Clinical effect of Huanglian Wendan decoction in treatment of chronic hepatitis B liver fibrosis patients with liver-gallbladder damp-heat syndrome

Objective To investigate the clinical effect of Huanglian Wendan decoction in the treatment of chronic hepatitis B liver fibrosis patients with liver-gallbladder damp-heat syndrome and its regulatory effect on T helper 17( Th17) cells/interleukin-17( IL-17) inflammatory axis. Methods A total of 128 chronic hepatitis B liver fibrosis patients with liver-gallbladder damp-heat syndrome who were diagnosed and treated in The First Affiliated Hospital of Guangxi University of Chinese Medicine from January 2016 to December 2018 were enrolled and divided into treatment group and control group using a random number table,with 64 patients in each group. In addition to the treatment with the nucleoside drug entecavir dispersible tablets,the patients in the control group were given the traditional Chinese medicine( TCM) placebo,and those in the treatment group were given oral administration of Huanglian Wendan decoction. The course of treatment was 24 weeks for both groups. The two groups were compared in terms of symptom score of liver-gallbladder damp-heat syndrome,liver function,serological parameters for liver fibrosis,liver stiffness measurement( LSM),and levels of IL-17 and Th17 cells in peripheral blood. The t-test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison within each group at different time points,and the least significant difference t-test was used for further comparison between two time points. The chi-square test was used for comparison of categorical data between two groups. Results After 12 and 24 weeks of treatment,both groups had significant reductions in the scores of the symptoms of liver-gallbladder damp-heat syndrome( distending pain in the hypochondrium,jaundice of the skin and eyes,deep-colored urine,dry mouth and bitter taste,and slimy yellow tongue fur)( all P < 0. 01),and there were significant differences in the scores of the symptoms of liver-gallbladder damp-heat syndrome between the two groups( all P < 0. 01). After 12 and 24 weeks of treatment,both groups had significant reductions in the liver function parameters aspartate aminotransferase,alanine aminotransferase,total bilirubin,and gamma-glutamyl transpeptidase( all P < 0. 01),and there were significant differences in these liver function parameters between the two groups( all P < 0. 01). After 12 and 24 weeks of treatment,both groups had significant reductions in serological parameters for liver fibrosis( hyaluronic acid,procollagen type Ⅲ,type Ⅳ collagen,and laminin) and LSM( all P < 0. 01),and there were significant differences in these serological parameters for liver fibrosis and LSM between the two groups( both P < 0. 01). After 24 weeks of treatment,the treatment group had significant reductions in the count of Th17 cells and the level of IL-17 in peripheral blood( t = 2. 79 and 2. 60,both P < 0. 01),and the control group had a significant reduction in the count of Th17 cells in peripheral blood( t = 2. 47,P < 0. 01); after 24 weeks of treatment,the treatment grop had significantly lower count of Th17 cells and level of IL-17 in peripheral blood than the control group( both P < 0. 01). There was a significant difference in overall response rate between the control group and the treatment group( 76. 56% vs 90. 63%,χ2= 4. 61,P < 0. 05). Conclusion On the basis of antiviral therapy with nucleosides in Western medicine,Huanglian Wendan decoction has a marked clinical effect in the treatment of chronic hepatitis B liver fibrosis patients with liver-gallbladder damp-heat syndrome,possibly by regulating the Th17/IL-17 inflammatory axis.