安络化纤丸联合恩替卡韦治疗可显著提高慢性乙型肝炎病毒感染者肝纤维化的改善率  

Combined anluohuaxianwan and entecavir treatment significantly improve the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection

作　　者：苗社 杨婉娜[1] 董晓琴[1] 张占卿 谢仕斌[3] 张大志[4,25] 张绪清 成军 张国 赵巍峰[8] 谢青 刘映霞[10] 马安林[11] 李军[12] 尚佳[13] 白浪[14] 曹立华 邹志强[16] 李家斌 吕福东[18] 刘晖[18] 王志津[19] 张明香 陈黎明[21] 梁伟锋 高慧 庄辉[23] 赵鸿 王贵强[1,24,25] Miao Liang;Yang Wanna;Dong Xiaoqin;Zhang Zhanqing;Xie Shibin;Zhang Dazhi;Zhang Xuqing;Cheng Jun;Zhang Guo;Zhao Weifeng;Xie Qing;Liu Yingxia;Ma Anlin;Li Jun;Shang Jia;Bai Lang;Cao Lihua;Zou Zhiqiang;Li Jiabin;Lyu Fudong;Liu Hui;Wang Zhijin;Zhang Mingxiang;Chen Liming;Liang Weifeng;Gao Hui;Zhuang Hui;Zhao Hong;Wang Guiqiang(Department of Infectious Disease,Center for Liver Disease,Peking University First Hospital,Beijing100034,China;Departmentof Infectious Diseases,Shenzhen Third People's Hospital,Shenzhen 518112,China;Department ofInfectious Diseases,China-Japan Friendship Hospital,Beijing 100029,China;Department of InfectiousDiseases,the First Affiliated Hospital,Nanjing Medical University,Nanjing 210029,China;Department of Infectious Diseases,the People's Hospital of Henan Province,Zhengzhou 450003,China;Infectious Disease Department of West China Hospital,Sichuan University,Chengdu 610041,China;Department ofHepatology,the Third Hospital of Qinhuangdao,Qinhuangdao 066000,China;Yantai Infectious DiseasesHospital,Yantai 264000,China;the First Affiliated Hospital of Anhui Medical University,Hehui 230022,China;Beijing Youan Hospital,Capital Medical University,Beijing 100000,China;the 305 Hospital of PLA,Beijing 100300,China;Department of Hepatology,Shanghai Public Health Clinical Center,Fudan University,Shanghai 201508,China;the 6th People s Hospital of Shenyang,Shenyang 110006,China;the 5thMedical Center of PLA General Hospital,Beijing 100039,China;First Affiliated Hospital of ZhejiangUniversity,Hangzhou 310058,China;Department of Microbiology and Center of Infectious Diseases,Peking University Health Science Center,Beijing 100191,China;Department of Infectious Diseases,Peking University International Hospital,Beijing 102206,China;the Collaborative Innovation Center forDiagnosis and Treatment of Infectious Diseases,Zhejiang University,Hangzhou 310058,China;Department of Infectious Disease,the Third Affiliated Hospital Sun Yat SenUniversity,Guangzhou 510630,China;Department of Infectious Diseases,Second Affiliated H

机构地区：[1]北京大学第一医院感染科,100034 [10]深圳市第三人民医院感染科,518112 [11]卫生部中日友好医院感染科,北京100029 [12]南京医科大学附属第一医院感染科,210029 [13]河南省人民医院感染科,郑州450003 [14]华西医院感染科,成都610041 [15]秦皇岛市第三医院肝病科,066000 [16]烟台市传染病医院,264000 [17]安徽医科大学第一医院,合肥230022 [18]首都医科大学附属北京佑安医院,100000 [19]解放军第三○五医院消化科,北京100300 [2]上海公共卫生中心肝胆内科,201508 [20]沈阳市第六人民医院,110006 [21]解放军总院第五医学中心,北京100039 [22]浙江大学医学院附属第一医院,杭州310058 [23]北京大学医学部病原生物学系和感染病中心,100191 [24]北京大学国际医院感染科,102206 [25]浙江大学感染性疾病诊治协同创新中心,杭州310058 [3]中山大学第三医院感染科,广州510630 [4]重庆医科大学附属第二医院感染科,400010 [5]陆军医科大学第一附属医院感染科,重庆400038 [6]首都医科大学附属北京地坛医院,100000 [7]广西壮族自治区人民医院消化内科,南宁530021 [8]新乡医学院附属第三医院感染科,453000 [9]上海交通大学附属瑞金医院感染科,200025

出　　处：《中华肝脏病杂志》2019年第7期521-526,共6页Chinese Journal of Hepatology

摘　　要：目的探索慢性乙型肝炎病毒(HBV)感染者接受恩替卡韦单独或联合安络化纤丸治疗78周对肝纤维化的改善作用。方法慢性HBV感染者随机接受恩替卡韦单独或联合安络化纤丸治疗78周,肝穿刺标本采用Ishakscore盲态判读。比较患者治疗前后的肝纤维化改善情况。对计量资料采用Student'st检验、非参数检验(Mann-WhitneyU-Test及Kruskal-Wallis检验)方法分析;计数资料采用Chi-squared检验方法分析;Spearman分级检验法分析双变量相关性。结果治疗78周后肝纤维化改善率为36.53%(80/219)、进展率为23.29%(51/219)。肝纤维化改善与基线纤维化程度和治疗方法相关(P<0.05)。在安络化纤丸联合恩替卡韦治疗且基线肝纤维化评分(F)≥3的患者中,肝纤维改善率(54.74%,52/95)显著高于仅接受恩替卡韦治疗者(33.33%,16/48),P=0.016;联合治疗组肝纤维化进展比例(13.68%,13/95)在数值上低于单独治疗组(18.75%,9/48),P=0.466。在基线F<3的患者中,联合治疗组肝纤维化改善和稳定的患者比例(68.08%,32/47)高于单独治疗组(51.72%,15/29)。结论安络化纤丸联合恩替卡韦治疗可显著提高慢性HBV感染者肝纤维化的改善率,并有提高肝纤维化稳定率和降低进展率的趋势。Objective To explore the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection who received entecavir alone or in combination with anluohuaxianwan for 78 weeks. Methods Patients with chronic HBV infection were randomly treated with entecavir alone or in combination with anluohuaxian for 78 weeks. Ishak fibrosis score was used for blind interpretation of liver biopsy specimens. The improvement in liver fibrosis condition before and after the treatment was compared. Student's t test and non-parametric test (Mann-Whitney U-Test and Kruskal-Wallis test) were used to analyze the measurement data. The categorical variables were analyzed by Chi-square test method and Spearman’s rank correlation coefficient was used to test bivariate associations. Results Liver fibrosis improvement rate after 78 weeks of treatment was 36.53%(80/219) and the progression rate was 23.29%(51/219). The improvement of liver fibrosis was associated to the degree of baseline fibrosis and treatment methods (P < 0.05). The improvement rate of hepatic fibrosis in patients treated with anluohuaxianwan combined with entecavir at baseline F < 3 (54.74%, 52/95) was significantly higher than that in patients treated only with entecavir (33.33%, 16/48), P = 0.016 and the progression rate of hepatic fibrosis (13.68%, 13/95) was lower than that in patients treated alone (18.75%, 9/48), P = 0.466. In patients with baseline F < 3, the proportion of patients with improved and stable liver fibrosis in the combined treatment group (68.1%, 32/47) was higher than that in the treatment group alone (51.7%, 15/29). Conclusion Combined anluohuaxianwan and entecavir treatment can significantly improve the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection. Furthermore, it has the tendency to improve the stability rate and reduce the rate of progression of liver fibrosis.

关 键 词：肝炎病毒 乙型 治疗 肝纤维化 改善 

分 类 号：R512.62[医药卫生—内科学]