柴胡当归散联合丙酚替诺福韦治疗慢性乙型肝炎肝纤维化的效果观察  

Effect of Bupleurum Angelica Powder Combined with Tenofovir Alafenamide in the Treatment of Liver Fibrosis in Patients with Chronic Hepatitis B

作　　者：赵彩莎 孔洪彬 李卫强 李改叶 裴晓敏 张运豪 ZHAO Caisha;KONG Hongbin;LI Weiqiang;LI Gaiye;PEI Xiaomin;ZHANG Yunhao(Department of Hepatology,Handan Infectious Disease Hospital,Handan,Hebei 056002,China;Department of Dermatology and Venereology,Handan Infectious Disease Hospital,Handan,Hebei 056002,China;Department of Spleen and Stomach,Handan Hospital of Traditional Chinese Medicine,Han⁃dan,Hebei 056002,China)

机构地区：[1]邯郸市传染病医院肝病科,河北邯郸056002 [2]邯郸市传染病医院皮肤性病科,河北邯郸056002 [3]邯郸市中医院脾胃一科,河北邯郸056002

出　　处：《临床误诊误治》2025年第5期77-83,共7页Clinical Misdiagnosis & Mistherapy

基　　金：河北省卫生健康委医学科学研究课题(20241669)。

摘　　要：目的探究柴胡当归散联合丙酚替诺福韦治疗慢性乙型肝炎肝纤维化的效果。方法选取2021年10月至2023年10月收治的100例慢性乙型肝炎肝纤维化患者,采用随机数字表法分为观察组(予柴胡当归散联合丙酚替诺福韦治疗)、对照组(仅予丙酚替诺福韦治疗)各50例。比较2组治疗效果、乙型肝炎病毒(HBV)-DNA阴转率、不良反应,以及治疗前后肝脏硬度、炎性因子[基质金属蛋白酶-2(MMP-2)、转化生长因子-β1(TGF-β1)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)]、中医证候积分、肠道菌群水平和治疗前后差值。结果观察组治疗总有效率为96.00%(48/50)高于对照组的82.00%(41/50),差异有统计学意义(P<0.05);2组HBV-DNA阴转率比较无明显差异(P>0.05)。治疗后,2组肝脏硬度及MMP-2、TGF-β1、IL-8、TNF-α水平低于治疗前,且观察组低于对照组(P<0.05,P<0.01);观察组治疗前后肝脏硬度及MMP-2、TGF-β1、IL-8、TNF-α差值大于对照组(P<0.01)。治疗后,2组各中医证候积分低于治疗前,且观察组低于对照组(P<0.05,P<0.01);观察组治疗前后各中医证候积分差值大于对照组(P<0.01)。治疗后观察组肠球菌、大肠杆菌菌落数低于治疗前且低于对照组,乳酸杆菌、双歧杆菌菌落数高于治疗前且高于对照组(P<0.05,P<0.01);观察组治疗前后肠球菌、大肠杆菌、乳酸杆菌、双歧杆菌菌落数差值大于对照组(P<0.01)。2组治疗期间不良反应发生率比较无明显差异(P>0.05)。结论柴胡当归散联合丙酚替诺福韦治疗慢性乙型肝炎肝纤维化的效果确切,可改善患者临床症状、肝脏硬度,抑制炎症反应,改善肠道菌群,且不影响治疗安全性。Objective To explore the effect of Bupleurum Angelica powder combined with Tenofovir Alafenamide(TAF)in the treatment of liver fibrosis in patients with chronic hepatitis B(CHB).Methods A total of 100 CHB patients with liver fibrosis treated from October 2021 to October 2023 were selected and divided into the observation group(treated with Bupleurum Angelica powder combined with TAF,n=50)and the control group(treated with TAF alone,n=50)by random number table method.The therapeutic effect,hepatitis B virus(HBV)-DNA negative conversion rate and adverse reactions were compared between the two groups.Liver stiffness,inflammatory factors[matrix metalloproteinase-2(MMP-2),transforming growth factor-β1(TGF-β1),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)],traditional Chinese medicine(TCM)syndrome score,intestinal flora level and the difference before and after treatment were also included.Results The total effective rate of the observation group was 96.00%(48/50),which was higher than that of the control group[82.00%(41/50),P<0.05],and there was no significant difference in the negative conversion rate of HBV-DNA between the two groups(P>0.05).After treatment,liver stiffness and levels of MMP-2,TGF-β1,IL-8 and TNF-αin the two groups were lower than those before treatment,and lower in the observation group than in the control group(P<0.05,P<0.01).The differences of liver stiffness,MMP-2,TGF-β1,IL-8 and TNF-αbefore and after treatment in the observation group were greater than those in the control group(P<0.01).After treatment,the TCM syndrome scores of the two groups were lower than those before treatment,and lower in the observation group than in the control group(P<0.05,P<0.01).The difference of TCM syndrome scores before and after treatment in observation group was greater than that in control group(P<0.01).After treatment,the colony number of enterococcus and Escherichia coli in observation group was lower than that before treatment and that in the control group,while the colony number of lactobacillus

关 键 词：乙型肝炎 慢性 肝纤维化 柴胡当归散 丙酚替诺福韦 肝脏硬度 基质金属蛋白酶-2 中医证候 肠道菌群 

分 类 号：R512.62[医药卫生—内科学]