| Objective To observe the effects of entecavir combined with traditional Chinese medicine for liver protection on the levels of T lymphocyte subsets and multiple cytokines in the blood of patients with chronic hepatitis B（CHB）,to investigate the clinical significance of traditional Chinese and Western medicine combined in the treatment of CHB,and to provide a new therapeutic scheme for CHB.Methods 200 cases of chronic hepatitis B patients,which were admitted by people’s hospital of Gaomi from June 2018 to June 2019,were randomly divided into 100 cases in two groups:western medicine group（conventional antiviral western medicine for hepatitis B）and combined group（Chinese medicine with traditional Chinese Medicine syndrome combined with western medicine）.The two groups were differentiated into five syndrome types,including the damp-heat blocked syndrome（DHBS）,the liver-stagnancy with spleen-deficiency syndrome（LSSD）,the liver-kidney yin-insufficiency syndrome（LKYI）,the blood-stasis blocking vessel syndrome（BSBV）and the spleen-kidney yang deficiency syndrome（SKYD）.There were 20 cases of five syndrome types.Real-time PCR,enzyme linked immunosorbent assay（ELISA）and automatic biochemical analysis system were used to detect HBV markers,HBV-DNA quantity and liver function related indexes before treatment.At the 36th week of treatment,HBeAg,HBV-DNA negative conversion rate and ALT,AST,ALP normalization rate were examined by automatic biochemical analysis system;flow cytometry was used to detect the percentage of peripheral blood CD4+CD25brightCD127lowow regulatory T cells（Treg）,CD8+T cells and the perforin and granzyme of peripheral blood lymphocytes;The serum expression level of IL-10 and TGF-βwere determined by enzyme linked immunosorbent assay.Results（1）Negative rate of HBeAg and HBV-DNA and ALT,AST and ALP normalization rate:The difference was statistically significant between combined group and western medicine group in LSSD and SKYD after 36 weeks of treatment（P<0.05）,but there was no significant difference between the two groups with other three syndrome types（P>0.05）.（2）The percentages of regulatory T cells were compared:After36 weeks of treatment,the five types were down-regulated in two groups.And there was significant difference between combined group and western medicine group compared to before treatment in 24 weeks and 36 weeks（P<0.05）.The down-regulation of combined group was better than that of western medicine group at 24th and 36th weeks in LSSD and SKYD（P<0.01）,but there was no significant difference between the two groups with other three syndrome types（P>0.05）.（3）The percentages of CD8+T cells were compared:After 36 weeks of treatment,the five types increased in two groups and there was significant difference between combined group and western medicine group compared to before treatment in 24 weeks and 36 weeks（P<0.05）.Compared with the two groups of LSSD and SKYD,the percentages of CD8+T cells increase was significant at 24 weeks and 36 weeks（P<0.01）,but there was no significant difference between the two groups with other three syndrome types（P>0.05）.（4）Expression rate of perforin and granzyme in peripheral blood lymphocytes:combined group of LSSD and SKYD at 24and 36 weeks was significantly higher than that before treatment（P<0.05）and there was no significant difference between other three syndrome types after 36 weeks and before treatment（P>0.05）.The expression rate of combined group was better than that of western medicine group at 24th and 36th weeks in LSSD and SKYD（P<0.01）,but there was no significant difference between the two groups with other three syndrome types（P>0.05）.（5）Comparison of serum IL-10 and TGF-βlevels:The five types were down-regulated in two groups after 36 weeks of treatment,and there was significant difference between combined group and western medicine group in 24 weeks and 36weeks（P<0.05）.The down-regulation of combined group was better than that of western medicine group at 24th and 36th weeks in LSSD and SKYD（P<0.01）,but there was no significant difference between the two groups with other three syndrome types（P>0.05）.Conclusion（1）Protect liver medicine dialectical treatment of CHB can effectively improve entecavir resistance to the therapeutic effect of hepatitis b virus（HBV）and improve on liver function by increasing HBe Ag,HBV-DNA negative conversion rate and ALT,AST,ALP normalization rate in LSSD and SKYD.（2）Combination of Chinese and Western medicine can significantly improve the immune function by regulating the status of T lymphocyte subsets and down-regulate the levels of cytokines IL-10 and TGF-βin five types,and improving the quality of life and living standard of patients,especially in LSSD and SKYD. |
