解毒化瘀汤联合阿德福韦酯对慢性乙型肝炎患者肝功能和纤维化的影响

Effect of detoxification and blood stasis dissipation decoction combined with adefovir dipivoxil on the liver function and fibrosis in patients with chronic hepatitis B

目的:研究解毒化瘀汤联合阿德福韦酯对慢性乙型肝炎(CHB)患者肝功能和纤维化的影响。方法:选取2016年9月至2018年9月本院CHB患者120例,依据随机数字表分为韦酯组和汤酯组,每组60例,韦酯组给予阿德福韦酯治疗,汤酯组在韦酯组基础上给予解毒化瘀汤治疗,比较2组患者T细胞亚群(CD3^+、CD4^+、CD4^+/CD8^+)水平,丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)水平,透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C)、层黏连蛋白(LN)水平,HBV-DNA转阴率、治疗疗效和不良反应发生率。结果:2组治疗后CD3^+、CD4^+、CD4^+/CD8^+水平均明显高于治疗前,且汤酯组均明显高于韦酯组,2组治疗后ALT、AST、TBIL、HA、PCⅢ、Ⅳ-C、LN水平均明显低于治疗前,且汤酯组均明显低于韦酯组,差异有统计学意义;汤酯组治疗6、12个月后HBV-DNA转阴率及治疗有效率均明显高于韦酯组,差异有统计学意义;2组不良反应发生率比较,差异无统计学意义。结论:解毒化瘀汤联合阿德福韦酯治疗可提高治疗CHB患者有效率、HBV-DNA转阴率和T细胞亚群水平,以及降低肝功能和肝纤维化指标水平的效果优于单纯阿德福韦酯治疗效果。

Objective:To discuss the effect of detoxification and blood stasis dissipation decoction combined with adefovir dipivoxil on the liver function and fibrosis in patients with chronic hepatitis B(CHB).Methods:120 CHB patients from September 2016 to September 2018 were selected,and they were divided into two groups according to the random number table:Weizhi group and Tangzhi group,60 cases in each group.The Weizhi group was treated with adefovir dipivoxil,and the Tangzhi group was treated with detoxification and blood stasis dissipation decoction.The cellular immune function[T lymphocyte subsets(CD3^+,CD4^+,CD4^+/CD8^+)],liver function[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL)],liver fibrosis[hyaluronic acid(HA),procollagen typeⅢ(PCⅢ),collagen typeⅣ(Ⅳ-c),laminin(LN)],HBV-DNA turning negative,therapeutic effect and adverse reaction were compared between the two groups.Results:The CD3^+,CD4^+,CD4^+/CD8^+in Weizhi group and Tangzhi group after treatment were significantly higher than those before treatment,the T lymphocyte subsets in Tangzhi group after treatment were significantly higher than those in Weizhi group.The ALT,AST,TBIL,HA,PCⅢ,Ⅳ-C,LN in Weizhi group and Tangzhi group after treatment were significantly lower than those before treatment,the liver function and fibrosis indicators in Tangzhi group after treatment were significantly lower than those in Weizhi group,and the difference was statistically significant.The negative rate after 6 and 12 months of treatment and effective rate of HBV-DNA in Tang Zhi group were significantly higher than those in Wei Zhi group,and the difference was statistically significant.There was no significant difference in the incidence of adverse reactions between Wei Zhi group and Tang Zhi group.Conclusion:The detoxification and blood stasis dissipation decoction combined with adefovir dipivoxil can improve the effective rate of CHB treatment,negative conversion rate of HBV-DNA and the level of T cell subsets,and reduce liver function and fibrosis indicators,which is better than adefovir dipivoxil alone.