拉米夫定和苦参碱治疗伴高胆红素血症的慢性乙型肝炎临床观察  

Combination lamivudine and matrine,a Chinese herbal medicine,in the treatment of chronic hepatitis B patients with hyperbilirubinemia

作　　者：陈从新[1] 刘波[1] 杨家宏[1] 刘克万[1] 徐宁[1] 宋海燕[1] 

机构地区：[1]解放军第105医院感染病科,合肥市230031

出　　处：《实用肝脏病杂志》2009年第4期256-261,共6页Journal of Practical Hepatology

基　　金：南京军区联勤部卫生部第"十一五"重大攻关课题资助(07Z007);\南京军区卫生专业人才培养"122"工程"资助项目(122-1A)

摘　　要：目的研究拉米夫定联合苦参碱治疗伴高胆红素血症的慢性乙型肝炎的疗效。方法在232例伴高胆红素血症的慢性乙型肝炎患者中,包括慢性乙型肝炎重度无明显消化道症状者(A1组)70例和有明显消化道症状者(A2组)58例,慢性乙型重型肝炎基础肝病为慢性HBV携带者(B1组)22例、慢性乙型肝炎(B2组)34例和肝硬化(B3组)48例。在基础治疗的基础上,各组患者均给予拉米夫定口服和苦参碱静脉滴注治疗,另给予A2、B1和B2组患者氢化可的松琥珀酸钠短程治疗。结果经过3～4周治疗,A1和A2组患者均获得临床和生化学痊愈,而在B1组有4例(18.2%)、B2组有9例(26.5%)和B3组有18例(37.5%)患者死亡;入院时,B1组患者HBeAg阳性率为90.0%,B3组以抗-HBe阳性为主(91.7%),B1组患者HBVDNA水平(lg7.2±1.4 copies/ml)最高,而B3组患者HBV DNA水平(lg5.4±0.9 copies/ml,P<0.01)较低;在各组存活者中,90%以上HBV DNA转阴,B2和B1组患者血清HBeAg/抗-Hbe转换率分别为72.3%(8/11)和27.8%(5/18);典型患者的腹部CT复查显示腹水消退,缩小的肝脏增大;两次肝活组织病理学检查显示Knodell’HAI计分明显改善。结论以拉米夫定联合苦参碱为基础的治疗对伴有高胆红素血症的慢性乙型肝炎患者有效。Objective The main strategy dealing with chronic hepatitis B is the application of interferon-alpha and/or nucleoside analogues to inhibit the viral replication. But how to treat the hepatitis B patients with hyperbilirubinemia is often neglected by western scholars and they sometimes give the diagnosis ad libitum. We conducted a pilot clinical trial to observe the efficacy of combination matrine,a Chinese herbal medicine,and lamivudine in the treatment of chronic hepatitis B patients with hyperbilirubinemia. Methods A total of two hundreds and thirty-two patients with hyperbilirubinemia were divided into subgroup A1 （chronic hepatitis B of severe degree with good appetite,n=70）,subgroup A2（with gastrointestinal symptoms,n=58）,subgroup B1 （chronic severe hepatitis B with underlying liver disease of chronic hepatitis B virus carrier,n=22）,subgroup B2 （with of chronic hepatitis B,n=34） and subgroup B3 （with of liver cirrhosis,n=48）. Lamivudine and matrine were given daily for all the patients except steroid for patients in subgroup A2,B1 and B2,and supporting therapy for all patients in group B. Results All patients in subgroup A1 and A2 recovered with three to four week treatment,while 4 （18.2%） in subgroup B1,9 （26.5%） in subgroup B 2 and 18 （37.5%） in subgroup B 3 died; At presentation,HBeAg positive dominated in subgroup B1 and anti-Hbe positive dominated in B3 and the highest HBV DNA level was in severe CHB patients with underlying HBV carriers （lg 7.2±1.4 copies/ml）,and the relatively lowest in with liver eirrhosis（lg5.4±0.9 copies/ml,P〈0.01）. 72.3% （8/11） and 27.8% （5/18） of patients in survived subgroup B2 and B1 had the serum HBeAg/anti-Hbe conversion,respectively. The serum HBV DNA got to negative in more than 90% of suvivals in every groups;The aseites subsided and the shrinked liver enlarged by CT scan in some patients and the liver pathohistological study showed the HAl scores and fibrosis improved. Conclusion It is feasible and efficient that combina

关 键 词：慢性乙型肝炎 高胆红素血症 拉米夫定 苦参碱 

分 类 号：R512.62[医药卫生—内科学]