健脾补肾益气补血法联合聚乙二醇干扰素α-2a和利巴韦林治疗慢性丙型肝炎临床观察

Clinical Study of Peginterferon α-2a and Ribavirin in Combination with Therapy of Strengthening Spleen and Tonifying Kidney, and Replenishing Qi and Nourishing Blood for Treatment of Chronic Hepatitis C

【目的】观察健脾补肾、益气补血法联合聚乙二醇干扰素α-2a和利巴韦林治疗慢性丙型病毒性肝炎的临床疗效。【方法】将62例慢性丙型病毒性肝炎患者随机分为治疗组32例与对照组30例。对照组给予西医标准化治疗方案治疗,即皮下注射聚乙二醇干扰素α-2a及口服利巴韦林片,治疗组在西医标准化治疗方案基础上联合健脾补肾、益气补血方(由黄芪、熟地黄、黄精、仙鹤草、鸡血藤、甘草等中药免煎颗粒剂及花生衣煎剂组成)治疗,每日1剂,2组疗程均为48周。比较2组治疗前后中医证候积分变化情况及治疗后12周、24周、36周、48周及停药后24周丙型肝炎病毒(HCV)RNA转阴率情况。【结果】(1)治疗后,2组中医证候积分均较治疗前升高(P<0.05),但治疗组的升高幅度低于对照组(P<0.05)。(2)治疗组在治疗12周、24周、36周后及停药后24周的HCVRNA转阴率均有优于对照组的趋势,但差异均无统计学意义(P>0.05);治疗组治疗48周后的HCVRNA转阴率与对照组相仿,差异无统计学意义(P>0.05)。(3)随访24周后,女性复发率有高于男性趋势,但差异无统计学意义(P>0.05)。【结论】中药健脾补肾、益气补血方联合聚乙二醇干扰素α-2a和利巴韦林治疗慢性丙型病毒性肝炎能有效改善患者临床症状,提高临床疗效,减轻西药副作用,达到增效减毒的效果,同时能降低患者停药后的复发率。

Objective To investigate the clinical effects of peginterferon ot-2a and ribavirin in combination with therapy of strengthening spleen and tonifying kidney, and replenishing Qi and nourishing blood for the treatment of patients with chronic hepatitis C. Methods Sixty-two cases of chronic hepatitis C were randomly divided into study group （32 cases） and control group （30 cases）. Both groups received subcutaneous injection of peginterferon ot-2a and oral use of ribavirin, and additionally, the study group was orally treated with the formula for strengthening spleen and tonifying kidney, and replenishing Qi and nourishing blood, which was composed of decoction-free granule of Radix Astragali, Radix Rehmanniae Preparata, Rhizoma Polygonati, Herba Agrimoniae, Caulis Spatholobi, Radix Glycyrrhizae, and the decoction of peanut-skin, one dose a day. The treatment for the two groups lasted for 48 weeks. The clinical outcomes included the scores of traditional Chinese medical syndromes before and after treatment and the rate for hepatitis C virus RNA （HCVRNA） turning negative on the 12th, 24th, 36th, 48th week after treatment and on the 24th week after suspension of medication. Results （1） In the two groups , the syndrome integrals were increased after treatment compared with those before treatment （P〈0.05）, and the increase in the study group was less than that in the control group （P〈0.05）.（2） The rate for HCVRNA turning negative on the 12th, 24th, 36th, 48th week after treatment and on the 24th week after suspension of medication in the study group showed an increasing trend as compared with those in the control group, but the differences were insignificant （P〉0.05）. On the 48th week after treatment, the negative conversion rate in the study group was similar to that in the control group （P〉0.05）. （3）After follow-up for 24 weeks, the recurrence rate of the female showed an increasing trend as compared with that of the male, but the differences were insignificant （P〉0.05）. Conclusion Therapy of strengthening spleen and tonifying kidney, and replenishing Qi and nourishing blood has a synergistic action on relieving clinical symptoms, increasing clinical efficacy, reducing the toxicity and decreasing the recurrence rate after drug suspension in the treatment of chronic hepatitis C with peginterferon α-2a and ribavirin.