目的观察解毒凉血方治疗乙型肝炎慢加急性肝衰竭(hepatitis B virus related acute-onchronic liver failure,HBV-ACLF)热毒瘀结证的疗效和安全性。方法采用随机对照设计方法,将105例热毒瘀结证的HBV-ACLF患者随机分为试验组与对照组,...目的观察解毒凉血方治疗乙型肝炎慢加急性肝衰竭(hepatitis B virus related acute-onchronic liver failure,HBV-ACLF)热毒瘀结证的疗效和安全性。方法采用随机对照设计方法,将105例热毒瘀结证的HBV-ACLF患者随机分为试验组与对照组,试验组64例,对照组41例。试验组在西医内科综合治疗的基础上加用解毒凉血方,对照组仅给予西医内科综合治疗,治疗8周,随访40周。比较两组治疗后及随访至48周时的病死率、肝功能[包括总胆红素(total bilirubin,TBIL)、白蛋白(albumin,ALB)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天冬氨酸氨基转移酶(aspartate transaminase,AST)]、凝血酶原活动度(prothrombin activity,PTA)的改善及用药安全性。结果在8周的治疗期内,试验组和对照组在总体病死率(15.63%vs 34.15%)、疾病处于中期患者的病死率(25.0%vs 64.7%)、第8周TBIL、第2及4周AST、第4及6周PTA方面比较,差异均有统计学意义(P<0.05);随访至48周,试验组病死率(21.88%)较对照组病死率(39.02%)下降了17.14%,差异有统计学意义(P<0.05)。试验期间两组均无明显不良反应发生。结论解毒凉血方能够显著降低HBV-ACLF患者的病死率。展开更多
Summary： Immune-mediated inflammatory injury is an important feature of the disease aggravation of hepatitis B virus-related acute-on-chronic liver failure （ACLF）. Toll-like receptors （TLRs） have been shown previ...Summary： Immune-mediated inflammatory injury is an important feature of the disease aggravation of hepatitis B virus-related acute-on-chronic liver failure （ACLF）. Toll-like receptors （TLRs） have been shown previously to play a pivotal role in the activation of innate immunity. The purpose of this study was.to characterize the TLR4 expression in peripheral blood mononuclear cells （PBMCs） of ACLF pa- tients and its possible role in the disease aggravation. Twelve healthy subjects, 15 chronic HBV-infected （CHB） patients and 15 ACLF patients were enrolled in this study. The TLR4 expression in PBMCs and T cells of all subjects was examined by real-time PCR and flow cytometry. The correlation of TLR4 ex- pression on T cells with the markers of disease aggravation was evaluated in ACLF patients. The ability of TLR4 ligands stimulation to induce inflammatory cytokine production in ACLF patients was ana- lyzed by flow cytometry. The results showed that TLR4 mRNA level was upregulated in PBMCs of ACLF patients compared to that in the healthy subjects and the CHB patients. Specifically, the expres- sion of TLR4 on CD4＋ and CD8＋ T cells of PBMCs was significantly increased in ACLF patients. The TLR4 levels on CD4＋ and CD8＋T cells were positively correlated with serum total bilirubin （TBIL）, direct bilirubin （DBIL）, international normalized ratio （INR） levels and white blood cells （WBCs）, and negatively correlated with serum albumin （ALB） levels in the HBV-infected patients, indicating TLR4 pathway may play a role in the disease aggravation of ACLF. In vitro TLR4 ligand stimulation on PBMCs of ACLF patients induced a strong TNF-α production by CD4＋ T cells, which was also posi- tively correlated with the serum markers for liver injury severity. It was concluded that TLR4 expression is upregulated on T cells in PBMCs, which is associated with the aggravation of ACLF.展开更多
基金supported by the National Science and Technology Major Project for Infectious Diseases of China(No.2012ZX10004503)
文摘Summary： Immune-mediated inflammatory injury is an important feature of the disease aggravation of hepatitis B virus-related acute-on-chronic liver failure （ACLF）. Toll-like receptors （TLRs） have been shown previously to play a pivotal role in the activation of innate immunity. The purpose of this study was.to characterize the TLR4 expression in peripheral blood mononuclear cells （PBMCs） of ACLF pa- tients and its possible role in the disease aggravation. Twelve healthy subjects, 15 chronic HBV-infected （CHB） patients and 15 ACLF patients were enrolled in this study. The TLR4 expression in PBMCs and T cells of all subjects was examined by real-time PCR and flow cytometry. The correlation of TLR4 ex- pression on T cells with the markers of disease aggravation was evaluated in ACLF patients. The ability of TLR4 ligands stimulation to induce inflammatory cytokine production in ACLF patients was ana- lyzed by flow cytometry. The results showed that TLR4 mRNA level was upregulated in PBMCs of ACLF patients compared to that in the healthy subjects and the CHB patients. Specifically, the expres- sion of TLR4 on CD4＋ and CD8＋ T cells of PBMCs was significantly increased in ACLF patients. The TLR4 levels on CD4＋ and CD8＋T cells were positively correlated with serum total bilirubin （TBIL）, direct bilirubin （DBIL）, international normalized ratio （INR） levels and white blood cells （WBCs）, and negatively correlated with serum albumin （ALB） levels in the HBV-infected patients, indicating TLR4 pathway may play a role in the disease aggravation of ACLF. In vitro TLR4 ligand stimulation on PBMCs of ACLF patients induced a strong TNF-α production by CD4＋ T cells, which was also posi- tively correlated with the serum markers for liver injury severity. It was concluded that TLR4 expression is upregulated on T cells in PBMCs, which is associated with the aggravation of ACLF.
