病证结合治疗慢性乙型肝炎肝纤维化的疗效观察

Clinical study on integrative therapy of disease and syndrome for liver fibrosis due to chronic hepatitis B

目的:探讨病证结合治疗慢性乙型肝炎(CHB)肝纤维化的临床疗效。方法:采用前瞻性队列研究方法,将69例患者分为病证结合组48例,西药治疗组21例。两组患者均予阿德福韦酯,病证结合组在此基础上进行辨证论治。在治疗24周时观察患者中医症状、肝功能、HBV DNA水平、血清肝纤维化指标(HA、PC-Ⅲ、Ⅳ-C、LN)的变化情况。结果:病证结合组患者的乏力、纳差症状改善明显优于西药治疗组(P<0.05);病证结合组在降低AST及升高Alb方面与治疗前相比,差异有显著性意义(P<0.05);病证结合组较西药治疗组更好地降低HBVDNA水平(P<0.05),且HBV DNA阴转率提高了20%;病证结合组患者在降低LN水平方面与西药治疗组比较,差异有统计学意义(P<0.05);病证结合组总体效率较西药治疗组提高了23.5%,差异有显著性意义(P<0.05)。结论:病证结合治疗能够较好缓解CHB患者临床症状,有效改善肝脏功能,提高抗病毒疗效,明显降低血清肝纤维化指标,提高抗肝纤维化总体效率。

Objective：To investigate the clinical effect of the integration of disease and syndrome therapy of liver fibrosis in chronic hepatitis B.Methods：Sixty-nine patients with chronic hepatitis B were separated into integration of disease and syndrome therapy group（n=48） and western medicine therapy group（n=21） with prospective cohort study.The patients in both group were received the anti-viral treatment with adefovir dipivoxil（ADV）,and the integration of disease and syndrome therapy group was also treated with syndrome differentiation of TCM for 24 weeks.The parameters including the TCM symptoms,liver function,HBV DNA as well as marks of liver fibrosis,such as hyaluronic acid（HA）,precollagenⅢ（PCⅢ）,type IV collagen（Ⅳ-C）,and laminin（LN）.Results： The patients′symptoms of anorexia and hypodynamia were remarkablely improved in integration of disease and syndrome therapy group（P〈0.05）.For the combination therapy group,reduced serum level of AST and elevated Alb were statistically significant（P〈0.05） compared with before treatment.Integration of disease and syndrome therapy group could better than western medicine therapy group to lower the level of HBV DNA（P〈0.05）,and HBV DNA negative conversion rate increased by 20%.The combination therapy group reduced LN compared with western medicine therapy group,and the difference was statistically significant（P〈0.05）.Integration of disease and syndrome therapy group could enhance the overall efficiency of 23.5% in anti-fibrosis than the western medicine therapy group,the difference was statistically significant（P〈0.05）.Conclusion：Integration of disease and syndrome therapy can alleviate clinical symptoms of patients with CHB,improve liver function and the anti-viral efficacy,reduce marks of the serum fibrosis indexes,and improve the overall efficiency of the anti-fibrosis.