拉米夫定治疗慢性乙型肝炎中医证型的疗效  

Efficacy of lamivudine in treatment of TCM syndrome types of chronic hepatitis B

作　　者：李芳[1] 尹德辉[1] 杨世忠[1] 林丹[1] 

机构地区：[1]海南医学院附属医院中医科,海南海口570102

出　　处：《中华医院感染学杂志》2013年第18期4511-4512,4537,共3页Chinese Journal of Nosocomiology

基　　金：国家中医药管理局中医肝胆病学重点学科建设项目(2009);海南省卫生厅重点项目(琼卫2110重点-23)

摘　　要：目的评价不同的慢性乙型肝炎中医证型与拉米夫定抗病毒治疗的疗效关系,从中医证型的角度,为拉米夫定抗病毒的具体选用时机和提高疗效作用提供理论依据。方法对85例在医院接受拉米夫定抗病毒相关治疗的患者进行HBeAg阳性慢性乙型肝炎中医辩证的具体分型,观察不同中医辨证分型患者应用拉米夫定抗病毒治疗后52周患者血清HBV-DNA阴转率、HBeAg转换率、ALT复常率、耐药率及肝纤维化指标的疗效。结果治疗52周后,肝胆湿热型患者的HBV-DNA阴转率、HBeAg转换率以及ALT复常率分别为93.33%、46.7%、93.33%,均明显高于肝肾阴虚型的60.00%、13.33、60.00%,肝郁脾虚型的73.33%、20.00%、70.00%及瘀血阻络型60.00%、0、50.00%的患者,肝胆湿热型、肝肾阴虚型、肝郁脾虚型及瘀血阻络的耐药率分别为3.30%、8.9%、10.0%、10.0%,以肝胆湿热型最低,与其他3组比较差异有统计学意义(P<0.05);肝纤维化改善方面肝胆湿热与肝郁脾虚治疗后与肝肾阴虚及瘀血阻络差异有统计学意义(P<0.05)。结论 HBeAg阳性的慢性乙型肝炎患者拉米夫定抗病毒疗效与患者的中医证型相关,在用药过程中,应考虑患者的中医证型,可显著提高HBeAg阳性的慢性乙型肝炎患者拉米夫定抗病毒的临床疗效,实现针对性用药和个性化抗病毒的相关用药方案的合理制定。OBJECTIVE To assess the relationship between the chronic hepatitis B Chinese traditional medicine card and the anti-viral curative effect of lamivudine so as to provide the theoretical basis for the choice opportunity and enhance the curative effect from the Chinese medicine dialectical aspect. METHODS Totally 85 cases of chronic hepatitis 13 patients with HbeAg masculine who accepted the anti-viral treatment by lamivudine were carried out the Chinese medicine dialectical minute so as to observe the percentage of patients with normalization of ALT, HBV-DNA negative conversion rate, the HbeAg commutation ratio, and HA 52 weeks after the treatment. RESULTS After 52 weeks of treatment, the HBV-DNA negative rate, HBeAg conversion rate, and ALT normalization rate of the patients with liver and gallbladder damp-heat were 93.33%, 46.7%, and 93.33%, respectively, which were significantly higher than those of the patients with liver and kidney （60.00%, 13.33%, 60.00%）, the patients with liver and spleen deficiency （73.33%, 20.00%, 70.00%）, and the patients with blood stasis （60.00%, 0,50.00%）. The drug resistance rate of the hepatobiliaryhot and humid patients was 3.30%, lower than 8.9% of the liver and kidney, 10.0% of the stagnation and spleen deficiency, or 10.0% of the blood stasis stasis, the difference was significant （P〈0.05）. the difference in the HA, the courage hot and damp,liver strongly fragrant spleen weakness, liver-kidney Yin deficient, or the ecchymosis arrest collaterals was significant （P〈 0.05）. CONCLUSION For the HBeAg masculine chronic hepatitis B patients, the anti-viral effect of lamivudine is related to a certain TCM. With TCM type of syndrome, the anti-viral effect of lamivudine can be enhanced by using targeted drugs,and it is of positive significance in the development of individual antiviral treatment program.

关 键 词：慢性乙型肝炎 中医辩证分型 拉米夫定 

分 类 号：R978.1[医药卫生—药品]