联用复方甘草酸苷和干扰素对慢性乙型肝炎的临床疗效及炎症因子的影响

摘要

目的：探讨复方甘草酸苷与干扰素α-2b联合治疗慢性乙型肝炎的临床疗效及炎症因子影响及其可能机制.方法：慢性乙型肝炎患者76例,随机分为联合治疗组(39例)和单用干扰素α-2b组(37例).联合治疗组由复方甘草酸苷(100 ml、80 ml、60 ml各一个月疗程)和干扰素α-2b (500万U,肌肉注射,1次/d,连续1个月,之后隔日1次,疗程共9个月)；单用干扰素α-2b组,其剂量与用法同联合治疗组中的干扰素α-2b用法.检测肝功能、乙肝两对半、HBV-DNA定量；采用双抗夹心ELISA法和放射免疫分析法测定血清IL-12和IL-6、TNF-α水平.结果：联合治疗组的HBsAg转阴率、HBeAg转阴率、HBeAb转阳率和HBV-DNA转阴率均明显高于单用干扰素α-2b组；随访6个月后,ALT复常率、HBeAg转阴率、HBeAb转阳率和HBV-DNA转阴率也明显高于单用干扰素α-2b组.联合治疗9个月后的血清IL-6和TNF-α水平显著低于联合治疗前(P<0.05)和干扰素组(P<0.01)；联合治疗后的血清IL-12水平显著高于治疗前和干扰素组(P<0.05).结论：复方甘草酸苷与干扰素α-2b联合治疗慢性乙型肝炎有显著疗效；其可能机制为,复方甘草酸苷与干扰素α-2b可协同抑制肝细胞分泌IL-6、TNF-α等炎症因子,促进IL-12分泌,抑制乙肝病毒复制、病毒清除作用有关.%　　Objective:To investigate the clinical effection and possible mechanism of compound glycyrrhizin combined with interferonα-2b for treating chronic hepatitis B (CHB).Methods:76 cases of patients with chronic hepatitis B were randomly divided into combined treatment group(39 cases) and single-interferon alphα-2b group(37 cases),combined treatment group which were given compound glycyrrhizin(100 ml,80 ml and 60 ml for 4 weeks respectively) combined with interferonα-2b (once per day for 4 weeks,and then 500 MU interferon a every day for 32 weeks),and the same dose of interferonα-2b alone for control. All patients were treated for 36 weeks,and then were followed up another 24 weeks with no treatments.The levels of IL-12 and IL-6,TNF-αin serum were detected by ELISA and radiommunoassay.Results:By the end of therapeutic course,the rates of negative conversion of HBsAg,HBeAg,HBV-DNA,and the rates of positive conversion of HBeAb in the experimental group were much higher those in control .By the end of follow-up,the ALT recovery rates,and the rates of negative conversion of HBeAg and HBV-DNA and the rates of positive conversion of HBeAb in the experimental group had statistically significance than those in control .The serum levels of TNF-αand IL-6 were significantly down-regulated 36 weeks after treatment with compound glycyrrhizin combined with interferonα-2b compared with before combined treatment and interferonα-2b alone(P<0.05,P<0.01).The serum levels of IL-12 of the combined treatment patients were significantly higher than those of before combined treatment and after treatment interferonα-2b alone(P<0.05).Conclusion:Compound glycyrrhizin combined with interferonα-2b is effective to treat chronic hepatitis B and improve the clinical symptoms,possible mechanism for the compound glycyrrhizin interferonα-2b synergistic inhibition of liver cells to secrete IL-6,inflammatory cytokines such as TNF-α,promote IL-12 secretion,inhibit the replication of the hepatitis B virus,virus removal role