恩替卡韦联合香砂六君丸治疗失代偿期乙型肝炎肝硬化的疗效及机制研究

Study on curative effect and mechanism of entecavir combined with Xiangsha Liujun pills in treatment of decompensated cirrhosis of reactive type B hepatitis

目的探讨恩替卡韦联合香砂六君丸治疗失代偿期乙型肝炎肝硬化患者的临床效果及机制。方法 60例失代偿期乙型肝炎肝硬化患者随机分成治疗组和对照组各30例。对照组在对症治疗基础上应用恩替卡韦,治疗组在对症治疗基础上应用恩替卡韦联合香砂六君丸,均以12周为1个疗程,共治疗4个疗程。治疗前及治疗后检测患者肝功能指标及Child-Pugh分级、血清肝纤维化指标、凝血酶原活动度以及血清HBV DNA水平,并进行临床疗效评价。结果治疗组和对照组临床总有效率分别为93%和67%,2组比较有显著性差异(P<0.01)。治疗48周后2组肝功能指标(ALT、AST、ALB和TBil)、Child-Pugh分级、血清肝纤维化指标(Ⅲ型前胶原、Ⅳ型胶原、层黏连蛋白和透明质酸)和凝血酶原活动度比较均有显著性差异(P均<0.01),但是2组HBV DNA水平和HBV DNA转阴率比较均无显著性差异(P均>0.05)。结论恩替卡韦联合香砂六君丸对失代偿期肝硬化患者具有显著的临床治疗效果,其作用机制与改善肝脏功、抑制肝脏纤维化、改善凝血酶原活动度有关。

Objective It is to observe the clinical effect and mechanism of entecavir combined with Xiangsha Liujun pills in treatment of decompensated cirrhosis of reactive type B hepatitis.Methods Sixty patients with decompensated cirrhosis of type B hepatitis were randomly divided into treatment group and control group,there was 30 cases in each group.Control group was treated by entecavir based on symptomatic treatment.Treatment group was treated by entecavir combined with Xiangsha Liujun pill based on symptomatic treatment.Twelve weeks was one course of treatment and they were treated for four courses.Before and after treatment,the liver function index,Child-Pugh classification,serum liver fiber index,prothrombin activity,and serum HBV DNA level were detected,and the clinical curative effect was evaluated.Results The total clinical effective rate of treatment group and control group was 93% and 67% respectively,there was significant difference（P0.01）.After 48 weeks of treatment,there were significant differences between both groups in liver function index（ALT,AST,ALB and TBil）,Child-Pugh classification,serum liver fiber index（Ⅲ type collagen,Ⅳ before collagen type,layer ankylosis protein and hyaluronic acid） and blood coagulation enzyme activity（P0.01）,but there was no significant difference in level and negative conversion rate of HBV DNA between both groups（P0.05）.Conclusion The treatment of entacavir combined with Xiangsha Liujun pill to decompensated cirrhosis of reactive type B hepatitis has significant clinical effect,its mechanism may be relevant to improve liver function,inhibit the liver fibrosis,and improve prothrombin activity.