Evaluation Of Clinical Efficacy And Cytokines In Chronic Severe Hepatitis B Treated By Integrative Therapy

Purpose Clinical efficacy and Experimental Research were conducted focused on patients of Chronic severe hepatitis/acute(subacute) on chronic,chronic hepatitis B liver failure treated with integrative therapy, at the same time, prognostic factors were explored.Methods1.Efficacy and prognostic factors were analysed through retrospective analysis of228cases of hospitalized patients diagnosed with chronic severe hepatitis B (cases were from302hospital),Integrative treatment measures, including hepatoprotective, jaundice-decreasing, antiviral, symptomatic and supportive and TCM treatment.2. A prospective,multicenter,randomized controlled trial was completed enrolled a total of962patient (cases from20hospitals which participated in the national the Eleventh Five-year" Major science and technology special issue","Study on Integrative program and Syndrome roles of chronic severe hepatitis",667cases were distributed into experimental group (Integrative treatment group) and295cases were distrobuted into the control group(Western medicine treatment group), according to the diagnosis,there were511patinets diagnosed as acute (subacute) on chronic liver failure, and451patients were diagnosed as chronic liver failure.The control group was given western medical comprehensive treatment, the experimental group was added traditional Chinese medcine based on the syndrome differentiation. Terms such as ortality,and survival analysis, effectiveness evaluation, biochemical indicators (including ALT and AST, CHE, the PT,PTA, TBIL,TC, TG,ALB,ammonia,etc), and symptoms were compared before and after treatment betwween the two groups.3.Cytokines included IL-17and IFN-γ, TNF-α,IL-10,IL-6, IL-4,IL-2were detected using serum of patients with hepatitis B-related liver failure, by streaming liquid detection of multiple protein quantitation,which were compared with that of chronic hepatitis B. Prognosis of the patients with liver failure were followed for24weeks.Result1.It shows that the overall effective rate is44.3%through retrospective analysis of228patients with chronic severe hepatitis B patients,according to different stages that are80.0%,50.4%,10.0%respectively of early,medium-term,late stages of live chronic severe hepatitis B,which has statistical significance (P<0.05). Relevant factors affecting the efficacy are CHE, PTA, TBIL, TC, ALB, course of disease stage and complications (P<0.05).2.All the962patients treated by integrative therapy, the total48-week mortality is37.08%, which are29.12%45.43%, respectively in chronic on acute(subacute) liver failure and chronic liver failure. Compared with the control group, the mortality of experimental group is significantly lower, the48-week mortality is25.99%compared to36.49%in the control group(P<0.05).For patients with chronic liver failure, the efficacy of two treatment methods has no significance, the48-week mortality is43.18%and46.51%respectively (P>0.05). Survival analysis shows that the survival rate in the experimental group is higher than the control group (P<0.05) in patients with acute on chronic liver failure,but there is no difference in chronic liver failure(P>0.05). Effectiveness evaluation for acute on chronic (subacute) liver failure, and Integrative therapy can improve clinical efficacy (P<0.05), but not for chronic liver failure,(P>0.05).Biochemical indicators for acute(subacute) on chronic liver failure patients are improved more significant than the control group, including AST,,PT, TBIL, ALB, and ammonia. For patients with chronic liver failure, ALB and ammonia are improved better than the control group. Clinical symptoms including fatigue, dark urine, loss of appetite and bloating are significantly improved in acute on chonic liver failure, symptoms like fatigue, loss of appetite, bloating are improved better in chronic liver failure compared to the control group.3.Levels of IL-17and IL-6are higher in patients with liver failure than in patients with chronic hepatitis B,Level of IL-17in died patients is higher than the survival group (P <0.05), there are no difference among levels of IFN-γ,TNF-α, IL-10, IL-6, IL-4, IL-2 between the two groups (P>0.05).Conclusion1.A retrospective case analysis shows that overall effective rate of chronic severe hepatitis B is low, Integrative Medicine can achieve better efficacy in the early and mid stage. The degree of liver cell’s necrosis and the incidence of complications are the factors affecting the efficacy of chronic severe hepatitis.Therefore, the efficacy can be improved by controlling the liver cell’s necrosis, preventing and treating various complications.2.Prospective, multicenter, randomized controlled clinical trial shows that integrative therapy program can significantly reduce mortality,improve survival, clinical outcomes, and biochemical index in patients with chronic severe hepatitis B. Compared to chronic liver failure, Integrative therapy can achieve more advantages in acute(subacute) on chronic liver failure.3.A variety of cytokines involved in the pathogenesis of hepatitis B-related liver failure.Lev els of IL-17and IL-6can reflect the degree of inflammation of the liver which may be involved in the onset of liver failure,level of IL-17has some correlations with the prognosis which may be used to predict the the clinical outcome.