自拟抗纤方对肝硬化纤维化的影响

Influence of anti-fibrosis prescription (抗纤方) on hepatic fibrosis in patients with cirrhosis

目的 :探讨中药抗纤方对肝硬化患者肝纤维化的治疗作用及其机制。方法 :将 86例乙型肝炎(乙肝 )后肝硬化患者随机分为两组观察。对照组用常规西药治疗方法 ,如维生素类和保肝类药物 ,必要时用人血白蛋白等 ;观察组在对照组用药基础上服用中药抗纤方 (主要成分 :丹参、川芎、赤芍、柴胡、黄芪、党参、当归、鳖甲、莪术、茯苓、白术、虎杖、白花蛇舌草、砂仁、炙甘草等 ) ;疗程均为 1年。观察患者治疗前后肝纤维化指标透明质酸酶 (HA)、层粘连蛋白 (L M)、 型前胶原 (PC )、 型胶原 ( C)、肝功能、乙肝病毒 (HBV)标志物的变化 ;部分患者进行肝活检病理检查。结果 :随着治疗时间的延长 ,两组肝纤维化指标水平均明显下降 ,除 C外 ,观察组各指标下降更显著 (P均 <0 .0 5 )。停药 4个月后肝纤维化指标均有所回升 ,但仍低于治疗前 ,且两组间差异存在显著性 (P均 <0 .0 5 ) ;治疗后观察组丙氨酸转氨酶 (AL T)和总胆红素 (TBil)复常率 (75 .4 %和4 9.6 % )均明显高于对照组 (40 .7%和 17.5 % ,P均 <0 .0 5 ) ;停药 4个月后 AL T和 TBil复常率两组比较差异无显著性 (P均 >0 .0 5 )。 HBs Ag、HBe Ag、HBV DNA阴转率及临床症状改善率优于对照组 (P均 <0 .0 5 )。观察组组织病理学改变稍优于对照组 ,但差异不明显。

Objective: To study the curative effects and mechanism of antifibrosis prescription in treatment for hepatic fibrosis in patients with cirrhosis. Methods: Eightysix patients with cirrhosis induced viral hepatitis B were randomly divided into two groups: the control group (42 cases) was treated with western medicine, including vitamins, hepatoprotective medicine, and albumin was administered if necessary; the treatment group (44 cases) was treated with antifibrosis prescription 〔main ingredients: salvia miltiorrhiza(丹参) , ligusticum (川芎), radix paeoniae rubra (赤芍), bupleurum chinense (柴胡), astragalus(黄芪) , codonopsis pilosula (党参), angelica sinensis (当归), carapax trionycis (鳖甲), curcuma zedoaria (莪术), poria cocos (茯苓), atractylodes macrocephala (白术), polygonum cuspidatum (虎杖), hedyotis diftusa (白花蛇草), amomum villosum (砂仁),and prepared licorice (炙甘草)〕. The therapeutic course were 1 year for all the patients. The indexes of cirrhosis such as hyaluronidase (HA), laminin (LM), precollagenⅢ(PCⅢ), collagenⅥ(ⅥC), liver function, markers of hepatitis B virus were observed before and after treatment, and biopsy was performed in part of the patients. Results: As the extension of therapeutic time, the levels of indexes of hepatic fibrosis were decreased in both groups, especially in the observation group (all P <0 05), they were recovered 4 months after withdrawal all the indexes of hepatic fibrosis stopping were increased again but were still lower than those before therapy and there were significantly different between two groups (all P <0 05).The rates of ALT and total bilirubin (TBil) turned to normal(75 4% and 49 6%) in observation group after therapy were significantly higher than those (40 7% and 17 5%, all P <0 05). After 4 months of withdrawal the rates returned to normal for ALT and TBil had not markedly different between two groups(all P >0 05). The rates returned to negative for HBsAg, HBcAg, and HBVDNA and the rates improving clinical symptoms in observation group were obviously superior to those in control group (all P <0 05), meanwhile the changes in tissue pathology in observation group were a little better than those in control group but the difference was not significant. No side effects of medication were found. Conclusion: Antifibrosis prescription has a good curative effect on hepatic fibrosis in patients with cirrhosis. It is able to improve the hepatic functions, inhibit HBV and its replication.