乙型肝炎失代偿期肝硬化的抗病毒与中药灌肠联合治疗

Antivirus treatment combined with traditional Chinese medicine enema in the treatment of hepatitis B cirrhosis in decompensation

目的观察抗病毒与中药灌肠联合治疗乙型肝炎失代偿期肝硬化患者的疗效,以寻求更佳的治疗方案,改善患者生活质量。方法60例乙型肝炎失代偿期肝硬化患者随机分为A、B、C3组。A组应用拉米夫定或阿德福韦酯并辨证施治,给予中药灌肠疗法,每日2次,疗程1个月。B组给予拉米夫定或阿德福韦酯。C组给予复方益肝灵、复方氨基酸、门冬酸钾镁、还原型谷胱甘肽等保肝支持疗法,酌情给予利尿剂、预防感染等对症治疗。观察肝功能、凝血功能、HBVDNA定量、HBV表面标志物及Child-Pugh评分、临床结局和药物不良反应。结果治疗后3组就上述指标进行比较,A组较B、C组疗效好,差异有显著性;只有A组发生2例HBeAg/HBeAb血清学转换;A组和B组临床结局好转率均为100%,3组均无药物不良反应发生。结论抗病毒与中药灌肠联合治疗乙型肝炎失代偿期肝硬化有协同作用,安全有效,可明显改善肝功能,提高生活质量,明显优于单独抗病毒和仅保肝对症治疗。

Objective To observe the efficacy of antivirus treatment combined with traditional Chinese medicine enema in the treatment of hepatitis B cirrhosis in decompensation and find better treatment options to improve the patients＇ life quality. Methods Sixty patients with hepatitis B cirrhosis in decompensation were randomly divided into group A, B and C. Patients in group A received lamivudine or adefovir dipivoxil and differential treatment, Chinese medicine enema therapy was also applied, 2 times daily, lasting for one month. Patients in group B received lamivudine or adefovir dipivoxil. Patients in group C received Compound Yiganling, Compound AminoAcid, Acid potassium magnesium aspartate and Reduced glutathione to support and protect liver function. Diuretics and infection prevention were given cautiously. To observe and compare the differences of liver function, coagulation, HBV DNA, HBV markers, Child-Pugh score, clinical outcome and drug adverse reaction. Results To compare the above indexes among the three groups. Compared with the other two groups, treatment program of group A had the best efficacy and the difference were significant. Two patients occurred HBeAg/HBeAb serological conversion in group A, but no one occurred in the other groups. Patients＇ clinical symptoms improved markedly in group A and group B with the improvement rate 100%. No drug adverse faction were observed in three groups. Conclusions The results suggest that combination therapy of antivirus treatment with traditional Chinese medicine enema is effective and safe in patients with hepatitis B cirrhosis in decompensation, which may improve liver function and the quality of life significantly, also obviously superior to separate antivirus and symptomatic liver treatment.