ABSTRACT
Objective:To clarify the effect of Fangfeng Tongshengtang on early-stage serum endotoxin (ET) and programmed death-1/programmed ligand-1(PD-1/PD-L1) in patients with hepatitis B virus-related acute-on-chronic liver failure（HBV-ACLF）(early-stage), and exploring the mechanism of Fangfeng Tongshengtang in the treatment of early stage HBV-ACLF. Method:The 69 patients with early stage HBV-ACLF were enrolled in the study and all of them received antiviral drugs, liver protection and jaundice relieving drugs as well as supporting therapy. According to the random number table, 35 patients were randomly assigned to observation group (to take Fangfeng Tongshengtang, and 34 patients were assigned to control group to take placebo. The observation period was 3 weeks in both groups. Before treatment and 1, 2, and 3 weeks after treatment, theserum ET, expression of PD-1/PD-L1 in serum CD4+ and CD8+ T cells, liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (Alb), total bilirubin (TBIL), and direct bilirubin (DBIL)], coagulation function [prothrombin time (PT), and prothrombin activity (PTA)] were detected to verify the effect of Fangfeng Tongshengtang on HBV-ACLF (early-stage). Result:After 3 weeks of treatment, ET, expression of serum CD4+PD-1+, CD4+PD-L1+, CD8+PD-1+, CD8+PD-L1+, ALT, AST, TBIL, DBIL, and PT decreased significantly (P<0.01), while Alb and PTA increased significantly（P<0.01）in both groups. As compared with the control group, the ET in observation group was lower at 1st, 2nd and 3rd week after treatment (P<0.01), the CD4+PD-1+, CD4+PD-L1+, CD8+PD-1+ and CD8+PD-L1+ in observation group were lower at 2nd week and 3rd week（P<0.05, P<0.01）， the ALT, AST, TBIL and DBIL in observation group were lower at 1st, 2nd and 3rd week（P<0.05, P<0.01）， the PT in observation group was lower at 2nd and 3rd week（P<0.05）， and the PTA in observation group was higher at the 2nd and 3rd week（P<0.01）. Conclusion:Fangfeng Tongshengtang can achieve the therapeutic effect for HBV-ACLF (early-stage) probably by reducing the serum ET and the expression of PD-1 / PD-L1 in serum CD4 +, CD8 + T cells.