中医辨证联合抗病毒治疗对乙型肝炎肝硬化失代偿发生率的影响

The Impact of the TCM Syndrome Differentiation Treatment Combined with Antiviral Treatment on the Incidence of HBV Related Decompensated Liver Cirrhosis

目的研究中医辨证论治联合抗病毒治疗乙型肝炎肝硬化代偿期患者的失代偿累积发病率,并探究失代偿发生的相关影响因素。方法采用回顾性队列研究,收集4个分中心共计453例乙型肝炎肝硬化代偿期患者,根据是否接受中医辨证论治治疗,分为中西医结合队列(中医辨证论治联合抗病毒治疗组)和西医队列(单纯抗病毒治疗组)(226例vs 227例)。观察两队列间肝硬化失代偿的累积发病率,并探究其发生的相关影响因素。结果治疗第3、5年,中西医结合队列和西医队列的乙型肝炎肝硬化失代偿的累积发病率分别为4.42%vs 18.5%和5.31%vs 21.59%,差别均有统计学意义(P<0.05)。辨证论治联合抗病毒治疗方案可以减少肝硬化失代偿的发生率7.63%以上。两队列腹水和食管胃底静脉曲张破裂出血的发生率分别为4.87%vs 17.62%和0.44%vs 5.29%,差别均有统计学意义(P<0.05)。发生乙型肝炎肝硬化失代偿的相关影响因素可能有:年龄大于50岁(OR=2.744,95%CI=1.521-4.950)、有过敏史(OR=2.148,95%CI=1.016-4.543)、家族史(OR=1.833,95%CI=1.108-3.035)、基线HBs Ag数值大于1000(OR=2.294,95%CI=1.307-4.027)、发生影像学改善(OR=0.077,95%CI=0.011-0.557)等。结论乙型肝炎肝硬化代偿期患者接受中医辩证论治联合抗病毒治疗,可以一定程度上减少肝硬化失代偿的累积发病率。发生影像学改善可能是肝硬化代偿期患者的保护因素,年龄大于50岁、有过敏史、家族史、基线HBs Ag数值大于1000可能是发生肝硬化失代偿的危险因素。

Objective To observe the clinical efficacy of the TCM syndrome differentiation treatment combined with antiviral treatment in HBV related compensated liver cirrhosis patients. Explore the related causative factors of the happening of decompensated liver cirrhosis. Methods In accordance with the method of retrospective cohort study, a total of 453 patients of compensated liver cirrhosis are divided into integrated Chinese and Western medicine cohort （TCM therapy and antiviral therapy） and Western medicine cohort（single antiviral treatment）（226 cases vs 227 cases） according to whether or not to accept the treatment of TCM. Observe and explore the accumulation incidence rates and the related causative factors of the happening of decompensated liver cirrhosis. Results In the third and fifth year , the accumulation incidence rates of decompensated liver cirrhosis of the integrated Chinese and western medicine cohort and the western medicine cohort are 4. 42% and 18.5%, 5.31% and 21.59% respectively, the differences have statistical significance （P〈0.05）. The TCM syndrome differentiation treatment combined with antiviral treatment can reduce the incidence rate of decompensated liver cirrhosis by more than 7.63%. The incidence rates of ascites and esophagogastric variceal bleeding （EGVB） of the two cohorts are 4.42%and 18.5%, 5.31% and 21.59% respectively, the differences have statistical significance （P〈0.05）. The related influence factors of decompensated cirrhosis happening might be older than 50 years （OR=2.744, 95%CI=1.521-4.950）, and having history of al ergies （OR=2.148, 95%CI=1.016-4.543）, family （OR=1.833, 95%CI=1.108-3.035）, baseline HBsAg values higher than 1000 （OR=2.294, 95%CI=1.307-4.027） and imaging improvement （OR=0.077, 95%CI=0.011-0.557）, etc. Conclusion The TCM syndrome differentiation treatment combined with antiviral treatment has good clinical effect , can reduce the cumulative incidence of decompensated liver cirrhosis to a certain extent. Imaging improvement may be the protection factor of HBV related compensated liver cirrhosis patients. Older than 50 years , and has al ergies , family history and baseline HBsAg values higher than 1000 may be the risk factors of the liver decompensation cirrhosis.