with short-term prognosis of patients in 8 weeks survival rate;Treg/Th17 cytokines incuding IL-17,IL-23,TNF-α,IL-10 participated in the body’s inflammatory response in the HBV-ACLF intestinal endotoxemia;3.The TCM combination clearing method and warming method in inter vening the HBV-ACLF intestinal endotoxemia maybe correlated withaj usting the Treg/Th17 cytokines,at the same time reduce pro-inflammat ory IL-17,TNF-α and anti-inflammatory IL-10 to improve comp-ensator y anti-inflammatory response syndrome. |
PDF Full Text Request