康氏抗纤方治疗慢性乙型肝炎肝纤维化的临床研究  

Clinical Research of Kangshi Kangxian Recipe Treating on Hepatic Fibrosis of Chronic Hepatitis B

作　　者：陈少东[1] 张利敏[1] 王瑶瑶 毛乾国[2] 王宏国 庄鸿莉[4] 蔡洋[5] 罗晨[5] 梁惠卿[2] 

机构地区：[1]厦门大学医学院,福建361102 [2]厦门市中医院肝病中心,福建361009 [3]甘肃中医院临床教学部,兰州730050 [4]厦门市第一医院中医科,福建361005 [5]福建中医药大学中医系,福州351012

出　　处：《中国中西医结合杂志》2017年第10期1185-1190,共6页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金资助项目(No.81503529;No.81673660);福建省科技计划引导性项目(No.2015D007;No.2016D012);厦门市科技惠民项目(No.3502Z20174028);福建中医药大学临床专项校管课题基金(No.XB2016080)

摘　　要：目的观察康氏抗纤方治疗慢性乙型肝炎肝纤维化的临床疗效,探讨其对肝组织N-花生四烯酸氨基乙醇(arachidonoylethanolamine,AEA)、2-花生四烯酸甘油(2-arachidonoylglycerol,2-AG)、大麻素受体1(cannabinoid receptor 1,CBR1)mRNA、大麻素受体2(cannabinoid receptor 1,CBR2)mRNA含量变化的影响。方法将110例慢性乙型肝炎肝纤维化患者按随机数字表法分为治疗组和对照组,每组55例。治疗组予中药康氏抗纤方联合恩替卡韦分散片治疗,对照组用恩替卡韦分散片单药治疗,两组均治疗48周。判定两组临床疗效,检测血清ALT水平,HBV DNA、HBsAg、HBs Ab定量,肝组织病理、肝硬度变化,肝组织AEA、2-AG含量和CBR1、CBR2 mRNA表达水平。结果与对照组比较,治疗组的临床总有效率、HBsAg阴转率、肝组织纤维化分期疗效有效率均高于对照组(χ2=4.453,4.152,6.364,均P<0.05)。与本组治疗前比较,治疗后两组患者肝纤维化瞬时弹性测定值、AEA、2-AG含量及CBR1、CBR2 mRNA表达均降低(均P<0.05),且治疗组降低更明显(均P<0.05)。肝组织病理显示:治疗后治疗组肝小叶结构基本完整,肝细胞轻度水样变性,汇管区纤维组织无增生,局部少量淋巴细胞浸润,炎症及纤维化较对照组明显改善。结论康氏抗纤方具有提高慢性乙型肝炎肝纤维化患者的临床总有效率、HBsAg阴转率、肝组织纤维化分期疗效有效率,其作用机制可能与调节内源性大麻素系统有关。Objective To observe the clinical effect of Kangshi Kangxian Decoction （KSKXD） in treating on patients of hepatic fibrosis of chronic hepatitis B （CHB）, and to explore the mechanisms of KSKXD by regulating the contents of arachidonoylethanolamine （AEA）, 2-arachidonoylglycerol （2-AG）, cannabinoid receptor 1 （CBR1 mRNA） and cannabinoid receptor 2 （CBR2 mRNA） in the liver tissue. Methods Totally 110 patients with hepatic fibrosis of CHB were assigned to the treatment group and the control group according to random digit table, 55 cases in each group. The treatment group was treated with Chinese herb KSKXD combined with Entecavir, and the control group was treated with Entecavir. Both of the two groups were treated for 48 weeks. The clinical efficacy of the two groups was determined. The serum ALT levels, HBV DNA, HBsAg and HBsAb quantification, liver pathological changes, liver stiffness changes, contents of AEA and 2-AG, mRNA expression of CBR1 and CBR2 in the liver tissue were detected. Results The total effective rate, HBsAg negative conversion rate, hepatic fibrosis staging and curative effect rate of the treatment group were higher than those of the control group （χ2 = 4.453,4. 152, 6.364, all P 〈0.05）. After treatment, the instantaneous elasticity of liver fibrosis, the contents of AEA and 2-AG, the mRNA expressions of CBR1 and CBR2 in the liver tissue in the two groups were decreased compared to those of the same group before treatment （P 〈0.05）, and the treatment group had better effect than that of the control group （P 〈0.05）. The pathological changes in the treatment group after treatment indicated the liver Iobules integrity, mild hydropic degeneration of liver cells, periportal fibrous tissue hyperplasia, local small lymphocytic infiltration, which fibrosis and inflammation were better than those of the control group. Conclusions KSKXD was effective in the treatment of hepatic fibrosis of CHB, which improved total effective rate, HBsAg seroconversion rate and li

关 键 词：康氏抗纤方 慢性乙型肝炎肝纤维化 内源性大麻素系统 

分 类 号：R259[医药卫生—中西医结合]