氧化苦参碱联合拉米夫定对慢性乙型肝炎患者免疫功能的影响

摘要

目的：观察氧化苦参碱联合拉米夫定对慢性乙型肝炎患者免疫功能的影响。方法选取2012年1月至2015年1月诊治的慢性乙型肝炎患者120例，随机分为对照组和观察组，每组60例，对照组在常规治疗基础上给予拉米夫定治疗，观察组在对照组基础上加用氧化苦参碱治疗，疗程为6个月。比较2组症状、体征改善情况、HBV-DNA水平、HBV-DNA阴转率、HBeAg阴转率。采用流式细胞术检测2组治疗前后患者外周血CD4＋CD2＋5调节性T细胞、T细胞亚群（ CD3＋、CD4＋、CD8＋、CD4＋／CD8＋比值）变化。酶联免疫吸附试验（ ELISA）检测叉头状螺旋转录因子（FOXP3）水平。免疫比浊法检测免疫球蛋白（IgA、IgG、IgM）及补体C3、C4水平。结果观察组症状、体征改善情况显著优于对照组（ P ＜0<．05），HBV-DNA水平显著低于对照组（ P ＜0．05），HBV-DNA阴转率、HBeAg阴转率显著高于对照组（ P ＜0．05）。治疗后2组CD3＋、CD4＋、CD4＋／CD8＋比值、C3、C4水平较治疗前显著升高（ P ＜0．05），CD4＋CD2＋5调节性T细胞、FOXP3、CD8＋、IgA、IgG、IgM较治疗前显著降低（ P ＜0．05），且观察组改善程度优于对照组（ P ＜0．05）。结论氧化苦参碱联合拉米夫定治疗慢性乙型肝炎能够通过改善患者免疫功能紊乱状态有效抑制病毒复制。%Objective To observe the effects of oxymatrine combined with lamivudine on immune function of patients with chronic hepatitis B.Methods One hundred and twenty patients with chronic hepatitis B were randomly divided into observation group ( n =60 ) and control group ( n =60 ) .The patients in control group, on the basis of symptomatic treatment,were treated by lamivudine, however, the patients in observation group, on the basis of the control group, were treated by oxymatrine, with a treatment course of 6 months for both groups.After treatment, the improvement status of symptoms and signs, HBV-DNA levels, HBV-DNA negative conversion rate, HBeAg negative conversion rate were observed and compared between two groups.The changes of CD4+CD2+5 regulatory T cells and T cell subgroup ( CD3+, CD4+, CD8+, CD4+/CD8+) in peripheral blood were detected by flow cytometry before and after treatment.The serum levels of FOXP3 were measured by ELISA. The immunoglobulins ( IgA, IgG, IgM ) and complement levels ( C3, C4 ) were detected by immunoturbidimetry for both groups.Results The improvement status of symptoms and signs in observation group was superior to that in control group ( P <0.05) , moreover, HBV-DNA levels in observation group were significantly lower than those in control group, however, HBV-DNA negative conversion rate and HBeAg negative conversion rate in observation group were significantly higher than those in control group ( P <0.05) .After treatment ,the levels of CD+3 , CD4+, ratio of CD4+/CD8+, C3 ,C4 levels were significantly increased,however, CD4+CD2+5 regulatory T cells, FOXP3, CD8+, IgA, IgG and IgM were significantly decreased in both groups ( P <0.05), furthermore, the improvement degree in observation group was superior to that of control group ( P <0.05).Conclusion Oxymatrine combined with lamivudine can improve immunological disorder of patients with chronic hepatitis B so as to inhibit effectively viral replication.