软肝化纤汤联合恩替卡韦治疗肝郁脾虚/瘀血阻络型慢性乙型肝炎肝纤维化临床疗效观察

Clinical observation of Ruangan Huaxian decoction combined with entecavir on hepatic fibrosis in patients with chronic hepatitis B of liver stagnation and spleen deficiency/extravasated blood stasis type

[目的]研究软肝化纤汤联合恩替卡韦治疗肝郁脾虚/瘀血阻络型慢性乙型肝炎(CHB)肝纤维化临床疗效。[方法]选取2014年7月~2016年10月我院门诊与住院治疗的108例肝纤维化患者。按照随机的方式将患者分成观察组与对照组(每组54例),对照组患者采用恩替卡韦治疗,观察组患者采用软肝化纤汤联合恩替卡韦治疗,疗程6个月。观察2组患者治疗前后中医症候积分、肝功能指标、APRI、血清肝纤维化指标、乙肝病毒定量、肝脾彩超改善程度。[结果]观察组患者的总有效率显著高于对照组的总有效率(90.74%vs.74.07%)(P<0.05)。治疗后观察组患者HBV-DNA转阴率为88.89%,对照组为87.04%,2组比较差异无统计学意义。治疗后观察组患者TBiL、ALT和AST检测结果为(18.64±9.34)μmol/L、(35.62±12.34)U/L、(35.14±24.17)U/L,显著低于对照组(P<0.05)。治疗后观察组患者HA、LN、Ⅳ-C、PCⅢ值为(91.35±31.29)mg/L、(105.24±52.34)μg/ml、(47.26±25.48)μg/L、(86.29±25.67)μg/L,显著低于对照组(P<0.05)。治疗后观察组患者门静脉内径、脾静脉内径、脾脏厚度为(10.25±1.59)mm、(9.24±1.02)mm、(3.14±0.12)cm,显著低于对照组(P<0.05)。[结论]软肝化纤汤联合恩替卡韦对CHB肝纤维化患者有较好的临床疗效,值得在临床上推广使用。

[Objective]To investigate the effect of Ruangan Huaxian decoction combined with entecavir on hepatic fibrosis in patients with chronic hepatitis B of liver stagnation and spleen deficiency/extravasated blood stasis type.[Methods]108 patients with liver fibrosis in our hospital from July 2014 to October 2016 were selected and divided into observation group and control group（n=54）according to the random.The control group were treated with entecavir and the observation group treated by Ruangan Huaxian Decoction combined with entecavir with a total of 6months of treatment.Symptoms of TCM determination,liver function,serum APRI,liver fibrosis,hepatitis B viral load,liver and Spleen Ultrasound improvement were observed and compared between two groups.[Results]The total efficiency of observation group was significantly higher than that in the control group（90.74% vs.74.07%）（P〈0.05）.There were no significant difference about HBV-DNA negative rate between the observation group and the control group after treat-ment（88.89%vs.87.04%）.After treatment,TBiL,ALT and AST test results for the observation group were[（18.64±9.34）μmol/L,（35.62±12.34）U/L,（35.14±24.17）U/L],which were significantly lower than those in the control group（P〈0.05）.The levels of HA,LN,Ⅳ-C and PC Ⅲ in the observation group were[（91.35±31.29）mg/L,（105.24±52.34）μg/ml,（47.26±25.48）μg/L,（86.29±25.67）μg/L],which were significantly lower than those in the control group（P〈0.05）.The portal vein and splenic vein,thickness of spleen in the observation group were[（10.25±1.59）mm,（9.24±1.02）mm,（3.14±0.12）cm],which were significantly lower than those in the control group（P〈0.05）.[Conclusion]Ruangan Huaxian decoction combined with entecavir has good clinical curative effect of patients with liver fibrosis,which is worthy of promotion in clinical use.