恩替卡韦联合自拟中药治疗慢性乙型肝炎患者疗效初步评价

doi:10.3969/j.issn.1672-5069.2017.06.011

摘要/Abstract

摘要： 目的研究自拟中药联合恩替卡韦治疗慢性乙型肝炎患者的疗效以及不良反应发生情况。方法 2015年1月~2016年12月我科收治的69例慢性乙型肝炎患者,34例接受自拟中药（党参20 g,醋柴胡10 g,郁金10 g,鳖甲30 g,丹参20 g,龙葵10 g,白花蛇舌草15 g,绞股蓝15 g,三七10 g,片姜黄10 g,赤芍15 g,炙甘草6 g,水煎 400 ml,每日1剂,分早晚温服）联合恩替卡韦治疗,35例只接受恩替卡韦治疗。应用SPSS 19.0统计软件完成数据分析处理。结果在治疗前和治疗24 w末,观察组与对照组血清ALB水平差别未见统计学意义（P> 0.05）,但治疗后观察组血清TBIL水平为（20.1± 4.7） μmol/L,显著低于对照组的（28.7± 4.8）μmol/L （P<0.05）;观察组血清ALT水平为（40.9± 6.8） U/L,显著低于对照组的（50.2± 6.7） U/L（P<0.05）;观察组血清AST水平为（39.6± 8.4） U/L,显著低于对照组的（52.5± 8.1） U/L （P<0.05）;治疗后,观察组和对照组血清透明质酸（HA）、层连蛋白（LN）、4型胶原（IV-C）和3型前胶原（PC-Ⅲ）水平均有所下降,其中观察组血清HA水平由[（256.3± 9.3）μg/L下降至（98.3± 9.1） μg/L,对照组血清HA水平由[（255.3± 9.8） μg/L下降至（140.3± 9.6） μg/L,观察组血清LN水平由[（241.3± 7.8） μg/L下降至（110.3± 7.7） μg/L,对照组血清LN水平由[（240.4± 7.8） μg/L下降至（170.5± 7.9） μg/L,观察组血清IV-C水平由[（98.4± 6.8） μg/L降至（53.6± 6.7） μg/L,对照组血清IV-C水平由[（98.00± 6.5） μg/L下降至（70.9± 6.6） μg/L,观察组血清PC-Ⅲ水平由[（193.6± 13.2） μg/L下降至（98.3± 9.9） μg/L,对照组血清PC-Ⅲ水平由[（193.5± 13.4） μg/L下降至（120.3± 9.7） μg/L,显示出治疗后观察组肝纤四项指标均显著低于对照组（P<0.05）。另外,治疗后观察组与对照组血清HBeAg转阴率和HBV DNA转阴率均未见统计学差异,而消化道症状,如腹泻、腹痛以及呕吐的发生率在观察组和对照组分别为2.9%和8.6%,差别也无统计学意义（P>0.05）。结论自拟中药联合恩替卡韦联合治疗慢性乙型肝炎患者,两者结合一方面可以迅速抑制HBV复制,在另一方面可以发挥祖国医学治本的优势,扶正而固本,增强了疗效。

关键词: 慢性乙型肝炎, 中药, 恩替卡韦, 肝纤维化指标

Abstract: Objective To evaluate the efficacy of combination of entecavir and Chinese herbal medicine in treatment of patients with hepatitis B. Methods 69 patients with hepatitis B were enrolled between January 2015 and December 2016 in this study. 34 patients with hepatitis B received combination of entecavir and herbal medicine,and 35 patients with hepatitis B received entecavir alone for 24 weeks. The data of liver function index and serum liver fibrosis markers were compared. SPSS 19.0 statistical software was applied to complete the data processing and analysis. Results There was no significant difference in serum albumin level between the two groups before and after the treatment （P>0.05）,while there were significant differences as respect to serum bilirubin, alanine aminotransferase,and aspartate aminotransferase levels between the two groups （P<0.05）,e.g. serum bilirubin level in the combination group at the end of 24 weeks was（20.1±4.7） μmol/L,much lower than（28.7±4.8）μmol/L in the controls （P<0.05）,serum ALT leves was （40.9±6.8） U/L,much lower than （50.2±6.7） U/L in the control （P<0.05）,and serum AST level was （39.6±8.4） U/L,much lower than （52.5±8.1） U/L in the control （P<0.05）;at the end of observation,serum HA,LN,IV-C and PC-Ⅲ levels decreased both in the two groups,e.g. serum HA level in the combination group decreased from [（256.3±9.3） μg/L to（98.3±9.1）μg/L,while serum HA levels in the control decreased from （255.3±9.8） μg/L to（140.3±9.6） μg/L,serum LN level in the combination decreased from[（241.3±7.8） μg/L to （110.3±7.7） μg/L,seerum LN level in the control decreased from [（240.4±7.8） μg/L to （170.5±7.9） μg/L,serum IV-C levels in the combination decreased from [（98.4±6.8） μg/L to（53.6±6.7）μg/L,serum IV-C level in the control decreased from [（98.00±6.5） μg/L to （70.9±6.6） μg/L,serum PC-Ⅲ level in the combination decreased from [（193.6±13.2） μg/L to（98.3±9.9） μg/L,while serum PC-Ⅲ levels in the control decreased from [（193.5±13.4） μg/L to（120.3±9.7） μg/L（P<0.05）;there was no significant differences as respect to serum HBeAg and/or HBV DNA negativity in the two groups（P>0.05）. Conclusion Combination of entecavir and Chinese herbal medicine can quickly inhibit HBV replication,and enhance the efficacy of anti-liver fibrosis.

Key words: Hepatitis B, Entecavir, Herbal medicine, Hepatic fibrotic markers

龚旭, 张玲. 恩替卡韦联合自拟中药治疗慢性乙型肝炎患者疗效初步评价[J]. 实用肝脏病杂志, 2017, 20(6): 680-683.

Gong Xu, Zhang Ling. Efficacy of combination of entecavir and herbal medicine in treatment of patients with hepatitis B[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2017, 20(6): 680-683.

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