恩替卡韦联合三甲益肝颗粒治疗慢性乙型肝炎抗肝纤维化的效果观察

Observation on the anti-hepatic fibrosis effect of Entecavir combining with Sanjia Yigan Granule in the treatment of chronic hepatitis B

目的 探讨恩替卡韦联合三甲益肝冲剂在慢性乙型肝炎（CHB）治疗中的保肝和抗肝纤维化作用的疗效.方法 回顾性分析新乡医学院第一附属医院2012年1月～2013年1月收治入院的CHB患者200例临床资料,根据治疗方法不同分为两组,对照组应用恩替卡韦抗病毒及护肝等治疗,观察组在对照组治疗方法的基础上,联合应用三甲益肝冲剂治疗6个月.观察治疗前后各组患者的症状、体征,治疗前后血清肝纤维化指标[透明质酸（HA）、层粘连蛋白（LN）、Ⅲ型前胶原（PⅢP）、Ⅳ型胶原（Ⅳ-C）]、肝功能指标及HBV-DNA的变化情况,观察用药过程中出现的不良反应.结果 经过6个月治疗,观察组患者疲乏感减轻（72.0％比53.0％）、食欲增加（83.0％比65.0％）、腹胀减轻（80.0％比58.0％）与对照组比较差异均有统计学意义（P＜0.05）;两组患者谷草转氨酶（AST）、白蛋白/球蛋白比例、总胆红素（TBIL）复常,谷丙转氨酶（ALT）降低,与治疗前比较,差异均有统计学意义（均P＜0.05）;观察组AST、白蛋白/球蛋白比例、TBIL复常,ALT降低,与对照组比较差异均有统计学意义（均P＜0.05）;两组患者治疗6个月后血清HA、LN、PⅢP、Ⅳ-C有较大程度改善,与治疗前比较差异均有统计学意义（均P＜ 0.05）;观察组血清HA、LN、PⅢP、Ⅳ-C有较大程度改善,与对照组比较差异均有统计学意义（均P＜ 0.05）.结论 CHB患者存在着不同程度肝纤维化,应用恩替卡韦联合三甲益肝冲剂治疗能改善肝功能,疗效好于单用恩替卡韦.

Objective To probe into the efficacy of liver protection and anti-hepatic fibrosis of Entecavir combining with Sanjia Yigan Granule in the treatment of chronic hepatitis B （CHB）.Methods Clinical data from 200 CHB patients admitted to the First Affiliated Hospital of Xinxiang Medical University from January 2012 to January 2013 were retrospectively analyzed.According to different therapeutic methods,they were divided into two groups.In control group,patients were treated by Entecavir for anti-virus and liver protection.In observation group,on the basis of the control group,Sanjia Yigan Granule was added for 6 months.The symptoms and signs,indicators of hepatic fibrosis from serum containing hyaluronic acid （HA）,laminin （LN）,procollagen in type Ⅲ （PⅢP）,and collagen in type Ⅳ （Ⅳ-C）,liver function,variations of HBV-DNA,and adverse reactions in medication were observed.Results After 6-month treatment,fatigue reduction,appetite increase,and alleviation of abdominal distension in the observation group and control group were 72.0% vs 53.0%,83.0% vs 65.0%,and 80.0% vs 58.0% respectively,which showed statistical differences in both groups （P 〈 0.05）.The AST,ration of albumin and globulin,total bilirubin being back to normal,and ALT reduction in both groups after treatment all displayed significant differences compared with those before treatment （P 〈 0.05）.In addition,the four indicators mentioned above in the observation group were statistically different with those in the control group （P 〈 0.05）.The HA,LN,PⅢp,and Ⅳ-C in both groups were improved greatly in the two groups after treatment,which displayed significant differences in comparison with prior treatment （P 〈 0.05）.Meanwhile,the HA,LN,P Ⅲ P,and Ⅳ-C all had statistical differences compared with those in the control group （P 〈 0.05）.Conclusion With hepatic fibrosis at different degrees in CHB patients,combination of Entecavir and Sanjia Yigan Granule can improve liver function and the efficacy is better than Entecavir alone.