基于“伏邪”说的肝复安治疗慢性乙型病毒性肝炎患者铁代谢异常临床观察

Clinical observation of the effects of “Ganfuan Decoction” on the iron metabolism dysregulation in chronic viral hepatitis B patients based on Fuxie theory

目的观察基于"伏邪"说的肝复安治疗慢性乙型病毒性肝炎(简称慢乙肝)患者铁代谢异常的临床疗效。方法将102例铁代谢异常相关性肝病(慢乙肝及肝硬化)患者分为治疗组(48例)与对照组(54例)。治疗组予中药"肝复安"辨证治疗,对照组予西医常规药物(抗病毒、保肝药)治疗。两组疗程均为36个月,观察肝脏铁质沉积疗效,比较血清铁代谢指标、肝功能、病毒及相关免疫指标等的变化情况。结果 1组间肝脏铁沉积疗效比较,第24个月、第36个月差异均有统计学意义,治疗组优于对照组(P<0.05)。2组间治疗后比较,血清铁(SI)、血清铁蛋白(SF)浓度及异常率差异有统计学意义,治疗组较对照组降低程度更显著、指标异常率更低(P<0.05)。组间治疗后比较,转铁蛋白(TRF)浓度及异常率差异有统计学意义,治疗组较对照组升高程度更显著、指标异常率更低(P<0.05)。3组间治疗后比较,治疗组丙氨酸氨基转移酶(ALT)水平较对照组降低更为明显,差异有统计学意义(P<0.05);乙肝表面抗原(HBs Ag)浓度差异有统计学意义,治疗组较对照组降低程度更显著(P<0.05);CD3^+水平及异常率差异有统计学意义,治疗组较对照组升高程度更显著、指标异常率更低(P<0.05);CD4^+/CD8^+异常率差异有统计学意义(P<0.05)。结论基于"伏邪"说的肝复安治疗慢乙肝患者铁代谢异常,能有效纠正铁代谢异常,恢复免疫功能,抑制病毒复制,减轻肝脏损伤。

Objective To observe the clinical effects of the ＂Ganfuan＂ decoction on the iron metabolism dysregulation in chronic viral hepatitis B patients based on Fuxie theory. Methods 102 HBV-infected patients（ chronic hepatitis and liver cirrhosis） with abnormal iron metabolism were divided into the treatment group （ n = 48 ） treated with ＂Ganfuan＂ decoction , and control group （ n = 54 ） treated with conventional drugs （ antivirus, hepatoprotectants ）, with a course of 36 months. The degree of iron deposition on liver, serum markers of iron metabolism, liver function, HBV level, immune cell counts and abnormal ratio were measured and compared. Results ①There was significant difference in hepatic iron deposition between the treatment group and control group on the 24th and 36th month （P 〈 0.05 ）, and the treatment group was more effective. ②There were significant differences in concentration and abnormal ratio of SF, SI and TRF between the treatment and control group after 36 months （ P 〈 0.05 ）. Compared with the control group, the degree of the SI, SF reduction in the treatment group was more significant and the abnormal rate was lower. ③There were significant differences in ALT, HBsAg, CD3^＋ and abnormal ratio of CD3^＋ and CD4^＋/CD8^＋ between the treatment and control group after treatment （P 〈 0.05） ,and the treatment group was more effective. Conclusion ＂Ganfuan＂ decoction based on Fuxie theory could rennrmalize the iron metabolism dysregulation effectively, recover the immune function, depress the virus replication, and alleviate the liver injury.