芪参二莲汤联合恩替卡韦治疗乙型肝炎肝纤维化临床研究.docVIP

芪参二莲汤联合恩替卡韦治疗乙型肝炎肝纤维化临床研究 　　摘要：目的 观察芪参二莲汤联合恩替卡韦片治疗乙型肝炎肝纤维化的临床疗效。方法 将74例乙型肝炎肝纤维化患者随机分为治疗组38例和对照组36例。对照组给予恩替卡韦片，治疗组在对照组治疗基础上加用芪参二莲汤。48周为1个疗程，治疗结束后继续给予恩替卡韦片，并随访24周。比较2组患者治疗前后肝功能、HBV-DNA、血清转化生长因子-β1（TGF-β1）、骨形态发生蛋白7（BMP-7）、肝纤维化指标及临床症状的变化。结果 治疗组剔除3例、失访3例，对照组失访6例。治疗组治疗12、24、36、48周及随访24周时肝功能指标、HBV-DNA均较治疗前明显下降（P0.01），且均明显优于对照组（P0.01）。与治疗前比较，2组治疗后TGF-β1均下降（P0.05），BMP-7均升高（P0.01），TGF-β1/BMP-7比值均下降（P0.01），组间比较差异有统计学意义（P0.05）。治疗组治疗后及随访时透明质酸、层黏连蛋白、Ⅲ型前胶原、Ⅳ型胶原、肝脏弹性成像较治疗前明显下降（P0.01），与对照组比较差异有统计学意义（P0.01）。治疗组治疗后及随访时乏力、肝区不适、恶心厌油及纳差均明显好转，与对照组比较差异有统计学意义（P0.05）。结论 芪参二莲汤联合恩替卡韦片具有良好的保肝降酶、抗病毒及逆转肝纤维化的作用。 　　关键词：芪参二莲汤；慢性乙型病毒性肝炎；肝纤维化；临床疗效 　　DOI：10.3969/j.issn.1005-5304.2016.11.008 　　中图分类号：R259.752 文献标识码：A 文章编号：1005-5304（2016）11-0029-05 　　Abstract： Objective To observe the clinical efficacy of Qishen Erlian Decoction combined with entecavir for patients with liver fibrosis of hepatitis B. Methods Totally 74 patients were divided into treatment group （38 cases） and control group （36 cases）. The control group was given entecavir， while treatment group was given Qishen Erlian Decoction combined with entecavir， 48 weeks for 1 course. Entecavir was given to both groups after treatment， and two groups were followed up for 24 weeks. The liver function， DNA-HBV， serum TGF-β1， BMP-7， liver fibrosis indexes and clinical symptom changes of the two groups were observed. Results 3 cases were excluded and 3 cases were lost during follow-up in treatment group； 6 cases were lost during follow-up in the control group. Liver function and HBV-DNA in 12， 24， 36， 48 weeks and 24 weeks in follow-up were significantly lower than those pre-treatment （P0.01） in the treatment group， and were significantly better than those in the control group （P0.01）. TGF-β1 decreased （P0.05）， BMP-7 increased （P0.01）， and the ratio of TGF-β1/BMP-7 decreased （P0.01） in both groups after treatment. There was significant difference between the two groups （P0.05）. HA， LN， PCⅢ， Ⅳ-C， and FS decreased significantly in treatment grou