章燕燕 姜宏伟 吴莹雯

[摘要] 目的 探討慢性乙型肝炎病毒e抗原（HBeAg）阳性乙型肝炎患者服用益肾健脾清化方结合恩替卡韦后对血清细胞免疫功能辅助性Th1/Th2细胞因子及其肝功能的影响。 方法 选取2018年1月至2019年12月余姚市人民医院感染科收治的慢性HBeAg阳性乙型肝炎患者120例，分为对照组（采用恩替卡韦治疗）与治疗组（采用益肾健脾清化方+恩替卡韦治疗），每组各60例。两组分别治疗12周，观察治疗前后肝功能中的谷丙转氨酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆红素（TBIL）、白蛋白（ALB）;血清Th1/Th2细胞因子γ干扰素（IFN-γ）、白介素IL-12、IL-4、IL-13;HBeAg阴转率、HBeAg血清学转换率及HBV DNA阴转率的变化。 结果 治疗12周后，治疗组肝功能ALT、AST、TBIL、ALB指标均明显优于对照组（P<0.05），同时治疗组对血清Th1中的IFN-γ、IL-12指标上升值优于对照组（P<0.05），而血清Th2中IL-4、IL-13指标下降值亦优于对照组（P<0.05），说明治疗组更利于血清Th1/Th2细胞因子平衡，从而提高患者免疫水平。在HBeAg阴转率、HBeAg血清学转换率及HBV DNA阴转率上，治疗组效果与对照组比较无明显提高，差异无统计学意义（P>0.05）。 结论 益肾健脾清化方可有效调节血清中Th1/Th2细胞因子功能的平衡，同时能改善慢性HBeAg阳性乙型肝炎患者肝功能，可一定程度提高HBeAg阴转率及HBeAg血清学转换率。

[关键词] 益肾健脾清化方;恩替卡韦;慢性HBeAg阳性乙型肝炎;血清Th1/Th2免疫水平

[中图分类号] R259.1          [文献标识码] A          [文章编号] 1673-9701（2021）28-0004-05

Research on the impacts of Yishen Jianpi Qinghua Prescription combined with entecavir on cellular immune function in patients with chronic HBeAg positive hepatitis B

ZHANG Yanyan   JIANG Hongwei   WU Yingwen

Department of Infectious Disease， Yuyao People′s Hospital in Zhejiang Province， Yuyao   315400， China

[Abstract] Objective To explore patients with chronic hepatitis B virus E antigen （HBeAg） positive hepatitis B after taking Yishen Jianpi Qinghua Prescription combined with entecavir on serum cellular immune function helper Th1/Th2 cytokines and hepatic function. Methods A total of 120 patients with chronic HBeAg positive hepatitis B admitted to the department of infectious disease of Yuyao People′s Hospital from January 2018 to December 2019 were selected and divided into the control group（n=50， using the entecavir treatment） and the treatment group（n=50， using the Yishen Jianpi Qinghua Prescription combined with entecavir treatment）. The patients in the two groups were treated for 12 weeks， and the alanine aminotransferase （ALT）， aspartic acid amino transferase （AST）， total bilirubin （TBIL）， albumin （ALB）， serum Th1/Th2 cytokine IFN-γ （gamma interferon）， IL （interleukin）-12， IL-4， IL-13， the negative conversion rate of HBeAg， the serological conversion rate of HBeAg and the negative conversion rate of HBV DNA in hepatic functions were observed before and after treatment. Results After 12 weeks of treatment，improvement of the hepatic functions in the treatment group was significantly superior to the control group in ALT， AST， TBIL and ALB indexes（P<0.05）. At the same time， the treatment group was superior to the control group in increasing indexes of IFN-γ and IL-12 in serum Th1（P<0.05）.The decreasing indexes of IL-4 and IL-13 in serum Th2 were also superior to the control group（P<0.05）， which indicated that the treatment group was more conducive to the balance of serum Th1/Th2 cytokines， thus improving the immune level of patients. The negative conversion rate of HBeAg， serological conversion rate of HBeAg and negative conversion rate of HBV DNA in the treatment group were not significantly improved as compared with those in the control group， with no statistically significant differences（P>0.05）. Conclusion Yishen Jianpi Qinghua Prescription can effectively regulate the balance of serum Th1/Th2 cytokine functions in serum. At the same time， it can improve hepatic function of patients with chronic HBeAg positive hepatitis B and improve the negative conversion rate of HBeAg and the serological conversion rate of HBeAg to a certain extent.

[Key words] Yishen Jianpi Qinghua Prescription; Entecavir; Chronic HBeAg positive hepatitis B; Serum Th1/Th2 immune level

众所周知，慢性乙型肝炎（Chronic hepatitis B，CHB）是常见的肝脏系统疾病主要因素之一，其并发症肝硬化、肝癌等肝脏系统疾病严重威胁着患者的生活质量及生命，已成为全世界亟待解决的问题[1]。慢性乙肝e-抗原（HBeAg）阳性CHB作为CHB的一种，HBeAg CHB携带率在我国已达到约7%[2]。相对于其他类型CHB患者，其具有病程短、炎症指标高、病毒复制性强等特点[3-4]，故抗病毒治疗作为目前公认的有效方法，作为核苷类药物代表性药物的恩替卡韦能有效控制病毒复制，降低HBV-DNA水平，但同时易出现渐进性耐药性且HBeAg血清学转换率较低，反弹率较高等缺点[5-6]。……