肝苏丸联合阿德福韦酯片治疗肝郁脾虚型慢性乙型肝炎临床观察

Clinical efficacy of Gansuwan combined with adefovir dipivoxil in the treatment of chronic hepatitis B with liver stagnation and spleen deficiency

目的降低病毒感染及延缓疾病进展是当前治疗慢性乙型肝炎的主要方法,然而患者长期存在的症状及不稳定的临床疗效一直是当前急需解决的难题。本研究观察肝苏丸联合阿德福韦酯片对肝郁脾虚型慢性乙型肝炎的临床疗效,旨在初步明确中西医治疗慢性乙型肝炎有效性和优势。方法选取2017-09-15-2018-09-20沈阳市第六人民医院收治的104例慢性乙型肝炎患者作为研究对象。采用性别、年龄和病程组间具有可比性的原则分成对照组和治疗组,每组52例。对照组予口服阿德福韦酯片常规西医治疗,治疗组予以肝苏丸联合阿德福韦酯片治疗,两组治疗周期均为48周。观察两组治疗前后中医证候积分、临床疗效、肝功能生化指标和T淋巴细胞亚群情况变化。结果治疗后,治疗组胁肋胀痛(t=5.09,P<0.01)、神疲身倦(t=4.72,P<0.01)、脘痞便溏(t=3.74,P<0.01)、抑郁懒言(t=5.89,P<0.01)和舌有齿痕(t=7.43,P<0.01)等中医证候积分均优于对照组,差异有统计学意义。治疗组丙氨酸转氨酶水平为(30.18±12.68)U/L,低于对照组的(45.77±20.06)U/L,t=4.74,P<0.01;治疗组天门冬氨酸转氨酶水平为(25.64±7.94)U/L,低于对照组的(38.09±13.28)U/L,t=5.80,P<0.01;治疗组总胆红素水平为(15.56±2.02)U/L,低于对照组的(20.01±2.63)U/L,t=9.68,P<0.01。治疗组总有效率为92.40%,高于对照组的71.16%,差异有统计学意义,χ~2=14.87,P=0.02。治疗后治疗组CD3^+(t=5.69,P<0.01)、CD4^+(t=4.14,P<0.01)、CD8^+(t=3.87,P<0.01)和CD4^+/CD8^+(t=5.22,P<0.01)水平均优于对照组,差异有统计学意义。两组治疗前后FibroScan检测值均<7.3kPa,属于无肝纤维化群体,组间差异无统计学意义,均P>0.05。结论肝苏丸联合阿德福韦酯片对肝郁脾虚型慢性乙型肝炎的临床疗效确切,能有效改善患者症状及肝功能。

OBJECTIVE Reducing viral infection and delaying disease progression are the main ways to treat chronic hepatitis B.However,the long-standing symptoms and unstable clinical efficacy of patients have always been the urgent problems to be solved.The purpose of this study was to observe the clinical efficacy of Gansu pill combined with Adefovir dipivoxil tablets in treating chronic hepatitis B of liver depression and spleen deficiency type,in order to preliminarily clarify the effectiveness and advantages of traditional Chinese and Western medicine in treating chronic hepatitis B.METHODS A total of 104 patients with chronic hepatitis B admitted to Shenyang Sixth People’s Hospital from September 15,2017 to September 20,2018 were selected as the study subjects.The patients were divided into control group and treatment group according to the principle of comparability of sex,age and course of disease,with 52 cases in each group.The control group was treated with oral adefovir dipivoxil tablets and the treatment group was treated with Gansu pills combined with adefovir dipivoxil tablets.The treatment period of the two groups was 48 weeks.The changes of TCM syndrome score,clinical efficacy,biochemical indexes of liver function and T lymphocyte subsets were observed before and after treatment.RESULTS After treatment,the scores of flank pain(t=5.09,P<0.01),fatigue(t=4.72,P<0.01),eczema(t=3.74,P<0.01),depression and laziness(t=5.89,P<0.01)and dental marks on the tongue(t=7.43,P<0.01)in the treatment group were better than those in the control group.The level of alanine aminotransferase in the treatment group was(30.18±12.68)U/L,lower than that in the control group(45.77±20.06)U/L,t=4.74,P<0.01;The level of aspartate aminotransferase in the treatment group was(25.64±7.94)U/L,lower than that in the control group(38.09±13.28)U/L,t=5.80,P<0.01;The total bilirubin level in the treatment group was(15.56±2.02)U/L,lower than that of the control group(20.01±2.63)U/L,t=9.68,P<0.01.The total effective rate in the treatment group was 92.40%,higher than 71.16%in the control group,and the difference was statistically significant,χ~2=14.87,P=0.02.After treatment,the levels of CD3^+(t=5.69,P<0.01),CD4^+(t=4.14,P<0.01),CD8^+(t=3.87,P<0.01)and CD4^+/CD8^+(t=5.22,P<0.01)in the treatment group were better than those in the control group,and the difference was statistically significant.The FibroScan values of both groups before and after treatment were<7.3 kPa,belonging to the group without hepatic fibrosis.There was no significant difference between the two groups,all P>0.05.CONCLUSION Gansuwan combined with adefovir dipivoxil is effective in the treatment of chronic hepatitis B with liver stagnation and spleen deficiency,which can effectively improve the symptoms and liver function of patients.