清肝利胆汤联合恩替卡韦治疗肝胆湿热证乙型肝炎患者的临床观察  

Effects of Qinggan Lidan Decoction Combined with Entecavir on Immune Indexes,Inflammatory Indexes,and Liver Fibrosis Indexes in the Treatment of Chronic Hepatitis B of Dampness-heat in Liver and Gallbladder Syndrome

作　　者：牟娟娟 陈阳梅 舒成凤 薛琴 MU Juan-juan;CHEN Yang-mei;SHU Cheng-feng;XUE Qin(Blood Transfusion Department,The People′s Hospital of Dazu,Chongqing 402360;Pain Rehabilitation Department,The People′s Hospital of Dazu,Chongqing 402360;Laboratory Department,Bishan Hospital of Chongqing,Chongqing 402760)

机构地区：[1]重庆市大足区人民医院输血科,重庆402360 [2]重庆市大足区人民医院疼痛康复科,重庆402360 [3]重庆市璧山区人民医院检验科,重庆402760

出　　处：《世界中西医结合杂志》2023年第5期1012-1017,共6页World Journal of Integrated Traditional and Western Medicine

基　　金：2021重庆市卫生计生委医学科研项目(2021MSXM133)。

摘　　要：目的 探讨清肝利胆汤联合恩替卡韦治疗慢性乙型肝炎(Chronic hepatitis B,CHB)的临床疗效。方法 选取2021年1月—2022年1月期间重庆市大足区人民医院收治的CHB肝胆湿热证患者94例,按随机数字表法分为对照组和试验组,每组各47例。两组患者均给予常规基础治疗,在此基础上,对照组给予恩替卡韦抗病毒治疗,试验组给予恩替卡韦联合清肝利胆汤中西医结合治疗。治疗24周后,观察比较两组患者临床疗效、病毒指标转阴率、治疗安全性及治疗前后中医证候积分、肝功能指标[总胆红素(Total bilirubin, TBil)、天门冬氨酸氨基转移酶(Aspartatetransaminase, AST)、谷氨酸氨基转移酶(Alaninetransferase, ALT)]、肝纤维化指标[层粘连蛋白(Laminin, LN)、透明质酸(Hyaluronic acid, HA)、Ⅲ型胶原(Type III collagen, PCⅢ)、Ⅳ型胶原(Type IV collagen,Ⅳ-C)]、免疫指标[T细胞亚群(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))]、炎症指标[肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白细胞介素-6(Interleukin-6,IL-6)、白细胞介素-8(Interleukin-8,IL-8)]水平变化。结果 治疗后试验组临床总有效率89.36%(42/47)高于对照组73.91%(34/46),差异有统计学意义(P<0.05)。治疗后两组患者主症、次症、总证候积分较治疗前降低,差异有统计学意义(P<0.05);且试验组试验组主症、次症、总证候积分低于对照组低,差异有统计学意义(P<0.05)。治疗后两组患者血清TBil、AST、ALT均较治疗前降低,差异有统计学意义(P<0.05);且试验组血清TBil、AST、ALT低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清LN、HA、PCIII、IV-C均较治疗前降低,差异有统计学意义(P<0.05);且试验组血清LN、HA、PCIII、IV-C低于对照组,差异有统计学意义(P<0.05)。治疗后试验组病毒指标转阴率HBsAg 55.32%(26/47)、HBeAg 38.30%(18/47)、HBV-DNA 76.60%(36/47)均明显高于对照组HBsAg 39.13%(18/46)、HBeAg 19.57%(9/46)、HBV-DNA Objective To investigate the clinical efficacy of Qinggan Lidan Decoction combined with entecavir in the treatment of chronic hepatitis B(CHB).Methods Ninety-four patients with CHB of dampness-heat in the liver and gallbladder syndrome admitted to The People′s Hospital of Dazu from January 2021 to January 2022 were selected and divided into a control group and an experimental group according to the random number table method,with 47 cases in each group.All patients were given routine basic treatment.The patients in the control group received entecavir treatment,while those in the experimental group received entecavir^(+)Qinggan Lidan Decoction.All patients were treated for 24 weeks.The clinical efficacy,negative conversion rate of viral index,treatment safety,traditional Chinese medicine(TCM)syndrome scores before and after treatment,liver function indexes[total bilirubin(TBil),aspartate aminotransferase(AST),and ala-nine transferase(ALT)],liver fibrosis indicators[laminin(LN),hyaluronic acid(HA),procollagen type III(PCIII),and type IV collagen(IV-C)],immune indicators[T cell subsets(CD3^(+),CD4^(+),and CD4^(+)/CD8^(+))],and inflammatory markers[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and interleukin-8(IL-8)]levels of the two groups were compared.Results The total clinical efficacy rate of the experimental group was 89.36%(42/47),higher than 73.91%(34/46)of the control group(P<0.05).After treatment,the scores of main symptom,secondary symptom,and total TCM syndrome scores in the two groups were lower than those before treatment(P<0.05),and the experimental group was lower than the control group(P<0.05).After treatment,serum TBil,AST,and ALT in the two groups decreased compared with those before treatment(P<0.05),and the experimental group was lower than the control group(P<0.05).After treatment,serum LN,HA,PCIII,and IV-C in the two groups decreased compared with those before treatment(P<0.05),and the experimental group was lower than the control group(P<0.05).The negative conversion rates of HB-sAg

关 键 词：慢性乙型肝炎 肝胆湿热证 清肝利胆汤 恩替卡韦 免疫功能 炎症反应 肝纤维化 

分 类 号：R373.21[医药卫生—病原生物学] R512.62[医药卫生—基础医学]