Clinical efficacy of glutathione combined with hepatosupplementation in the treatment of chronic hepatitis B

 Chronic hepatitis B is a chronic liver disease caused by infection with the hepatitis B virus (HBV), which is transmitted through blood, sex and mother-to-child. It is transmitted through blood, sex, and mother-to-child transmission. HBV can remain in the body for long periods, leading to liver inflammation and damage, and eventually to chronic hepatitis B. Symptoms of chronic hepatitis B usually appear months to years after infection. Some patients have symptoms that may appear months to years after infection. 

Symptoms of chronic hepatitis B usually appear months to years after infection, and some people may have no symptoms at all. Common symptoms include fatigue, loss of appetite, discomfort in the liver area, nausea and malaise [1]. In patients with chronic hepatitis B, jaundice, hepatomegaly and ascites may also occur. Antiviral therapy is the mainstay of treatment for chronic hepatitis B. The presence and replication of the hepatitis B virus in the body is the cause of the persistence of chronic hepatitis B. Antiviral drugs are currently used to suppress the hepatitis B virus. Currently, antiviral drugs are used to inhibit the proliferation of hepatitis B virus and reduce liver damage.

 

However, some patients are unable to completely clear the hepatitis B virus after long-term antiviral treatment, and long-term use of medication can lead to side effects and drug resistance, as well as immune disorders in some patients. This makes patients susceptible to other infections and inconsistent responses to treatment. One of the challenges is to regulate the patient's immune system to improve treatment effectiveness and prevent complications. Most patients have a long history of the disease, and the effects of prolonged viral infection can lead to impaired liver function and, in severe cases, to cirrhosis and liver cancer. In addition to controlling viral replication, clinical treatment needs to protect and repair the liver function of patients. However, the liver's self-repair ability is limited, and how to promote the recovery and repair of liver function remains a challenge [2]. Therefore, this article selects relevant patient cases from our hospital to comprehensively analyze the combination of viral therapy and liver function protection in patients with chronic hepatitis B, to improve the comprehensive therapeutic effect of the patients, which is now reported as follows.

 

1 Information and methodology

1.1 General information

One hundred and twenty patients with chronic hepatitis B from January 2022 to January 2023 were selected for the study, and were divided into a control group and an observation group according to the method of randomized numerical tables, with 60 cases in each group. In the observation group, there were 29 males and 31 females, aged 25-79 years, with a mean of 43.54±3.42 years. In the control group, there were 28 males and 32 females, aged 25-77 years, with an average of 42.95±3.98 years. Comparison of the general data between the two groups showed no statistically significant difference (P>0.05), and are comparable.

Inclusion criteria: age <80 years; signed informed consent.

Exclusion criteria: patients with hepatitis A or C; patients with malignant tumors; patients with cardiac diseases; patients with renal diseases.

 

1.2 Methodology

The control group was treated with Shujianning oral solution, the dosage was 20mL, to which was added 250mL of glucose injection solution with 5% concentration, for 4 weeks.

The observation group was treated with glutathione on this basis. Intravenous drip method, choose glutathione injection 40mL, add 5% concentration of dextrose injection 250mL, once a day, continuous treatment for 4 weeks.

 

1.3 Observation indicators

Observe the liver function of the two groups after 4 weeks of treatment, and select TBIL, ALT and AST as the indicators of liver function. Compare the treatment efficiency of the two groups. Observe the occurrence of adverse reactions in the two groups.

 

2 Results

2.1 Comparison of treatment recovery between the two groups of patients

The recovery of patients in the observation group was significantly better than that of patients in the control group, with a significant difference between the two groups (P<0.05). See Table 1 for details.

 

2.2 Comparison of treatment efficiency between the two groups of patients

The effective rate of treatment of patients in the observation group was significantly better than that of patients in the control group, and there was a significant difference between the two groups (P<0.05). For details, see Table 2.

 

2.3 Comparison of adverse reactions between the two groups of patients

Anxiety and depression in the observation group were significantly better than those in the control group, with significant differences between the two groups (P<0.05). For details, see Table 3.

 

3 Discussion

Chronic hepatitis B, which is caused by hepatitis B virus infection, can be characterized by a wide range of symptoms, and clinical management is challenged by the presence and replication of the virus, immune dysregulation, and the protection and repair of liver function. Further research and development of more effective therapeutic strategies are needed to better manage this disease. According to TCM, the etiology of chronic hepatitis B is mainly related to the attack of hepatitis B virus. According to TCM theory, hepatitis B virus is a dampness-heat toxicity that, when introduced into the body, causes internalization of dampness-heat toxicity, leading to liver dysfunction. The symptoms are categorized as liver depression, spleen deficiency, dampness, and blood stasis [3]. Liver depression refers to the stagnation of liver qi, which often manifests as irritability, chest tightness, and distension and pain in the chest and ribs; spleen deficiency refers to the weakness of spleen qi, which often manifests as loss of appetite and diarrhea; dampness refers to the retention of dampness and qi in the body, which often triggers symptoms of distension in the epigastrium and abdomen, nausea, and vomiting; and blood stasis refers to the obstruction of stasis of blood and blood, which often manifests as dysfunction of the internal organs and symptoms of hepatic sclerosis. According to TCM, the pathogenesis of chronic hepatitis B mainly includes liver qi stagnation, internalized dampness and heat, spleen and stomach dysfunction, and stagnation of qi and blood. Liver qi stagnation is the most common pathomechanism of chronic hepatitis B. It leads to liver qi dysfunction, which triggers spleen and stomach dysfunction, resulting in pathological changes such as internalized dampness and heat, and qi and blood stasis.

 

Heparin Injection is a kind of Chinese medicine preparation mainly used for the treatment of hepatitis. Its main ingredients include Inoceramus, Gardenia jasminoides, Scutellaria baicalensis, Ganoderma lucidum, Panax quinquefolium and other active ingredients. Yin Chen is a kind of herb with the function of detoxification, which can clear away heat and toxins, dredge the liver and benefit the gallbladder. It can increase the detoxification function of the liver, reduce the burden of the liver, and promote the regeneration and repair of liver cells, thus playing a role in the treatment of hepatitis. Gardenia glycoside has the function of clearing away heat and removing toxins, inducing choleretic and laxative. It can promote the secretion and excretion of bile, improve the function of biliary tract, reduce the inflammation of liver, and promote the recovery and repair of liver cells. Scutellaria baicalensis has anti-inflammatory, detoxifying and heat-clearing effects. It can reduce liver inflammation, inhibit viral replication and improve liver function. Ganoderma lucidum has antioxidant, antiviral and immunity-enhancing effects. It can reduce liver inflammation, enhance the antiviral ability of the liver and promote the repair and regeneration of liver cells. Banlangen has the function of clearing heat and detoxification and anti-virus, which can reduce liver inflammation, inhibit viral replication, and promote the recovery and repair of liver cells. Based on the efficacy of Liver Shuning Injection, it is mainly manifested in clearing heat and removing toxins, dredging the liver and inducing gallbladder, anti-virus and enhancing immunity. Through these effects, it can reduce liver inflammation, promote liver cell repair and regeneration, improve liver function, and thus achieve the purpose of hepatitis treatment.

 

Reduced glutathione is widely found in human cells, especially in liver cells, which are the richest in reduced glutathione. This substance not only participates in the body's trihydroxy acid cycle, but also plays a significant role in glycogen conversion, fat accumulation, and protein metabolism, and activates a variety of enzymes, which promotes metabolism and plays a significant role in the normal functioning of liver cells. Reduced glutathione has a significant effect on the normal functioning of liver cells. Reduced glutathione plays an important role in the protection of liver cells, as it is an important participant in the antioxidant cycle by combating lipid peroxidation [4].

 

Chronic hepatitis B is a long term chronic viral hepatitis with changes in TBIL (total bilirubin), ALT (alanine aminotransferase) and AST (aspartate aminotransferase). In patients with chronic hepatitis B, TBIL is usually elevated as liver function deteriorates. Hepatitis B virus infection causes damage to liver cells and the liver is unable to metabolize bilirubin properly, allowing it to accumulate in the blood. Elevated TBIL may therefore be an indicator of chronic hepatitis B. Clinicians usually measure TBIL in the blood by testing the blood for bilirubin. Clinicians usually measure TBIL in the blood to assess the liver function of patients. In the observation group, after treatment with glutathione and Heparin injection, the TBIL level decreased by more than 80%, which is a significant advantage compared with the control group. ALT and AST are also commonly used indicators of liver function, compared with TBIL, ALT and AST mainly exist in liver cells, and when liver cells are damaged, the damaged stem cells will release ALT and AST into the blood through the blood circulation, leading to an increase in ALT and AST. In patients with chronic hepatitis B, elevated ALT and AST are usually associated with active viral replication, hepatocyte damage, and inflammation. Hepatitis B virus can infect liver cells and cause an inflammatory response, which can lead to liver injury and hepatocyte damage, resulting in elevated ALT and AST. From the patient data obtained in this controlled trial study, it can be seen that before the treatment, the ALT and AST levels of the two groups of patients were elevated to 80 mmoL, which is more than 70% of the elevated level compared to the patients in the physical examination; after four cycles of treatment, the overall ALT and AST levels of the patients decreased to a good extent, especially in the observation group, where the ALT and AST levels decreased by more than 90%, compared to the control group. In particular, the patients in the observation group showed a decrease of more than 90% in ALT and AST levels, which was significantly different from the patients in the control group.

 

The occurrence of chronic hepatitis B is closely related to the obstruction of hepatic microcirculation. After infection with hepatitis B virus, the hepatic microcirculation is damaged, and bilirubin is obviously elevated, which brings about the obstruction of microcirculation and further deepens the stagnation of blood flow in patients [5]. The application of Liver Shuning Injection can help to relieve the stagnation of blood flow, slow down the damage of capillaries and accelerate the excretion function of capillaries, so that bilirubin can be effectively discharged from the biliary tract, thus further improving the effectiveness of patient treatment. From the total effectiveness of treatment in the Observation Group, it can be seen that after the use of Liver Shuning Injection, the patients' bilirubin levels dropped by 70% on average, and the total bilirubin levels of patients in the Control Group who used only Liver Shuning Injection decreased by 70% on average. In the control group, the total bilirubin level of patients who used Liver Shunning Injection alone also decreased by more than 65% on average, which indicates that the application of Liver Shunning Injection has a significant effect on alleviating the microcirculation obstacles of patients.

 

The main ingredients in Liver Shuning Injection are: Panax quinquefolium, Yin Chen, Scutellaria baicalensis, Ganoderma lucidum and Gardenia jasminoides which can effectively enhance the circulation of liver blood cells and effectively improve the circulation level of patients, and at the same time, it has the ability to promote two-way regulation of the body, enhance the immunity of the body, and further improve the tolerance ability of the liver cells to ischemia and ischemia, so as to reduce the destruction of hepatitis B virus on patients' liver cells and further control inflammatory cell infiltration and enhance the internal regeneration of patients' liver cells. Control inflammatory cell infiltration and enhance the regeneration of liver cells in patients. Currently, the treatment of patients with chronic viral hepatitis B is mainly based on hospitalization and absolute bed rest, with adequate nutritional support. Glutathione intake ensures nutritional support, supports quality improvement, and ensures a high caloric and protein intake.

 

Abstaining from smoking and alcohol, for some severely infected patients, it may be necessary to reduce the protein in the diet as much as possible, under this circumstance, guaranteeing sufficient intake of glutathione can also help to improve the metabolic level of the liver cells of the patients, promote the recovery of liver function of the patients and reduce the damage caused by viral hepatitis B to the liver function of the patients, and at the same time, there is a good combination of glutathione and hepatic shuning injection, and the combination of the two can maintain the balance of water and electrolyte function in the liver cells of patients, and further improve the liver function of patients. At the same time, glutathione and heparin injection have a good combination effect, and the combination of these two treatments for patients with viral hepatitis B can maintain the balance of water and electrolyte function in the liver cells of patients, and further improve the function of the liver of patients.

 

Gan Shuning Injection is mainly based on the composition of "Yin Chen Artemisia Tang" in the "Treatise on Typhoid Miscellaneous Diseases", which contains active ingredients that can have synergistic effects on each other. In particular, Scutellaria baicalensis, Artemisia capillaris, Ganoderma lucidum and Radix et Rhizoma Cymbopogonis can cool the blood, benefit the pharynx, clear away heat and detoxify the toxin, and have a significant inhibitory effect on the replication, transcription, and transmission of the hepatitis B virus; together with the adequate intake of glutathione, it can further enhance the immune function of the patient, and has the effect of clearing away and relieving fever; the use of Radix et Rhizoma Cymbopogonis can help reduce the jaundice and have a good protective effect on the secretion of the digestive juices and bile. The use of Yin Chen can reduce jaundice and protect the secretion of digestive fluid and bile. Combined with glutathione, it can further protect the liver cells of patients, and to a certain extent promote the regulation of myocardial function of patients, so that the serum aminotransferase and blood lipids of patients can be significantly reduced, further reducing the immune response of liver cells of patients under the attack of viral hepatitis B, so that the immune activity of patients is significantly enhanced. Under the intervention of the combination of drugs, the overall anti-inflammatory and decongestive effects of the patients in the observation group and the level of hepatocyte protection and hepatocyte nutrition have been effectively improved, so that the level of the relevant liver function indexes of the patients has been reduced to a level higher than that of the control group.

 

According to Qi Jinghu[1] , TBIL, ALT and AST indexes in patients with chronic hepatitis B will show certain changes, mainly including the increase of TBIL, and the increase of ALT and AST. Changes in these markers can be used as indicators of liver function and severity of the disease, which can help clinicians make diagnostic and therapeutic decisions. Xu Yongping[2] concluded that the changes in TBIL, ALT and AST may vary between patients, and that the specific situation needs to be evaluated and analyzed on an individual basis. From the actual situation of the observation group in this paper, under the intervention of the combination of drugs, the decrease of liver function indexes of the patients in the observation group was more than 60%, and the effective rate of treatment was increased by 20%, and the safety of treatment was not significantly affected. This is consistent with the results of literature research.

 

CRP is highly sensitive to inflammation and is an important indicator for evaluating the degree of inflammatory response. In this study, the levels of CRP, IL-6 and TNF-α in the observation group were lower than those in the control group in the 3d postoperative period (P<0.05). This suggests that low-position small incision surgery is less traumatic to the body, and the degree of postoperative inflammatory reaction is less severe, which contributes to the rapid recovery of tissue damage [6]. The FT3, FT4, TT3 and TT4 of the two groups were comparable at 7d postoperatively (P>0.05). It is confirmed that this procedure does not significantly affect the normal thyroid function, and the patients' thyroid function recovers faster after the operation.

In conclusion, the low small incision treatment of benign thyroid nodules is more effective, less traumatic, with less postoperative inflammation, fewer complications, and less impact on thyroid function, and is worth popularizing.

 

References:

[1] YANG Guofeng, YU Xuexue. Observation on clinical effect of low small incision thyroid surgery for benign thyroid nodules[J]. Henan Medical Research,2017,26(7):1295-1296.

[2] Zong Hongfei. Comparative analysis of low small incision and traditional thyroid surgery for benign thyroid nodules[J]. Zhongguo Nankang Medicine,2017,29(18):40-41.

[3] JI Lansheng, YU Dongmei, HAO Jianhua. Therapeutic effects of low-level small incision and traditional thyroid surgery on benign thyroid nodules[J]. China Medical Abstracts Otolaryngology,2022,37(5):13-15.

[4] Su Zhenxi, Xu Xing, Cao Feng, et al. Exploration of the efficacy of low-level small-incision thyroid surgery for benign thyroid nodules[J]. Chinese Drugs and Clinics, 2021,21(11):1845-1848.

[5] XU Zhao-Wei, ZANG Jian-Feng. Comparison of clinical effects between low small incision and traditional thyroid surgery for benign thyroid nodules[J]. Modern Diagnosis and Treatment,2020,31(19):3137-3139.

[6] WEI Ning, XU Changhao, GAO Chengqiu. Observations on the clinical effects of traditional thyroid surgery and low-level small incision surgery for benign thyroid nodules[J]. China Medical Abstracts Otolaryngology,2022,37(4): 93-94,90.