丙酚替诺福韦联合肝爽颗粒治疗慢性乙型肝炎患者疗效及其对肝纤维化指标的影响  

Improvement of liver fibrosis in patients with chronic hepatitis B after tenofovir alafenamide fumarate antiviral and herbal medicine anti-fibrotic therapy

作　　者：张天挺 许晶 姜正伟 嵇卉[2] Zhang Tianting;Xu Jing;Jiang Zhengwei(Department of Hepatology,Fourth People's Hospital,Huai'an 223001,Jiangsu Province,China)

机构地区：[1]江苏省淮安市第四人民医院肝病科,223001 [2]南京医科大学附属淮安第一医院影像科

出　　处：《实用肝脏病杂志》2024年第6期820-823,共4页Journal of Practical Hepatology

基　　金：江苏省卫生健康委科研基金资助项目(编号:ZD2022041)。

摘　　要：目的观察丙酚替诺福韦(TAF)联合肝爽颗粒治疗慢性乙型肝炎(CHB)患者的疗效,并重点评估肝纤维化指标的变化。方法2020年1月~2023年12月我院诊治的76例CHB患者被随机分为对照组38例和观察组38例,分别给予TAF治疗或TAF联合肝爽颗粒治疗,在治疗48周末评估疗效。采用实时荧光定量PCR法检测血清HBV DNA载量,采用化学发光免疫分析法检测血清HBeAg水平,计算肝纤维化4因子指数(FIB-4),使用瞬时弹性成像仪行肝硬度检测(LSM),采用ELISA法检测血清转化生长因子β1(TGF-β1)、基质金属蛋白酶1(MMP-1)、金属蛋白酶组织抑制因子1(TIMP-1)水平。结果在治疗48 w末,观察组血清ALT复常率为94.7%,显著高于对照组的78.9%(P<0.05);观察组胁肋胀痛、舌苔黄腻、纳呆呕恶和尿黄等中医评分分别为(0.9±0.1)分、(1.0±0.2)分、(0.9±0.1)分和(0.7±0.1)分,均显著低于对照组【分别为(1.3±0.2)分、(1.3±0.2)分、(1.2±0.2)分和(0.9±0.2)分,均P<0.05】;观察组FIB-4、LSM、血清TGF-β1和TIMP-1水平分别为(1.8±0.3)、(7.0±0.6)kPa、(21.4±5.4)ng/mL和(119.3±19.5)ng/mL,均显著低于对照组【分别为(2.2±0.4)、(9.7±1.1)kPa、(39.1±6.1)ng/mL和(168.9±22.3)ng/mL,P<0.05】,而血清MMP-1水平为(9.8±1.2)ng/mL,显著高于对照组【(7.1±1.0)ng/mL,P<0.05】。结论应用丙酚替诺福韦联合肝爽颗粒治疗CHB患者可显著减轻中医证候评分,改善肝功能,减轻肝纤维化,值得进一步验证。Objective The aim of this study was to investigate efficacy of tenofovir alafenamide fumarate(TAF)and Ganshuang granules,a herbal medicine compound,combination in the treatment of patients with chronic hepatitis B(CHB).Methods 76 patients with CHB were enrolled in our hospital between January 2020 and December 2023,and were randomly divided into control(n=38)and observation group(n=38).They were treated with TAF or TAF and herbal medicine combination for 48 weeks.Serum HBV DNA load was assayed by real-time fluorescence quantitative PCR,and serum HBeAg level was detected by chemiluminescence immunoassay.TCM syndromes scores were evaluated according to the Guidelines for the Traditional Chinese Medicine Diagnosis and Treatment of Chronic Hepatitis B(2018 Edition).Fibrosis index based on four factors(FIB-4)was obtained and liver stiffness measurement(LSM)was detected by transient elastography.Serum transforming growth factor-β1(TGF-β),matrix metalloproteinase-1(MMP-1)and tissue inhibitor of metalloproteinase-1(TIMP-1)levels were determined by ELISA.Results By end of 48 week treatment,ALT normalization rate in the observation group was 94.7%,much higher than 78.9%(P<0.05)in the control;scores of distending pain at hypochondrium,yellow and greasy tongue coating,poor appetite and nausea and yellow urine in the observation group were(0.9±0.1),(1.0±0.2),(0.9±0.1)and(0.7±0.1),all much lower than[(1.3±0.2),(1.3±0.2),(1.2±0.2)and(0.9±0.2),all P<0.05]in the control;FIB-4 score,LSM,serum TGF-β1 and TIMP-1 levels were(1.8±0.3),(7.0±0.6)kPa,(21.4±5.4)ng/mL and(119.3±19.5)ng/mL,all significantly lower than[(2.2±0.4),(9.7±1.1)kPa,(39.1±6.1)ng/mL and(168.9±22.3)ng/mL,respectively,P<0.05],while serum MMP-1 level was(9.8±1.2)ng/mL,significantly higher than[(7.1±1.0)ng/mL,P<0.05]in the control group.Conclusion Combination of TAF and Ganshuang granules in the treatment of patients with CHB could significantly reduce TCM syndrome scores,improve liver function and relieve liver fibrosis.

关 键 词：慢性乙型肝炎 丙酚替诺福韦 肝爽颗粒 肝纤维化 转换生长因子β1 治疗 

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