叶氏鳖甲旋覆花汤联合替诺福韦治疗慢性乙型肝炎肝硬化代偿期临床疗效观察  

Clinical effect of Yeshi Biejia Xuanfuhua Decoction combined with tenofovir in treating chronic hepatitis B of compensatory phase cirrhosis

作　　者：沈燕平 高倩 姚青 SHEN Yanping;GAO Qian;YAO Qing(Department of Hepatology,Suzhou Hospital of Integrated Traditional Chinese and Western Medicine,Suzhou,Jiangsu 215101)

机构地区：[1]江苏省苏州市中西医结合医院肝病科,江苏苏州215101

出　　处：《河北中医》2025年第2期221-224,共4页Hebei Journal of Traditional Chinese Medicine

基　　金：苏州市中西医结合医院科技项目(编号:YJ2022017)。

摘　　要：目的研究叶氏鳖甲旋覆花汤联合替诺福韦治疗慢性乙型肝炎肝硬化代偿期的临床疗效。方法将80例慢性乙型肝炎肝硬化代偿期患者按照信封法随机分为对照组、治疗组,各40例。对照组予富马酸替诺福韦二吡呋酯片治疗,治疗组在对照组治疗基础上加叶氏鳖甲旋覆花汤,2组均治疗6个月。比较2组治疗前后肝脾静脉血流动力学指标[门静脉内径(DPV)、门静脉血流量(QPV)、脾静脉内径(DSV)、脾静脉血流量(QSV)、门静脉血流速度(VPV)、脾静脉血流速度(VSV)]、肝纤维化指标[Ⅲ型前胶原(PCⅢ)、透明质酸(HA)、层粘连蛋白(LN)、Ⅳ型胶原(Ⅳ-C)]、症状(体力减退、肝掌、乏力、腹胀、黄疸)评分、肝脏和脾脏弹性指数变化。结果治疗组34例、对照组39例完成试验。治疗后对照组DPV、QPV、DSV均较本组治疗前降低(P<0.05),治疗组DPV、QPV、DSV、QSV均较本组治疗前降低(P<0.05),且治疗组DPV、QPV、DSV、QSV均低于对照组(P<0.05)。治疗后,2组PCⅢ、HA、LN、Ⅳ-C水平及肝脏弹性指数、脾脏弹性指数、各项症状评分均较本组治疗前降低(P<0.05),且治疗组均低于对照组(P<0.05)。结论叶氏鳖甲旋覆花汤联合替诺福韦治疗慢性乙型肝炎肝硬化代偿期患者,能够显著改善患者肝脾静脉血流动力学,减轻肝纤维化,改善患者临床症状。Objective To study the clinical effect of Yeshi Biejia Xuanfuhua Decoction combined with tenofovir in treating chronic hepatitis B(CHB)of compensatory phase cirrhosis.Methods Eighty CHB patients of compensatory phase cirrhosis were randomly divided into a control group(n=40)and a study group(n=40)via Sequential numbered,opaque,sealed envelopes(SNOSE)method.All patients were managed by tenofovir,and those in the study group were additionally given Yeshi Biejia Xuanfuhua Decoction for six months.The blood dynamic index of liver and spleen,including diameter of portal vein and splenic vein(DPV and DSV),quantity of blood flow in portal vein and splenic vein(QPV and QSV),portal vein velocity(VPV),velocity of splenic vein blood flow(VSV),liver fibrosis indexes,such as procollagen typeⅢ(PCⅢ),hyaluronic acid(HA),laminin(LN),collagen typeⅣ(Ⅳ-C),and traditional Chinese medicine(TCM)symptom scores,including physical decline,liver palm,fatigue,abdominal distension,jaundice,as well as elasticity index of liver and spleen were determined before and after treatment.Results The treatment was finally completed by 73 patients(39 in the control group and 34 in the study group).The levels of DPV and DSV,QPV and QSV were significantly decreased in the study groups than those before treatment(P<0.05),and the decreases were more pronounced in the study group relative to the control group(P<0.05).The levels of PCⅢ,HA,LN andⅣ-C,as well as the elasticity index of liver and spleen and the scores of TCM symptom in the both groups were remarkably lower than those before treatment(P<0.05),and the decreases were more common in the study group relative to the control group(P<0.05).Conclusion Yeshi Biejia Xuanfuhua Decoction combined with tenofovir can significantly improve the hemodynamics,alleviate liver fibrosis,and improve clinical symptoms in CHB patients of compensatory phase cirrhosis.

关 键 词：肝硬化 代偿期 中西医结合疗法 替诺福韦 叶天士 

分 类 号：R575.205.8[医药卫生—消化系统]