目的 观察拉米夫定联合苦参素治疗对慢性乙型肝炎患者血清细胞因子水平的影响和T细胞亚群的变化.方法 86例慢性乙型肝炎患者被随机分为治疗组42例和对照组44例,治疗组给予拉米夫定联合苦参素治疗,对照组单用拉米夫定治疗,在48周末观察结果.采用ELISA双抗体夹心法检测IL-2、IL-6、IL-10和IFN-γ水平；采用FACScalibur流式细胞仪检测外周血T细胞亚群.结果 在治疗48周末,治疗组和对照组谷丙转氨酶复常率分别为90.2％和83.3％(P＞0.05)；治疗组HBeAg转阴率、HBeAg/HBeAb转换率和HBV DNA转阴率分别为57.1％、35.3％和88.5％,显著高于对照组的30.2％、19.8％和67.1％(P＜0.05)；治疗组和对照组IL-2水平分别为181.1±26.1 pg/ml和86.9±10.7pg/ml(P＜ 0.05),IFN-γ水平分别为47.5±4.3pg/ml和27.8±4.4pg/ml(P＜0.05),IL-6水平分别为13.2±5.8pg/ml和27.1±6.4pg/ml(P＜0.05),IL-10水平分别为109.7±32.1pg/ml和169.5±36.2pg/ml(P＜0.05)；治疗组和对照组CD4+T淋巴细胞百分率分别为37.2±5.8％和27.8±6.4％(P＜0.05),CD8+T淋巴细胞百分率分别为20.8±5.2％和26.3±6.2％(P＜0.05),CD4+/ CD8+比值分别为1.56±0.3和1.34±0.2(P＜0.05).结论 拉米夫定联合苦参素治疗可以纠正慢性乙型肝炎患者Thl和Th2型细胞因子紊乱,改善T细胞亚群中各成分的比值,对慢性乙型肝炎患者细胞免疫有一定的调节作用,因而具有治疗作用.%Objective To observe the changes of peripheral blood T lymphocyte subsets and serum cytokine levels in patients with chronic hepatitis B receiving lamivudine and kurorinone treatment.Methods 86 patients with chronic hepatitis B were randomly divided into two groups.Forty-two patients were treated with lamivudine and kurorinone,a herbal medicine,for 48 weeks,and forty-four with lamivudine alone for 48 weeks.At the end of the observation,we detected the serum levels of cytokines by ELISA and the proportion of T lymphocyte subsets in blood by Facs.Results At the end of 48 weeks,serum levels of IL-2 in combination and lamivudine group were 181.1±26.1pg/ml and 86.9±10.7pg/ml(P＜0.05),the levels of IFN-γ were 47.5±4.3pg/ml and 27.8±4.4pg/ml(P＜0.05),the levels of IL-6 were 13.2±5.8pg/ml and 27.1±6.4pg/ml (P＜0.05),and the levels of IL-10 were 109.7±32.1 pg/ml and 169.5±36.2pg/ml(P＜0.05),respectively ;the proportion of CD4+ T lymphocytes were 37.2±5,8％ and 27.8±6.4％(P＜0.05),the proportion of CD8+ were 20.8±5.2％ and 26.3±6.2％(P＜0.05),and the CD4+/CD8+ ratio in the two groups were 1.56±0.3 and 1.34±0.2 (P＜0.05),respectively.Conclusion The combination of lamivudine and kurorinone could modulate Th1/Th2 cytokines by changing the proportions of T lymphocyte subsets.
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