清热化湿法对慢性乙型肝炎湿热证血清白细胞介素2受体的影响

目的]探讨清热化湿法对慢性乙型肝炎湿热证患者的临床疗效及对可溶性白细胞介素2受体(SIL-2R)水平的影响。方法]采用不完全随机法将慢性乙型肝炎湿热证患者分为2组,治疗组31例采用清热化湿法治疗,对照组17例予以常规西药护肝治疗,观察两组疗效,并于治疗前后抽取患者外周血检查肝功能和SIL-2R水平。结果]两组患者血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TB)、SIL-2R水平均较正常组明显升高,经治疗后明显下降(P<0.01或P<0.05);两组治疗后的SIL-2R差值比较有显著性差异(P<0.05)。治疗组4例血清HBV-DNA、HBeAg阴转的患者,肝功能恢复正常,SIL-2R水平降低至正常水平;HBeAg未阴转者,或HBeAg阴转但HBV-DNA未降至正常范围者,虽肝功能恢复正常,SIL-2R水平仍较高。两组总有效率相比较无显著性差异(P>0.05),但两组显效率有显著性差异(P<0.01)。结论]清热化湿法是治疗慢性乙型肝炎湿热证的有效方法,其远期疗效可能要优于西药组,这可能与调节SIL-2R水平有关;治疗后肝功能正常但SIL-2R水平仍较高的患者,病毒重新复制活跃的可能性大,应继续治疗。

Effect of Heat-Clearing and Dampness-Eliminating Therapy on Soluble Interleukin-2 Receptor in Chronic Hepatitis B with Damp-Heat Syndrome

Objective] To observe the therapeutic effect of heat-clearing and dampness-eliminating therapy for chronic hepatitis B with damp-heat syndrome and its influence on soluble interleukin-2 receptor (SIL-2R). Methods] Chronic hepatitis B patients with damp-heat syndrome were divided into two groups by incomplete randomization. Group A ( n = 31) was treated with heat-clearing and dampness-eliminating therapy and Group B (n = 17) with routine western medicine for protecting hepatic function. SIL-2R level in peripheral blood was observed before and after treatment. Results] Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB) and SIL-2R in chronic hepatitis B patients were much higher than those in healthy volunteers before theatment and were decreased after treatment (P < 0.01 or P < 0.05). The difference of SIL-2R level in Group A differed from that in Group B (P < 0.05). Hepatic function became normal and SIL-2R recovered to normal in 4 cases with HBV-DNA and HBeAg turning negative in Group A; hepatic function became normal but SIL-2R remained still higher in cases with HBeAg turning negative while HBV-DNA level being abnormal or in cases with HBeAb still being positive. The difference of total effective rate was insignificant between the two groups (P > 0.05) and that of markedly effective rate was significant (P<0.01). Conclusion] Heat-clearing and dampness-eliminating therapy is effective for chronic hepatitis B with damp-heat syndrome and its long-term effect seem to be superior to that of western medicine. Its therapeutic mechanism may be related to the regulation of serum SIL-2R level. For those cases with normal hepatic function and higher SIL-2R level, hepatitis virus B probably replicate actively and continuous treatment will be needed.