苦参素联合拉米夫定治疗乙型肝炎早期肝硬化33例

Therapeutic efficacy of oxymatrine combined with lamivudine in treatment of early cirrhosis after chronic hepatitis B: an analysis of 33 cases

目的:探讨苦参素联合拉米夫定治疗乙型肝炎早期肝硬化的临床疗效.方法:随机选择65例代偿期乙型肝炎早期肝硬化患者,苦参素联合治疗组33例,拉米夫定对照组32例,观察第0、3、6和12月肝功能、Child-Pugh评分、肝纤维化指标(PCⅢ、HA、LN、Ⅳ-C)和HBV DNA定量,并行肝穿病理检查.结果:苦参素联合组在疗程结束时,肝功能(ALT、TBIL)均较对照组明显好转(t=2.267,2.256,P<0.05);两组4项肝纤维化指标(PCⅢ、HA、LN和Ⅳ-C)均较治疗前明显下降,组间比较联合组较对照组下降更为明显,差异显著(t=2.358,2.367,2.236,2.217,P<0.05).乙肝病毒定量第6和12月联合组较对照组明显减少,有显著差异(t=2.235,2.326;P<0.05).治疗后两组肝细胞坏死、汇管区炎细胞浸润分级均较治疗前明显减轻(t=136,P<0.05;t=144.5,P<0.01).结论:苦参素具有改善肝功能、减轻肝脏炎症及增强拉米夫定的抗病毒作用,减轻或延缓肝肝硬化的进展.

AIM： To investigate the therapeutic effect of oxymatrine combined with lamivudine on early cirrhosis after chronic hepatitis B. METHODS： A total of 65 patients with early cirrhosis after chronic hepatitis B were included in this study, 33 of which received oxymatrine and lamivudine, and the rest of which only received lamivudine, serving as controls, Liver function, serum markers of liver fibrosis including procollagen type Ⅲ （PC Ⅲ）, hyaluronic acid （HA）, laminin （LN）, and type IV collagen （IV-C） as well as HBV DNA were detected at 0, 3, 6, and 12 mo, At the same time, Child-Pugh scores were evaluated. Liver pathological examination was also done at the end of therapy. RESULTS： Liver function （ALT and TBIL） was improved in combined group in comparison with that in control group （t= 2.267, 2.256; both P 〈 0.05）. The levels of serum PC Ⅲ, HA, LN and IV-C were decreased significantly after 12-mo treatment in both groups, and the effects in combined group were significantly superior to those in control group （t = 2.358, 2.367, 2.236, 2.217; all P 〈 0.05）. The quantification of HBV DNA in combined group was significantly lower at 6 and 12 mo than that in control group （t = 2.235, 2.326; both P 〈 0.05）. The liver pathological changes such as necrosis of liver cells and infiltration of inflammatory cells in portal areas were lessened obviously after 12-mo treatment in both groups （t = 136, P 〈 0.05; t = 144.5, P 〈 0.01）. CONCLUSION： Oxymatrine can not only improve liver function, lessen inflammation and enhance anti-viral effect of lamivudine, but also delay the progression of early cirrhosis after chronic hepatitis B.