难治性丙型肝炎临床病理特点及中西药抗病毒治疗效果比较  

Clinical pathology feature of refractory hepatitis C and therapeutic effect of integrated traditional Chinese and western medicine

作　　者：张琼 胡蓉 毛创杰 杨启 康信通 

机构地区：[1]成都市公共卫生临床医疗中心一病区,610000

出　　处：《疑难病杂志》2015年第3期251-253,257,共4页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的探讨难治性丙型肝炎(RHC)的临床病理特点及中西药治疗效果。方法难治性丙型肝炎患者70例(研究组)随机分为观察亚组37例和对照亚组33例,对照亚组采用常规方案治疗,观察亚组在对照亚组基础上加用自拟犀角地黄汤合黄连解毒汤;另选择同期治疗的普通慢性丙型肝炎患者50例作为普通组。观察难治性丙型肝炎的临床病理特点并比较治疗前后肝功能指标和病毒载量的变化。结果研究组丙氨酸氨基转氨酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBil)、直接胆红素(DBil)、碱性磷酸酶(ALP)均显著高于普通组(P<0.05);研究组重度肝细胞脂肪变性率、小叶间胆管损伤率、淋巴滤泡样结构发生率均显著高于普通组(P<0.05)。治疗12个月,2亚组ALT、AST及HCV-RNA定量均较治疗前降低(P<0.05),且观察亚组低于对照亚组(P<0.05)。观察亚组HCV-RNA阴转率为10.81%(4/37),高于对照亚组的3.03%(1/30),差异有统计学意义(X^2=4.699,P=0.030),治疗12个月后2亚组HCV-RNA载量均明显降低(t=4.929,2.225,P<0.05),且观察亚组低于对照亚组(t=2.475,P<0.05)。结论难治性丙型肝炎临床病理特点为重度肝细胞脂肪变性、小叶间胆管损伤和淋巴滤泡样结构,血清ALT、AST及病毒载量显著升高。中西药联合治疗能够显著改善肝功能,具有一定抗病毒作用,可以作为难治性丙型肝炎治疗的方法之一。Objective To investigate the clinical pathologic characteristics of refractory hepatitis C(RHC) and therapeutic effect of integrated traditional Chinese and western medicine.Methods Seventy patients with refractory hepatitis C(study group) were randomly divided into the observation sub group with 37 cases and control sub group with 33 cases,control sub group using conventional treatment,the observation sub group based on the conventional treatment,also used of self-made Xijiaodihuang decoction of Huanglianjiedu decoction;another 50 patients with chronic hepatitis C were enrolled as ordinary group.Compared the pathological characteristics and liver function and viral load before and after treatment.Results Study group's alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),direct bilirubin(DBil),alkaline phosphatase(ALP)were significantly higher than those in ordinary group(P <0.05);the study group's severe liver cell fatty degeneration rate,interlobular bile duct injury rate,incidence of lymph follicle like structures was significantly higher than that of ordinary group(P <0.05).After 12 months treatment,2 sub-groups' ALT,AST and HCV-RNA quantitative were lower than those before therapy(P <0.05),and observation sub group was lower than the control subgroup(P <0.05).Observation subgroup' s HCV-RNA negative rate was 10.81%(4/37),higher than the control subgroup of3.03%(1/30),the difference was statistically significant(x^2 = 4.699,P =0.030).after 12 months of treatment,2 subgroups' HCV-RNA load were decreased significantly(t =4.929,(=2.225,P <0.05),and the observation sub group was lower than the control subgroup(t =2.475,P <0.05).Conclusion Refractory hepatitis C's clinicopathological characteristics was severe liver cell fatty degeneration,interlobular bile duct injury and lymph follicle like structures,serum ALT,AST and viral load increased significantly.Traditional Chinese medicine combined with western medicine can significantly improve the liver function,has some antiviral effect

关 键 词：难治性丙型肝炎 病理特点 抗病毒治疗 病毒载量 

分 类 号：R512.63[医药卫生—内科学]