一贯煎加味联合阿德福韦酯片治疗HBeAg阴性慢性乙型肝炎活动性代偿期肝硬化患者的疗效观察  

Efficacy Observation of Yiguanjian Decoction Combined Adefovir Dipivoxil Tablet in Treating HBe Ag Negative Chronic Viral Hepatitis B Active Compensated Liver Cirrhosis Patients

作　　者：段淑红[1] 鲍中英[1] 苑晓冬[1] 王蕾[1] 刘梅生[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院感染科,北京100038

出　　处：《中国中西医结合杂志》2016年第5期535-538,共4页Chinese Journal of Integrated Traditional and Western Medicine

摘　　要：目的观察一贯煎加味联合阿德福韦酯片治疗HBeAg阴性慢性乙型肝炎活动性代偿期肝硬化患者的临床疗效。方法采用随机数字表法将68例初治的HBeAg阴性慢性乙型肝炎活动性代偿期肝硬化患者分为治疗组及对照组,每组34例。对照组单用阿德福韦酯片治疗,10 mg,每日1次。治疗组在此基础上予以中药一贯煎加味,每日1剂。两组疗程均为48周。每2周检测1次ALT、AST、总胆红素(TBil)水平;每4周检测1次乙肝病毒HBV-DNA及血清肝纤维化4项[Ⅳ型前胶原(PCIV)、透明质酸酶(HA)、Ⅲ型前胶原(PCⅢ)及层粘连蛋白(LN)]。治疗前后行腹部B超,记录门静脉内径及脾脏大小。采用肝脏瞬时弹性探测仪(Fibroscan)评估肝脏纤维化程度。观察治疗前后两组患者中医证候积分评价中医疗效,应用ChildPugh分级评分进行西医疾病疗效评价。结果与本组治疗前比较,治疗48周后,两组ALT、AST均恢复正常,HBV-DNA阴转(HBV-DNA≤1×102),且TBil、ALB、PCIV、HA、PCⅢ、LN水平明显降低(P<0.05,P<0.01),B超示门静脉内径及脾脏大小均减小,Fibroscan示肝脏弹性值明显降低(P<0.05),且治疗后治疗组PCIV、HA、PCⅢ、LN及肝脏弹性值下降程度较对照组更明显(P<0.01)。两组治疗后ALT、AST、TBil、ALB水平、门静脉内径及脾脏大小比较,差异无统计学意义(P>0.05)。与本组治疗前比较,两组患者治疗后中医证候积分及Child-Pugh评分均下降(P<0.05,P<0.01),且治疗组中医证候积分较对照组下降更明显(P<0.05)。治疗组有效率为88.24%(30/34),明显高于对照组的67.65%(23/34),差异有统计学意义(P<0.05)。结论一贯煎加味联合阿德福韦酯片治疗HBeAg阴性慢性乙型肝炎活动性代偿期肝硬化能显著改善患者的中医症状及肝脏纤维化程度。Objective To explore clinical efficacy of Yiguanjian Decoction（YD） combined Adefovir Dipivoxil Tablet（ADT） in treating HBe Ag negative chronic viral hepatitis B（CVHB） active compensated liver cirrhosis（LC） patients.Methods Total y 68 HBe Ag negative CVHB active compensated LC patients initial y treated were assigned to the treatment group and the control group using random digit table, 34 in each group. Patients in the control group took ADT alone, 10 mg each time, once per day. Those in the treatment group additional y took YD, one dose per day. The therapeutic course for al was 48 weeks. Levels of alanine aminotransferase（ALT）, aspartate aminotransferase（AST）, total bilirubin（TBil） were detected once in every two weeks. Hepatitis B virus（HBV）-DNA and four items of serum liver fibrosis[procolagen type Ⅳ（PCⅣ）, hyaluronidase（HA）, procolagen Ⅲ peptide（PCⅢ）, laminin（LN）]were detected once per every 4 weeks. Abdominal ultrasound B was performed before and after treatment. The inner diameter of the portal vein and the size of spleen were recorded. The fibrosis degree of liver was evaluated using Fibroscan. Efficacy of Chinese medicine（CM） was evaluated between the two groups before and after treatment using CM syndrome integrals. Efficacy of Western medicine（ WM） was also evaluated between the two groups using Child-Pugh grading. Results Compared with before treatment in the same group, ALT and AST levels restored to normal levels, HBV-DNA turnednegative（HBV-DNA≤1 × 102） in the two groups after 48-week treatment. Besides, levels of TBil, ALB, PCIV, HA, PCⅢ,and LN obviously decreased（P〈0. 05, P〈0. 01）. Results of ultrasound B showed the inner diameter of the portal vein and the size of spleen decreased. Fibroscan results showed that the elasticity value of the liver obviously decreased（P〈0. 05）. Besides, post-treatment levels of PCIV, HA, PCⅢ, and LN, and the elasticity value of the liver decreased more obviously in the treatment g

关 键 词：一贯煎 阿德福韦酯片 慢性乙型肝炎 活动期 HBEAG阴性 代偿期肝硬化 

分 类 号：R512.62[医药卫生—内科学]