摘要
目的:观察二至和肝方联合恩替卡韦治疗肝郁肾虚型慢性乙型肝炎患者外周血中CD4^(+)T细胞表面程序性死亡受体1(PD-1)/程序性死亡配体1(PD-L1)表达水平的影响。方法:将59例慢性乙型肝炎患者随机分为两组,观察组患者29例,予以二至和肝方+恩替卡韦片治疗;对照组患者30例,单用恩替卡韦片治疗。两组患者分别于治疗前、治疗24周、治疗48周后检查外周血丙氨酸氨基转移酶(ALT)、乙型肝炎病毒(HBV)标志物、HBV DNA和CD4^(+)T细胞表面PD-1/PD-L1表达水平。结果:治疗24、48周时两组患者外周血CD4^(+)T细胞表面PD-1/PD-L1表达水平均较本组基线值显著下调(P<0.01)。两组患者治疗前、治疗后24周CD4^(+)T细胞表面PD-1/PD-L1表达水平无明显差异(P>0.05);治疗48周后观察组患者CD4^(+)T细胞表面PD-1/PD-L1表达水平较对照组下降明显(P<0.05)。在治疗24、48周时,观察组患者HBV DNA转阴率显著高于对照组(P<0.05)。两组ALT复常率均较高,但差异无统计学意义(P>0.05)。结论:二至和肝方可能通过影响CD4^(+)T细胞表面PD-1/PD-L1表达水平,打破机体免疫耐受,改善机体免疫机制,增强抗病毒能力。
Objective:To observe the effect of Erzhi Hegan decoction combined with entecavir on the expression of PD-1/PD-L1 on the surface of CD4^(+)T cells in peripheral blood of patients with chronic hepatitis B of"liver depression and kidney deficiency"type.Methods:A total of 59 patients with chronic hepatitis B were randomly divided into traditional Chinese medicine group(29 cases)and control group(30 cases).The traditional Chinese medicine(TCM)group was treated with Erzhi Hegan Decoction plus ETV,while the control group was treated with ETV only.Before treatment,24 weeks after treatment and 48 weeks after treatment,the expression level of ALT,Immunological markers of hepatitis B virus,HBV DNA and PD-1/PD-L1 on CD4^(+)T cells were detected.Results:Compared with their baseline values,PD-1/PD-L1 expression levels on the surface of CD4^(+)T cells in peripheral blood of patients in both groups were significantly down-regulated compared with the baseline at 24 and 48 weeks of treatment(P<0.01).There was no significant difference in the expression level of PD-1/PD-L1 on the surface of CD4^(+)T cells between the two groups before and 24 weeks after treatment(P>0.05);after 48 weeks of treatment,the expression level of PD-1/PD-L1 on the surface of CD4^(+)T cells in the treatment group was significantly lower than that in the control group(P<0.05).After 24 and 48 weeks of treatment,the negative rate of HBV DNA in TCM group was significantly higher than that in control group(P<0.05).ALT normalization rate was higher in both groups(P>0.05).Conclusion:Erzhi Hegan decoction can break the immune tolerance of the body by affecting the expression level of PD-1/PD-L1 on the surface of CD4^(+)T cells,so as to improve the immune mechanism of the body and enhance the antiviral ability.
作者
丁月平
施维群
罗水荣
宋舒瑛
祝婷
林妍安
DING Yue-ping;SHI Wei-qun;LUO Shui-rong(The Second Affiliated Hospital of Zhejiang Chinese Medical University,(Hangzhou Zhejiang,310005),China;不详)
出处
《中西医结合肝病杂志》
CAS
2023年第4期307-310,共4页
Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases
基金
浙江省中医药科技计划一般项目(No.2019ZA061,No.2021ZB142)。
