银杏叶提取物联合复方甘草酸苷治疗HBV感染慢加急性肝功能衰竭疗效及对外周血NF-κB、TNF-α、LXA4和LPS的影响
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摘要
目的观察银杏叶提取物联合复方甘草酸苷治疗HBV感染慢加急性肝功能衰竭(HBV-ACLF)的疗效及对外周血核因子-κB(NF-κB)、肿瘤坏死因子-α(TNF-α)、脂氧素A4(LXA4)和内毒素(LPS)的影响。方法将60例HBV-ACLF患者随机分为对照组和观察组,每组30例。2组均采取常规西医治疗(抗病毒+保肝+营养支持+血浆置换等),在常规治疗基础上对照组给予复方甘草酸苷注射液治疗,观察组在对照组治疗基础上给予银杏叶提取物注射液治疗,疗程2个月。观察2组治疗前后临床症状体征、肝功能、营养状态、凝血功能情况,记录MELD评分、Child-Pugh改良分级评分变化,检测2组治疗前后血浆NF-κB、TNF-α、LXA4和LPS水平,并记录2组临床结局。结果 2组治疗后恶心呕吐、腹胀、腹水、黄疸、乏力、食欲减退、尿少积分均显著降低(P均<0.05),且观察组上述积分均显著低于对照组(P均<0.05);2组治疗后TBil、AST、ALT、GGT、ALB、PA、Plt、PTA均显著改善(P均<0.05),观察组改善情况显著优于对照组(P均<0.05);2组治疗后MELD评分、Child-Pugh改良分级评分均显著降低(P均<0.05),且观察组上述评分均显著低于对照组(P均<0.05);2组治疗后血浆NF-κB、TNF-α、LPS水平显著降低而LXA4水平显著升高(P均<0.05),且观察组上述指标改善情况均优于对照组(P均<0.05);观察组不良结局发生率显著低于对照组(P均<0.05)。结论银杏叶提取物联合复方甘草酸苷能够显著改善HBV-ACLF患者的临床症状,促进肝功能、营养和凝血功能的恢复,并可减少并发症,其机制可能与调节血浆NF-κB、TNF-α、LXA4和LPS的水平有关。
Objective It is to observe the effect of Ginkgo biloba extract combined with Compound Glycyrrhizin in the treatment of Hepatitis B virus related acute-on-chronic liver failure( HBV-ACLF) and the influence of peripheral blood nuclear factor-κB( NF-κB),tumor necrosis factor-α( TNF-α),lipoxygenin A4( LXA4) and endotoxin lipopolysaccharide( LPS). Methods Sixty patients with HBV-ACLF were randomly divided into control group and observation group,30 cases in each group. The two groups were treated with conventional Western Medicine( antiviral + liver protection + nutritional support + plasma exchange,etc.). On the basis of the above conventional treatment,the control group was treated with Compound Glycyrrhizin injection,the observation group was treated with Compound Glycyrrhizin injection combined with Ginkgo Biloba extract injection,the treatment lasted for 2 months. The clinical symptoms and signs,liver function,nutritional status and coagulation function of the two groups before and after treatment were observed,the MELD score and Child-Pugh improved grading score were recorded,the levels of plasma NF-κB,TNF-α,LXA4 and LPS were measured before and after treatment in the two groups,and the clinical outcomes of two groups were recorded. Results After treatment,the scores of nausea and vomiting,abdominal distension,ascites,jaundice,asthenia,loss of appetite,and less urine in the two groups were decreased significantly( all P < 0. 05),and the above scores in the observation group were lower significantly than those in the control group( all P < 0. 05); the levels of TBil,AST,ALT,GGT,ALB,PA,Plt and PTA in the two groups were significantly improved( all P < 0. 05),and the improvement of the observation group was better significantly than that of the control group( P < 0. 05); The MELD score and Child-Pugh improved grading score of the two groups were decreased significantly( all P < 0. 05),and the scores of the observation group were lower significantly than those of the control group( all P < 0. 05); The levels of plasma NF-κB,TNF-α and LPS were decreased significantly but LXA4 level were increased significantly in the two groups( all P < 0. 05),and the improvement of the above indexes in the observation group was better significantly than that in the control group( P < 0. 05). The total incidence of adverse outcomes in the observation group was lower significantly than that in the control group( P < 0. 05). Conclusion Ginkgo Biloba extract combined with Compound Glycyrrhizin can significantly improve the clinical symptoms of HBV-ACLF patients,promote the recovery of liver function,nutrition and coagulation function,and reduce the complications. The mechanism may be related to the regulation of plasma NF-κB,TNF-α,LXA4 and LPS.
Objective It is to observe the effect of Ginkgo biloba extract combined with Compound Glycyrrhizin in the treatment of Hepatitis B virus related acute-on-chronic liver failure( HBV-ACLF) and the influence of peripheral blood nuclear factor-κB( NF-κB),tumor necrosis factor-α( TNF-α),lipoxygenin A4( LXA4) and endotoxin lipopolysaccharide( LPS). Methods Sixty patients with HBV-ACLF were randomly divided into control group and observation group,30 cases in each group. The two groups were treated with conventional Western Medicine( antiviral + liver protection + nutritional support + plasma exchange,etc.). On the basis of the above conventional treatment,the control group was treated with Compound Glycyrrhizin injection,the observation group was treated with Compound Glycyrrhizin injection combined with Ginkgo Biloba extract injection,the treatment lasted for 2 months. The clinical symptoms and signs,liver function,nutritional status and coagulation function of the two groups before and after treatment were observed,the MELD score and Child-Pugh improved grading score were recorded,the levels of plasma NF-κB,TNF-α,LXA4 and LPS were measured before and after treatment in the two groups,and the clinical outcomes of two groups were recorded. Results After treatment,the scores of nausea and vomiting,abdominal distension,ascites,jaundice,asthenia,loss of appetite,and less urine in the two groups were decreased significantly( all P < 0. 05),and the above scores in the observation group were lower significantly than those in the control group( all P < 0. 05); the levels of TBil,AST,ALT,GGT,ALB,PA,Plt and PTA in the two groups were significantly improved( all P < 0. 05),and the improvement of the observation group was better significantly than that of the control group( P < 0. 05); The MELD score and Child-Pugh improved grading score of the two groups were decreased significantly( all P < 0. 05),and the scores of the observation group were lower significantly than those of the control group( all P < 0. 05); The levels of plasma NF-κB,TNF-α and LPS were decreased significantly but LXA4 level were increased significantly in the two groups( all P < 0. 05),and the improvement of the above indexes in the observation group was better significantly than that in the control group( P < 0. 05). The total incidence of adverse outcomes in the observation group was lower significantly than that in the control group( P < 0. 05). Conclusion Ginkgo Biloba extract combined with Compound Glycyrrhizin can significantly improve the clinical symptoms of HBV-ACLF patients,promote the recovery of liver function,nutrition and coagulation function,and reduce the complications. The mechanism may be related to the regulation of plasma NF-κB,TNF-α,LXA4 and LPS.
引文
[1]刘晓燕,辛绍杰,陈婧,等.肝衰竭分期对HBV感染慢加急性肝衰竭预后判断的意义[J].解放军医学院学报,2014,35(6):521-524
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[3]党志博,党中勤,王宇亮,等.中西医结合治疗乙型肝炎慢加急性肝功能衰竭临床研究[J].中医学报,2017,32(8):1491-1493
[4]王贵强,王福生,成军,等.慢性乙型肝炎防治指南(2015年更新版)[J].中国病毒病杂志,2015,31(6):1941-1960
[5]中华医学会感染病学分会肝衰竭与人工肝)学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊疗指南(2012年版)[J].实用肝脏病杂志,2013,16(3):210-216
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[7]陶金好,陈伟明,胡静,等.终末期肝病模型评分对人工肝治疗儿童急性肝衰竭的预测价值[J].中华儿科杂志,2015,53(4):280-284
[8]张清格,苗士奎.465例HBV感染所致慢加急性肝功能衰竭的临床分析[J].肝脏,2014,19(9):682-684
[9]方建凯,赖静兰,周锐,等.早期凝血酶原活动度对预测慢性乙型肝炎慢加急性肝衰竭预后的价值[J].中国急救医学,2015,35(7):603-607
[10]刘明明,胡冬青,孙欢娜,等.护肠清毒微丸结肠靶向给药治疗HBV相关慢加急性肝衰竭肠源性内毒素血症的临床研究[J].中西医结合肝病杂志,2017,27(3):137-140
[11]袁淑芳,张丽娟,郑嵘炅,等.NF-κB、TNF-α与乙型肝炎患者肝细胞损伤和肝纤维化的关系[C].全国病毒性肝炎慢性化重症化基础与临床研究进展学术会议,2013
[12]于盈,王凤玲.大黄素治疗大鼠急性肝功能衰竭时核因子-κB的动态变化[J].中国药业,2016,25(22):23-26
[13]李晖,杨晓冬,杨永锐,等.慢加急性乙型肝炎肝功能衰竭患者血浆脂氧素A4含量及其与TNF-α和IL-6的相关性研究[J/CD].中华实验和临床感染病杂志:电子版,2014,8(5):25-28
[14]许世琴,贾安奎,李冰,等.慢加急性乙型肝炎肝功能衰竭患者肝功能及血炎性因子与脂氧素A4变化的相关性研究[J].中华医院感染学杂志,2016,26(17):3886-3888
[15]彭福江,张天晓,袁美蓉.复方甘草酸苷对慢性乙型肝炎患者肝功能、肝纤维化指标及炎症因子的影响[J].海南医学院学报,2017,23(4):485-488
[16]茆玲.复方甘草酸苷注射液与异甘草酸镁注射液治疗病毒性肝炎合并高胆红素血症的疗效比较[J].世界临床医学,2016,10(17):103-104
[17]张嵩.银杏叶提取物对D-氨基半乳糖/内毒素诱导的小鼠急性肝衰竭FGL2及TNF-α表达的影响[D].南昌:南昌大学医学院,2015
[18]刘花,高卉.银杏叶提取物对肝缺血再灌注NF-κB p65表达的影响[J].时珍国医国药,2015,26(12):2865-2867
[2]杨方集,彭亮,高志良,等.乙型肝炎慢加急性肝衰竭诊疗的新策略与新进展[J].中华临床感染病杂志,2017,10(2):101-106
[3]党志博,党中勤,王宇亮,等.中西医结合治疗乙型肝炎慢加急性肝功能衰竭临床研究[J].中医学报,2017,32(8):1491-1493
[4]王贵强,王福生,成军,等.慢性乙型肝炎防治指南(2015年更新版)[J].中国病毒病杂志,2015,31(6):1941-1960
[5]中华医学会感染病学分会肝衰竭与人工肝)学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊疗指南(2012年版)[J].实用肝脏病杂志,2013,16(3):210-216
[6]国家中医药管理局.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:219
[7]陶金好,陈伟明,胡静,等.终末期肝病模型评分对人工肝治疗儿童急性肝衰竭的预测价值[J].中华儿科杂志,2015,53(4):280-284
[8]张清格,苗士奎.465例HBV感染所致慢加急性肝功能衰竭的临床分析[J].肝脏,2014,19(9):682-684
[9]方建凯,赖静兰,周锐,等.早期凝血酶原活动度对预测慢性乙型肝炎慢加急性肝衰竭预后的价值[J].中国急救医学,2015,35(7):603-607
[10]刘明明,胡冬青,孙欢娜,等.护肠清毒微丸结肠靶向给药治疗HBV相关慢加急性肝衰竭肠源性内毒素血症的临床研究[J].中西医结合肝病杂志,2017,27(3):137-140
[11]袁淑芳,张丽娟,郑嵘炅,等.NF-κB、TNF-α与乙型肝炎患者肝细胞损伤和肝纤维化的关系[C].全国病毒性肝炎慢性化重症化基础与临床研究进展学术会议,2013
[12]于盈,王凤玲.大黄素治疗大鼠急性肝功能衰竭时核因子-κB的动态变化[J].中国药业,2016,25(22):23-26
[13]李晖,杨晓冬,杨永锐,等.慢加急性乙型肝炎肝功能衰竭患者血浆脂氧素A4含量及其与TNF-α和IL-6的相关性研究[J/CD].中华实验和临床感染病杂志:电子版,2014,8(5):25-28
[14]许世琴,贾安奎,李冰,等.慢加急性乙型肝炎肝功能衰竭患者肝功能及血炎性因子与脂氧素A4变化的相关性研究[J].中华医院感染学杂志,2016,26(17):3886-3888
[15]彭福江,张天晓,袁美蓉.复方甘草酸苷对慢性乙型肝炎患者肝功能、肝纤维化指标及炎症因子的影响[J].海南医学院学报,2017,23(4):485-488
[16]茆玲.复方甘草酸苷注射液与异甘草酸镁注射液治疗病毒性肝炎合并高胆红素血症的疗效比较[J].世界临床医学,2016,10(17):103-104
[17]张嵩.银杏叶提取物对D-氨基半乳糖/内毒素诱导的小鼠急性肝衰竭FGL2及TNF-α表达的影响[D].南昌:南昌大学医学院,2015
[18]刘花,高卉.银杏叶提取物对肝缺血再灌注NF-κB p65表达的影响[J].时珍国医国药,2015,26(12):2865-2867
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