OBJECTIVE To observe the effect of Wenyang Huazhuo Tuihuang decoction on treatment of hepatitis B virus (HBV) infection-associated acute-on-chronic liver failure (ACLF) and analyze the impact on liver function indexes and expression levels of programmed death factor-1/programmed death factor ligand-1 (PD-1/PD-L1).

METHODS A total of 86 patients with HBV infection-associated ACLF were randomly divided into the group A and the group B, with 43 cases in each group. The group A was given conventional therapy, the group B was treated with Wenyang Huazhuo Tuihuang decoction on basis of the therapy of the group A.Both groups were treated for 8 consecutive weeks. The clinical therapeutic effects, liver function indexes, PD-1/PD-L1, model for end-stage liver disease (MELD) score and safety were observed and compared between the two groups.

RESULTS After the treatment for 8 weeks, the total effective rate of the group B was 76.74%, higher than 44.19% of the group B (P < 0.05). The levels of serum glutamic oxaloacetic transaminase (GOT), direct bilirubin (DBIL), peripheral blood CD₄⁺PD-1⁺, CD₄⁺PD-L1⁺, CD₈⁺PD-1⁺and CD₈⁺PD-L1⁺ of the two groups were lower after the treatment than before the treatment(P < 0.05), and the levels of the above indexes of the group B were lower than those of the group A (P < 0.05). The levels of serum albumin (ALB) and cholinesterase (CHE) of the two groups were higher after the treatment than before the treatment(P < 0.05), and the levels of the above indexes of the group were higher than those of the group A (P < 0.05). The MELD score of the two groups was lower after the treatment for 4 and 8 weeks than before the treatment(P < 0.05), the MELD score was lower after the treatment for 8 weeks than after the treatment for 4 weeks(P < 0.05), and the MELD score of the group B was lower than that of the group A(P < 0.05). There were no severe adverse reactions in both groups during the treatment.

CONCLUSION Wenyang Huazhuo Tuihuang decoction can effectively reduce the MELD score of the patients with HBV infection-associated ACLF, boost the liver function and reduce the expression levels of PD-1/PD-L1 so as to improve the clinical therapeutic effect, with the safety favorable.