發(fā)布時間：2018-06-05 16:36

  本文選題：HBeAg陽性慢性HBV攜帶者 + 腎虛型��； 參考：《浙江大學》2016年碩士論文

【摘要】：背景:乙型肝炎病毒(Hepatitis B virus,HBV)感染呈全球流行,據(jù)世界衛(wèi)生組織統(tǒng)計,全球慢性HBV感染者約有2.4億人,每年約有65萬人死于HBV感染所致的肝功能衰竭、肝硬化等疾病。慢性HBV攜帶者(ASC)常常進展為慢性乙型肝炎,肝硬化,甚至肝癌,是全球目前較為關注的話題。目前用于抗病毒治療的藥物主要有普通干擾素、聚乙二醇干擾素和核苷類似物。西醫(yī)的抗病毒藥物可以通過長期持續(xù)地抑制病毒復制,減輕肝臟炎癥,具有確切的臨床療效以及可重復性的優(yōu)點,但是也有其局限性。中醫(yī)對慢性HBV攜帶者的認識目前主要集中在"腎虛濕熱毒邪內伏肝血"的理論,中醫(yī)治療較西醫(yī)將會產(chǎn)生"治本"的效應。能否通過中醫(yī)藥干預來改善慢性HBV攜帶者免疫功能將成為中醫(yī)治療HBV感染者的新的研究方向。補腎清透方能否改善慢性HBV攜帶者的免疫功能還有待于進一步研究和探討。方法:為了解慢性HBV攜帶者的中醫(yī)體質,我們進行了相關的流行病學分析。我們采用ASC證候規(guī)律研究病例報告表(CRF),醫(yī)生現(xiàn)場問卷調查、慢性HBV攜帶者自填問卷調查、中醫(yī)專家醫(yī)院檢查及實驗室檢測相結合的方式,對中醫(yī)證侯和中醫(yī)體質進行調查和分析。本研究將200例HBeAg陽性的慢性HBV攜帶者,按中醫(yī)理論進行辨證分型及體質分類,選取"腎虛證"的HBeAg陽性的慢性HBV攜帶者予以中藥"補腎清透方"干預。為了評估慢性HBV攜帶者在補腎清透方干預后免疫功能是否有所改善,我們通過ELISA檢測Th1/Th2型細胞因子IL-2、IL-10、TNF-α和IFN-γ分泌情況,并觀察HBV-DNA載量,評估"補腎清透方"在調節(jié)慢性HBV攜帶者免疫功能方面的作用,了解抗病毒療效,為中醫(yī)藥及時有效干預提供理論依據(jù)。結果:本研究發(fā)現(xiàn),流行病學分析涉及的中醫(yī)證候有13個,有證可辨中主要集中在腎陽虛、肝氣郁結、腎陰虛、腎氣虛、脾氣虛等12個證型,其中以腎虛證為主,占68.9%(82/119)。200例HBeAg陽性的HBV攜帶者的中醫(yī)體質類型根據(jù)量化評定表分為10種,出現(xiàn)頻率最高的為平和質,其中以合并腎虛質為主(24.5%,49/200)。干預48周后,干預組血清IL-2、TNF-α、IFN-γ水平升高的程度高于對照組,兩組比較均有統(tǒng)計學差異(P0.01);干預組IL-10水平降低的程度也高于對照組,兩組比較有統(tǒng)計學差異(P0.01);干預組血清HBV-DNA下降1 log10、21og10、3log10的例數(shù)明顯多于對照組,干預組療效明顯優(yōu)于對照組,兩組比較有統(tǒng)計學意義。干預結束后復查兩組的血常規(guī)、大便常規(guī)、尿常規(guī)、腎功能、肝功能、心電圖、腹部B超均無明顯異常,顯示補腎清透方具有較好的安全性。結論:本研究發(fā)現(xiàn),慢性HBV攜帶者以"腎虛型"為主;中藥"補腎清透方"治療腎虛型慢性HBV攜帶者,可改善相關免疫功能指標,降低HBV載量,安全性良好。
[Abstract]:Background: hepatitis B virus (HBV) infection is prevalent all over the world. According to the statistics of the World Health Organization, there are about 240 million people living with chronic HBV infection in the world, and about 650000 people die of liver failure and cirrhosis caused by HBV infection every year. Chronic hepatitis B, liver cirrhosis and even liver cancer are the most important topics in the world. At present, the main antiviral drugs are interferon, polyethylene glycol interferon and nucleoside analogues. Western antiviral drugs can reduce liver inflammation by inhibiting viral replication for a long time. It has definite clinical efficacy and reproducibility, but it also has its limitations. The knowledge of chronic HBV carriers in TCM is mainly focused on the theory of "kidney deficiency, dampness, heat, toxin, internal accumulation of liver and blood", and TCM treatment will have the effect of "treating the root cause" compared with western medicine. Whether the immune function of chronic HBV carriers can be improved through TCM intervention will become a new research direction of TCM in treating HBV infected persons. Whether Bushen Qingdu recipe can improve the immune function of chronic HBV carriers remains to be further studied and discussed. Methods: in order to understand the TCM constitution of chronic HBV carriers, we carried out epidemiological analysis. We used the ASC syndrome study case report form CRF, the doctor field questionnaire, the chronic HBV carrier self-filling questionnaire, the traditional Chinese medicine expert hospital examination and the laboratory examination. Investigation and analysis of TCM syndromes and TCM constitution. In this study, 200 HBeAg-positive chronic HBV carriers were divided into two groups according to TCM theory, and the HBeAg-positive chronic HBV carriers with "Kidney deficiency Syndrome" were selected to intervene with the traditional Chinese medicine "Bushen Qingdu recipe". In order to evaluate whether the immune function of chronic HBV carriers improved after the intervention of Bushen Qing Qing Fang, we detected the secretion of Th1 / Th2 cytokines IL-10 TNF- 偽 and IFN- 緯 by Elisa, and observed the HBV-DNA load. To evaluate the effect of "Bushen Qingdu recipe" on regulating the immune function of chronic HBV carriers, to understand the antiviral effect and to provide theoretical basis for timely and effective intervention of TCM. Results: this study found that there were 13 TCM syndromes involved in epidemiological analysis, in which there were mainly 12 syndrome types, including deficiency of kidney yang, stagnation of liver qi, deficiency of kidney yin, deficiency of kidney qi, deficiency of spleen qi, and so on. The TCM physique types of 200 HBV carriers with HBeAg positive were divided into 10 types according to the quantitative evaluation table. The most frequent ones were calmness and quality, of which 24.549 / 200 were associated with kidney deficiency. After 48 weeks of intervention, the level of serum IL-2TNF- 偽 IFN- 緯 in the intervention group was higher than that in the control group (P 0.01), and the level of IL-10 in the intervention group was also higher than that in the control group. The serum HBV-DNA in the intervention group was significantly lower than that in the control group, and the curative effect in the intervention group was significantly better than that in the control group, and there was statistical significance between the two groups. After the intervention, the blood routine, stool routine, urine routine, renal function, liver function, electrocardiogram, abdominal B ultrasound were not significantly abnormal. Conclusion: in this study, we found that the main type of chronic HBV carriers was "kidney deficiency", and the treatment of chronic HBV carriers with kidney deficiency by "Bushen Qingshen prescription" could improve the related immune function indexes, reduce the amount of HBV load, and have good safety.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R259

【參考文獻】

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1 王貴強;王福生;成軍;任紅;莊輝;孫劍;李蘭娟;李杰;孟慶華;趙景民;段鐘平;侯金林;賈繼東;唐紅;盛吉芳;彭R，

本文編號：1982650