扶正化瘀片联合恩替卡韦治疗对乙肝肝硬化患者的纤维化改善作用单中心观察  

Single center observation of fibrosis improvement about Fuzheng Huayu combined with entecavir in the treatment of hepatitis B cirrhosis patients

作　　者：徐云芳[1] 赵志敏[2] 张媛媛 王莉娟[1] 堵妍 赵云[1] 刘兴祥[1] 朱礼尧[1] 于凤芹[1] 孙秀娟[1] 刘成海[2] XU Yun-fang;ZHAO Zhi-min;ZHANG Yuan-yuan;WANG Li-juan;DU Yan;ZHAO Yun;LIU Xing-xiang;ZHU Li-yao;YU Feng-qin;SUN Xiu-juan;LIU Cheng-hai(Institute of Liver Disease,Huai'an Fourth People's Hospital,Huai'an 223002,China;Liver Cirrhosis Department,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]淮安市第四人民医院肝病研究所,江苏淮安223002 [2]上海中医药大学附属曙光医院肝硬化科,上海201203

出　　处：《中国中西医结合消化杂志》2020年第12期909-914,共6页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

基　　金：科技部“十二五”重大科技专项课题(No:2014ZX10005001);淮安市科技计划项目(No:HAB2017034)。

摘　　要：[目的]探索乙肝肝硬化患者接受恩替卡韦(ETV)或者联合扶正化瘀片治疗48周对肝纤维化的改善作用。[方法]选择2014年10月~2016年12月就诊于淮安市第四人民医院疑似肝硬化的初治慢性HBV感染者72例,行肝组织病理活检,符合盲评Ishak评分≥5分且HBV DNA>20U/mL的患者57例,经随机、双盲使用ETV或联合扶正化瘀治疗48周后行第2次肝脏病理穿刺检查,最终44例患者随访到60周,揭盲后显示扶正化瘀联合ETV组18例,ETV组26例,比较2组患者的纤维化改善情况。[结果]治疗48周后,45.45%(20/44)的患者肝组织纤维化改善,43.18%(19/44)的患者肝组织炎症改善,36.36%(16/44)的患者肝脏组织学改善。扶正化瘀联合ETV治疗组的患者肝组织炎症改善率(61.11%)和纤维化改善率(55.56%)高于ETV单药治疗组(30.77%和38.46%),且具有较低的纤维化进展率(11.11%);较ETV单药组,扶正化瘀联合ETV治疗组的患者在治疗48周后具有较低的纤维化评分(P=0.0447)和炎症评分(P=0.0217)。[结论]扶正化瘀联合ETV治疗可以提高乙肝肝硬化患者肝纤维化和炎症的改善率,并可降低肝纤维化的进展率。[Objective]To explore the improvement rate of liver fibrosis in patients with hepatitis B cirrhosis who received entecavir alone or in combination with Fuzheng Huayu for 48weeks.[Methods]Seventy-two antiviral treatment-naive CHB patients suspected hepatitis B cirrhosis who visited Huai'an Fourth People's Hospital from October 2014to December 2016were screened.All patients underwent liver biopsy.Three expert pathologists were blinded to patient clinical characteristics scored all liver biopsy specimens and gave a final score.Fifty-seven patients with Ishak score≥5and HBV DNA>20U/mL were enrolled in this study.After 48weeks of randomized and double-blind treatment with entecavir or combined Fuzheng Huayu,a second biopsy of the liver was performed.Finally,44patients were followed up to 60 weeks,after unblinding,18cases of Fuzheng Huayu combined with entecavir group and 26cases of entecavir group were revealed.The fibrosis improvement was compared between the two groups.[Results]After 48weeks of treatment,the improvement of liver fibrosis occurred in 45.45%(20/44)patients,the in-flammation of liver tissue improved in 43.18%(19/44)patients,and the histological improvement of liver tissue occurred in 36.36%(16/44)patients.The liver inflammation improvement rate(61.11%)and fibrosis improvement rate(55.56%)of the patients treated with Fuzheng Huayu combined with entecavir were higher than those treated with entecavir alone(30.77%and 38.46%),and the fibrosis progression rate was lower(11.11%).Compared with entecavir alone,patients in the Fuzheng Huayu combined entecavir group had lower fibrosis score(P=0.0447)and inflammation score(P=0.0217)after 48weeks of treatment.[Conclusion]The improvement rate of liver fibrosis and inflammation can be increased,and the rate of progression of liver fibrosis reduced in patients with hepatitis B cirrhosis who received Fuzheng huayu and entecavir treatment for 48weeks.

关 键 词：乙型肝炎 肝硬化 扶正化瘀 恩替卡韦 改善 

分 类 号：R575.1[医药卫生—消化系统]