温阳健脾方联合恩替卡韦治疗乙型肝炎肝硬化失代偿期的疗效及对血清炎性因子和肠黏膜屏障功能的影响  

Effects of Wenyang Jianpi Recipe combined with entecavir on decompensated hepatitis B cirrhosis and its influence on serum inflammatory factors and intestinal mucosal barrier function

作　　者：沈初 孔俊姚 任华 Shen Chu;Kong Junyao;Ren Hua(Department of Traditional Chinese Medicine,Zhejiang Medical and Health Group Hangzhou Hospital,Hangzhou Hanggang Hospital,Hangzhou,Zhejiang 310000,China)

机构地区：[1]浙江省医疗健康集团杭州医院,杭州杭钢医院中医科,浙江杭州310000

出　　处：《中国药物与临床》2024年第13期822-827,共6页Chinese Remedies & Clinics

基　　金：浙江省杭州市医药卫生科技项目(B20200415)。

摘　　要：目的探究温阳健脾方+恩替卡韦治疗乙型肝炎肝硬化失代偿期效果。方法选取2020年5月至2022年5月杭州杭钢医院148例乙型肝炎肝硬化失代偿期患者,按治疗方法分组,对照组(74例)接受恩替卡韦治疗,研究组(74例)在此基础上加用温阳健脾方治疗。比较2组疗效、肝功能、乙型肝炎病毒、肝纤维化指标、炎性因子、肠黏膜屏障功能相关指标及不良反应。结果研究组治疗总有效率96%,比对照组的85%高(χ^(2)=5.049,P<0.05)。2组治疗后中医证候积分、谷草转氨酶、总胆红素、谷丙转氨酶水平较治疗前低,且研究组[(4.2±1.1)分、(55±8)U/L、(24±6)μmol/L、(48±5)U/L]低于对照组[(5.8±1.1)分、(64±11)U/L、(30±8)μmol/L、(78±8)U/L](t=9.055、5.494、6.107、27.095,P<0.05)。2组治疗后乙型肝炎病毒DNA、Ⅲ型前胶原、层黏连蛋白、透明质酸比治疗前低,且研究组[(1.5±0.3)×10^(5) U/ml、(109±13)ng/ml、(130±12)ng/ml、(119±19)ng/ml]比对照组[(2.0±0.5)×10^(5) U/ml、(149±18)ng/ml、(181±15)ng/ml、(149±26)ng/ml]低(t=8.481、15.813、22.770、7.865,P<0.05)。2组治疗后肿瘤坏死因子-α、白细胞介素-6、超敏C反应蛋白水平较治疗前低,且研究组[(54±9)pg/ml、(96±18)pg/ml、(43±8)ng/L]比对照组[(71±16)pg/ml、(117±26)pg/ml、(60±11)ng/L]低(t=8.152、5.712、10.729,P<0.05)。研究组治疗后二胺氧化酶、D-乳酸、内毒素[(5.2±0.6)U/L、(3.8±0.4)mmol/L、(0.21±0.05)EU/ml]低于治疗前,且低于对照组[(6.4±0.7)U/L、(4.5±0.6)mmol/L、(0.27±0.07)EU/ml](t=10.979、7.886、6.000,P<0.05)。2组间不良反应对比,差异无统计学意义(P>0.05)。结论温阳健脾方联合恩替卡韦治疗乙型肝炎肝硬化失代偿期疗效确切,可降低患者炎性因子水平,修复肠黏膜屏障,抑制病毒复制,且联合用药不会增加不良反应,用药安全。Objective To investigate the efficacy of Wenyang Jianpi Recipe combined with entecavir in the treatment of decompensated hepatitis B cirrhosis.Methods From May 2020 to May 2022,148 patients with decompensated hepatitis B cirrhosis in Hangzhou Hanggang Hospital were selected and randomly divided into two groups by treatment.The control group(74 cases)received entecavir treatment,and the study group(74 cases)treated with Wenyang Jianpi prescription on this basis of te same treatment.The efficacy,liver function,hepatitis B virus,liver fibrosis indicators,inflammatory factors,intestinal mucosal barrier function related indicators,and adverse reactions were compared between the two groups.Results The total effective rate of the study group was 96%,which was higher than 85%of the control group(χ^(2)=5.049,P<0.05).After treatment,the scores of TCM syndrome,AST,TBil,and ALT levels in both groups were lower than before treatment,and the study group[(4.2±1.1)scores,(55±8)U/L,(24±6)μmol/L,(48±5)U/L]was lower than the control group[(5.8±1.1)score,(64±11)U/L,(30±8)μmol/L,(78±8)U/L](t=9.055,5.494,6.107,27.095,P<0.05).After treatment,hepatitis B virus DNA(HBV-DNA),HBV-DNA,typeⅢprocollagen(PC-Ⅲ),laminin(LN)and hyaluronic acid(HA)in both groups were lower than those before treatment,and those in the study group[(1.5±0.3)×10^(5) U/ml,(109±13)ng/ml,(130±12)ng/ml,(119±19)ng/ml]were lower than those in the control group[(2.0±0.5)×10^(5) U/ml,(149±18)ng/ml,(181±15)ng/ml,(149±26)ng/ml](t=8.481,15.813,22.770,7.865,P<0.05).After treatment,the level of TNF-α,IL-6 and hs-CRP in both groups were lower than before treatment,and the study group[(54±9)pg/ml,(96±18)pg/ml,(43±8)ng/L]was lower than the control group[(71±16)pg/ml,(117±26)pg/ml,(60±11)ng/L](t=8.152,5.712,10.729,P<0.05).After treatment,the levels of diamine oxidase(DAO),D-lactate,and endotoxin in the study group[(5.2±0.6)U/L,(3.8±0.4)mmol/L,(0.21±0.05)EU/ml]were lower than before treatment and the control group[(6.4±0.7)U/L,(4.5±0.6)mmol/L,(0.27�

关 键 词：乙型肝炎 肝硬化 温阳健脾方 恩替卡韦 肿瘤坏死因子-α 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]