菖郁逍遥方联合恩替卡韦分散片治疗慢性乙型病毒性肝炎伴抑郁症35例临床观察

Clinical Observation on 35 Cases of Chronic Hepatitis B Complicated with Depression Treated with Changyu Xiaoyao Fang( 菖郁逍遥方) Combined with Entecavir Dispersible Tablets

目的观察菖郁逍遥方联合恩替卡韦分散片治疗慢性乙型病毒性肝炎伴抑郁症的临床疗效及可能的作用机制。方法 67例慢性乙型病毒性肝炎伴抑郁症患者随机分为治疗组35例、对照组32例。在口服恩替卡韦分散片每日0.5 mg的基础上,对照组加服氟哌噻吨美利曲辛片,每日2次,每次1片;治疗组加服中药复方菖郁逍遥方,每日1剂,两组疗程均为8周。治疗前后分别观察两组患者17项汉密尔顿抑郁量表(HAMD)、慢性肝病问卷(CLDQ)积分以及血清白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平;比较两组患者抑郁状态疗效、血清丙氨酸氨基转移酶(ALT)复常率及乙型肝炎病毒DNA(HBV DNA)阴转率。结果治疗组抑郁状态疗效总有效率、ALT复常率、HBV DNA阴转率分别为80.00%、80.00%、60.00%,对照组分别为65.63%、62.50%、46.88%,治疗组均优于对照组(P<0.05)。与治疗前比较,治疗后两组患者HAMD评分、IL-6、TNF-α水平均降低,CLDQ各项得分及总积分均增加(P<0.05或P<0.01);治疗后治疗组IL-6、TNF-α水平和CLDQ各项得分及总积分改善程度较对照组更显著(P<0.05)。结论菖郁逍遥方联合恩替卡韦分散片可显著改善慢性乙型病毒性肝炎伴抑郁症患者的抑郁状态,并能增强抗病毒疗效、提高患者生活质量,其作用机制可能与抑制炎症反应相关。

Objective To observe the clinical effect and possible mechanism of Changyu Xiaoyao Fang combined with entecavir dispersible tablets in treating chronic hepatitis B accompanied with depression. Methods67 patients with chronic hepatitis B accompanied with depression were randomly divided into a treatment group of 35 cases and a control group of 32 cases. In addition to taking 0. 5 mg of entecavir dispersible tablet orally,control group was given flupentixol（ 0. 5 mg） and melitracen（ 10 mg） tablet,one tablet twice a day orally,and treatment group was given Changyu Xiaoyao Fang one dose a day orally,both for 8 weeks. The scores of Hamilton Depression Scale（ HAMD） and Chronic Liver Disease Questionnaire（ CLDQ）,as well as serum levels of interleukin 6（ IL-6） and Tumor Necrosis Factorα（ TNF-α） were detected before and after treatment. The improvement of depression,the normalization rate of serum level of alanine aminotransferase（ ALT）,and negative conversion rate of Hepatitis B Virus DNA（ HBV DNA） in patients in both groups were observed after treatment. Results After treatment,the total effective rate in depression improvement,the normalization rate of ALT,and the negative conversion rate of HBV DNA was 80. 0%,80. 00% and 60. 00%,respectively in treatment group,65. 6%,62. 50% and 46. 88%,respectively in control group. The effects of all indexes in treatment group were superior to those in control group（ P〈0. 05）. The scores of HAMD,and levels of IL-6 and TNF-αwere decreased,and the scores of every items and total score of CLDQ were increased after treatment（ P〈0. 05 or P〈0. 01）. The improvement of IL-6,TNF-αand the scores of every items and total score of CLDQ in treatment group were superior to those in control group（ P〈0. 05）.Conclusion Changyu Xiaoyao Fang combined with entecavir dispersible tablets could improve depression condition in patients with chronic hepatitis B accompanied with depression,strengthen antiviral effect,and improve quality of life. The mechanism may relate to inhibiting inflammation reaction.