补肾解毒方与健脾解毒方对慢性乙肝患者不同阶段的T淋巴细胞功能影响的研究

目的:比较补肾解毒方和健脾解毒方对乙肝病毒(Hepatitis B virus，HBV)慢性感染患者在不同免疫状态下外周血T淋巴细胞(Ts)功能影响。方法:选取本院感染科2013年9月至2014年5月门诊慢性HBV感染患者40例,据患者不同免疫状态分为清除组和耐受组,另选本院健康职工10例作为对照组。采用大鼠补肾解毒药物血浆和健脾解毒药物血浆进行干预。以T淋巴细胞亚群CD3+、CD4+、CD8+、CD28+分子的表达及干扰素-γ(Interferon-γ,IFN-γ)的水平作为研究指标,判断干预对外周血T淋巴细胞(Ts)功能影响情况。结果:各组健脾组和补肾组血浆在干预后CD3+、CD4+、CD8+、CD28+的表达均显著升高,耐受组中P<0.05,补肾组血浆干预后CD28+及CD8+分子显著高于健脾组,P<0.05;两种药物血浆分别干预后,CD28+分子表达均显著高于清除组同期,P<0.05。结论:健脾解毒法和补肾解毒法均能促进慢性HBV感染患者T细胞功能的恢复,免疫耐受期可能是中医药治疗的一个重要时期,补肾解毒药物效果优于健脾毒药物,需要分子实验和临床实验提供更多循证依据。

Effect of Bushen Jiedu Decoction and Jianpi Jiedu Fang on the Function of T Lymphocytes in Different Stages of Chronic Hepatitis B Patients

To compare the effect of Bushen Jiedu Decoction and Jianpi Jiedu Fang on the function of T lymphocytes(Ts)in different immune status of chronic hepatitis B(HBV)patients. Methods: A total of 40 cases of patients with chronic HBV infection who were enrolled in September 2013 to May 2014 in the department of outpatients of our hospital were selected and randomly divided into immune clearance group(n=20)and immune tolerance group(n=20)according to different immune status. Another 10 cases of healthy workers in our hospital were selected as healthy group. Select the venous blood anticoagulated peripheral to separate peripheral blood mononuclear cells(PBMCs), making a further separation and extraction of cultured T lymphocytes and use the rat kidney detoxification plasma and spleen detoxification drug plasma to make intervention. To detect the expression of T lymphocyte subsets and CD3+, CD4+, CD8+, CD28+ molecules and observe T cell culture supernatant of IFN-gamma level. Results: CD3+, CD4+, CD8+ and CD28+ expression in the Bushen Jiedu group and spleen detoxification group decreased at a greater level than that of the normal group. When compared with before intervention, the expression levels of CD3+,CD4+, CD8+, CD28+ after intervention with the kidney and spleen detoxification plasma drug were increased, and the levels of CD28 + and CD8+ in the immune tolerance group of spleen detoxification intervention group was significantly lower than that of Bushen Jiedu group(P<0.05)and expression of CD28+ after two kinds of plasma drugs intervention was significantly higher than that of immune clearance group(P<0.05)at the same period. Conclusion: Kidney detoxification method and spleen detoxification method can promote the recovery of T cell function in patients with chronic HBV infection, which have a significant effect of two kinds of drug containing plasma on T cell function in patients with chronic HBV infection during the immune tolerant phase.