CAJ | 학술논문

目的：探讨熊去氧胆酸对HBeAg阳性高病毒载量乙肝肝硬化患者抗病毒疗效及安全性，及其对患者外周血Th17、Treg水平影响。方法选取2012年11月至2014年2月诊治的80例HBeAg阳性高病毒载量乙型肝硬化患者，随机分为对照组与观察组，每组40例。对照组患者给予常规治疗，观察组患者在对照组的基础上给予熊去氧胆酸，比较2组患者抗病毒疗效及安全性，治疗前后外周血Th17、Treg水平变化。结果与治疗前比较，治疗后两组ALT、AST、ALB、TBil水平均显著性降低（ P＜0．01），治疗后观察组ALT、AST、ALB、TBil水平均显著低于对照组（ P＜0．01）；观察组HBV－DNA转阴率（85．0％）与HBV－DNA下降幅度均明显高于对照组（7．5％）（χ2＝48．322，t＝11．490，P＜0．01）；观察组ALT复常率（52．5％）、HBeAg转阴率（57．5％）明显高于对照组（15．0％、17．5％）（χ2＝12．579，χ2＝13．653，P＜0．01）；治疗后并发症情况比较，观察组死亡、原发性肝细胞癌、自发性腹膜炎，消化道出血等发生率与对照组比较，差异均无统计学意义（χ2＝1．01，χ2＝2．05，χ2＝3．12，χ2＝0．21，P＞0．05）；治疗后2组患者Th17水平升高，Treg水平降低，观察组Th17水平显著高于对照组，Treg水平显著低于对照组，Th17／Treg比值高于对照组（ P＜0．05）。结论熊去氧胆酸可显著改善HBeAg阳性高病毒载量乙肝肝硬化患者肝功能，提高HBeAg转阴率，抑制HBV病毒复制，延缓病情发展，且不良反应较小；熊去氧胆酸可增加患者Th17细胞数，降低Treg细胞数，可能是其抗病毒作用机制之一。
목적：탐토웅거양담산대HBeAg양성고병독재량을간간경화환자항병독료효급안전성，급기대환자외주혈Th17、Treg수평영향。방법선취2012년11월지2014년2월진치적80례HBeAg양성고병독재량을형간경화환자，수궤분위대조조여관찰조，매조40례。대조조환자급여상규치료，관찰조환자재대조조적기출상급여웅거양담산，비교2조환자항병독료효급안전성，치료전후외주혈Th17、Treg수평변화。결과여치료전비교，치료후량조ALT、AST、ALB、TBil수평균현저성강저（ P＜0．01），치료후관찰조ALT、AST、ALB、TBil수평균현저저우대조조（ P＜0．01）；관찰조HBV－DNA전음솔（85．0％）여HBV－DNA하강폭도균명현고우대조조（7．5％）（χ2＝48．322，t＝11．490，P＜0．01）；관찰조ALT복상솔（52．5％）、HBeAg전음솔（57．5％）명현고우대조조（15．0％、17．5％）（χ2＝12．579，χ2＝13．653，P＜0．01）；치료후병발증정황비교，관찰조사망、원발성간세포암、자발성복막염，소화도출혈등발생솔여대조조비교，차이균무통계학의의（χ2＝1．01，χ2＝2．05，χ2＝3．12，χ2＝0．21，P＞0．05）；치료후2조환자Th17수평승고，Treg수평강저，관찰조Th17수평현저고우대조조，Treg수평현저저우대조조，Th17／Treg비치고우대조조（ P＜0．05）。결론웅거양담산가현저개선HBeAg양성고병독재량을간간경화환자간공능，제고HBeAg전음솔，억제HBV병독복제，연완병정발전，차불량반응교소；웅거양담산가증가환자Th17세포수，강저Treg세포수，가능시기항병독작용궤제지일。
Objective To explore the ursodeoxycholic acid efficacy and safety analysis of nucleoside drugs for HBeAg-positive with high viral load in patients with liver cirrhosis, and its effect on peripheral blood Th17, Treg levels.Methods 80 patients with high viral load B HBeAg-positive from November 2012 to February 2014 were selected and randomly divided into control group and observation group, 40 cases in each group.Patients in control group received conventional treatment, observation group was treated with ursodeoxycholic acid based on the control group, antiviral efficacy and adverse reactions, peripheral blood Th17, Treg levels were compared between two groups.Results After treatment, the ALT, AST, ALB, TBil levels between two groups were significantly lower compared with before treatment(P<0.01), the ALT, AST, ALB, TBil levels in observation group were significantly lower than the control group ( P<0.01 ); HBV-DNA negative rate ( 85.0%) and decrease of HBV-DNA in observation group were significantly higher (7.5%) than those in control group, the difference was statistically significant (χ2 =48.322, t =11.490, P<0.01); ALT normalization rate (52.5%), HBeAg seroconversion rate (57.5%) in observation group was significantly higher than those in control group(15.0%, 17.5%), the difference was statistically significant (χ2 =12.579,χ2 =13.653, P<0.01);complications compared with the situation observed group of death, hepatocellular carcinoma, spontaneous bacterial peritonitis, gastrointestinal bleeding compared with control group, the difference was not statistically significant (χ2 =1.01, χ2 =2.05, χ2 =3.12, χ2 =0.21, P>0.05).After treatment, the Th17 levels elevated, Treg level decreased in two groups, Th17 level in observation group was significantly higher than control group, Treg levels were significantly lower than the control group, Th17/Treg ratio was higher than the control group (P<0.05).Conclusion Ursodeoxycholic acid can significantly improve liver function of patients with HBeAg positive with high viral load, increase the rate of HBeAg seroconversion, inhibit HBV viral replication and delay progression of the disease, and less adverse reactions.It can increase the number of Th17 cells, reduce the number of Treg cells in patients, which may be one of its antiviral mechanism.