护肝逐瘀汤联合熊去氧胆酸对原发性胆汁性肝硬化患者免疫球蛋白及T淋巴细胞亚群的影响
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摘要
目的探讨护肝逐瘀汤联合熊去氧胆酸对原发性胆汁性肝硬化(PBC)患者免疫球蛋白及T淋巴细胞亚群的影响。方法以入院病例号为编号,根据随机数字表,将2013年10月—2016年10月建德市第一人民医院收治的110例原发性胆汁性肝硬化(肝郁脾虚证)患者随机分成2组,每组各55例。对照组给予熊去氧胆酸治疗;观察组联合中药护肝逐瘀汤,2个月为1个疗程。观察患者治疗前后症状改善情况,并评估肝功能、免疫球蛋白(IgA、IgG、IgM)、T淋巴细胞亚群(CD4~+、CD8~+、CD4~+/CD8~+水平,CD4~+CD25~+调节性T细胞)的变化。结果治疗后,观察组总有效率高于对照组(P<0.05);观察组中医证候评分低于对照组(P<0.05);观察组ALT、ALP、TBiL、GGT水平降低,低于对照组(均P<0.05);观察组IgA、IgG、IgM水平下降,低于对照组(均P<0.05);CD4~+、CD4~+/CD8~+水平降低,CD8~+水平升高,Treg水平升高,与对照组比较差异有统计学意义(均P<0.05)。结论护肝逐瘀汤联合熊去氧胆酸可改善肝郁脾虚证PBC乏力、瘙痒等临床症状和体征,改善肝功能,提高机体免疫功能,具有多靶点治疗功效,充分发挥中医药治疗优势,为中医药治疗PBC提供新的临床思路。
Objective To investigate the effect of Hugan Zhuyu decoction combined with ursodeoxycholic acid on immunoglobulin and T lymphocyte subsets in patients with primary biliary cirrhosis(PBC). Methods A total of 110 patients with primary biliary cirrhosis(liver depression and spleen deficiency syndrome) were randomly divided into two groups from October 2013 to October 2016, 55 cases in each group. The control group was treated with ursodeoxycholic acid and the observation group was treated with Hugan Zhuyu Decoction for 2 months. The improvement of symptoms, liver function, immunoglobulin(IgA, IgG and IgM) and T lymphocyte subsets(CD4~+, CD8~+, CD4~+/CD8~+ and CD4~+CD25~+Treg)were observed before and after treatment. Results After treatment, the total effective rate of the observation group was higher than that of the control group(P<0.05); the score of TCM syndromes in the observation group was lower than that of the control group(P<0.05); the levels of ALT, ALP, TBiL and GGT in the observation group were lower than that of the control group(all P<0.05). The levels of IgA, IgG and IgM in group A were lower than those in control group(all P<0.05), the levels of CD4~+, CD4~+/CD8~+ were lower, the levels of CD8~+ were higher, and the levels of Treg were higher than those in control group(P<0.05). Conclusion Hugan Zhuyu Decoction combined with ursodeoxycholic acid can improve the clinical symptoms and signs of PBC with liver depression and spleen deficiency syndrome, improve liver function, and improve immune function. Hugan Zhuyu Decoction combined with ursodeoxycholic acid has the effect of multi-target therapy, and give full play to the advantages of traditional Chinese medicine in treating PBC.
Objective To investigate the effect of Hugan Zhuyu decoction combined with ursodeoxycholic acid on immunoglobulin and T lymphocyte subsets in patients with primary biliary cirrhosis(PBC). Methods A total of 110 patients with primary biliary cirrhosis(liver depression and spleen deficiency syndrome) were randomly divided into two groups from October 2013 to October 2016, 55 cases in each group. The control group was treated with ursodeoxycholic acid and the observation group was treated with Hugan Zhuyu Decoction for 2 months. The improvement of symptoms, liver function, immunoglobulin(IgA, IgG and IgM) and T lymphocyte subsets(CD4~+, CD8~+, CD4~+/CD8~+ and CD4~+CD25~+Treg)were observed before and after treatment. Results After treatment, the total effective rate of the observation group was higher than that of the control group(P<0.05); the score of TCM syndromes in the observation group was lower than that of the control group(P<0.05); the levels of ALT, ALP, TBiL and GGT in the observation group were lower than that of the control group(all P<0.05). The levels of IgA, IgG and IgM in group A were lower than those in control group(all P<0.05), the levels of CD4~+, CD4~+/CD8~+ were lower, the levels of CD8~+ were higher, and the levels of Treg were higher than those in control group(P<0.05). Conclusion Hugan Zhuyu Decoction combined with ursodeoxycholic acid can improve the clinical symptoms and signs of PBC with liver depression and spleen deficiency syndrome, improve liver function, and improve immune function. Hugan Zhuyu Decoction combined with ursodeoxycholic acid has the effect of multi-target therapy, and give full play to the advantages of traditional Chinese medicine in treating PBC.
引文
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[18] 张喆,赵静洁,王永志,等.柴胡疏肝散药理作用及机制研究进展[J].中国中医药信息杂志,2017,24(9):128-131.
[19] 熊山,丁晓晨.四君子汤化学成分和药理作用研究进展[J].山东医学高等专科学校学报,2017,39(5):371-374.
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[2] 李彦丽.分析熊去氧胆酸联合通胆汤对原发性胆汁性肝硬化的治疗作用[J].中医临床研究,2017,9(22):83-84.
[3] 孔祥璐,郭晓霞.中药联合熊去氧胆酸胶囊治疗原发性胆汁性肝硬化疗效系统评价[J].实用肝脏病杂志,2015,18(4):379-382.
[4] 宁惠明.原发性胆汁性肝硬化诊治进展[J].临床肝胆病杂志,2016,32(4):802-805.
[5] 王眭,王江滨.原发性胆汁性肝硬化的诊断与治疗[J].临床肝胆病杂志,2015,31(10):1605-1607.
[6] 郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:151.
[7] 王青云,覃悦,牛艳丽,等.延续性健康教育路径对肝硬化患者出院后生存状态的影响[J].中国临床保健,2017,20(5):601-603.
[8] 韩晓颖,王劲松,李小芬,等.肝硬化门静脉高压患者血清胃蛋白酶原Ⅰ与胃蛋白酶原Ⅱ水平的变化及其临床意义[J].中国临床保健,2017,20(5):589-591.
[9] 卢芳汀,廉哲雄.原发性胆汁性肝硬化发病机制研究的应用前景[J].临床肝胆病杂志,2015,31(2):153-156.
[10] 李晓姝,曾辉,王宪波,等.原发性胆汁性肝硬化的免疫发病机制研究进展[J].临床肝胆病杂志,2015,31(8):1365-1369.
[11] 万敏.自身抗体和免疫功能指标对诊断原发性胆汁性肝硬化及评估病情的价值[J].中国卫生标准管理,2016,7(8):155-156.
[12] 苏兰,杨晋辉,唐映梅,等.Th17/Treg细胞在原发性胆汁性肝硬化发病中的作用研究进展[J].实用肝脏病杂志,2015,18(2):213-216.
[13] 樊雪强,王彩生,刘金涛,等.熊去氧胆酸在原发性胆汁性肝硬化临床治疗中的进展[J].中国医药导报,2016,13(24):58-61.
[14] 席奇,宋春荣,刘亚珠,等.健脾活血方联合熊去氧胆酸胶囊治疗原发性胆汁性肝硬化的研究[J].现代中西医结合杂志,2016,25(3):242-244.
[15] 任朦,郑亚江,祝峻峰,等.原发性胆汁性肝硬化中医辨证分型[J].吉林中医药,2016,36(7):678-681.
[16] 刘贝,陈碧华.原发性胆汁性肝硬化的中医辨识及治疗进展[J].上海医药,2017,38(12):32-34.
[17] 莫世燥,王璐,张荣臻,等.柴胡疏肝散合四君子汤治疗肝硬化肝郁脾虚证临床疗效观察[J].大众科技,2015,17(9):106-107.
[18] 张喆,赵静洁,王永志,等.柴胡疏肝散药理作用及机制研究进展[J].中国中医药信息杂志,2017,24(9):128-131.
[19] 熊山,丁晓晨.四君子汤化学成分和药理作用研究进展[J].山东医学高等专科学校学报,2017,39(5):371-374.
[20] 何枫葆.中药鸡血藤研究进展综述[J].产业与科技论坛,2015,14(4):40-41.
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