富马酸替诺福韦联合扶正化瘀治疗对乙肝肝硬化患者肝纤维化程度及免疫状态的影响

Effects of Tenofovir Disoproxil Fumarate Combined with Fuzheng Huayu on Liver Fibrosis Degree and Immune Status of Patients with Hepatitis B Cirrhosis

目的:观察富马酸替诺福韦联合扶正化瘀治疗对乙肝肝硬化患者肝纤维化程度及免疫状态的影响。方法:选取2018年1月至2019年6月于我院接受治疗的150例乙肝肝硬化患者为受试对象,简单随机分组法分为观察组与对照组各75例。对照组给予富马酸替诺福韦治疗,观察组在对照组基础上联合扶正化瘀治疗。两组均以治疗24周为1个疗程,比较两组治疗前、治疗24周后的肝功能[丙氨酸转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、白蛋白(ALB)]、肝纤维化指标[透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C)]、病毒学指标[乙肝病毒基因转阴率(HBV DNA转阴率)、乙型肝炎病毒e抗原转阴率(HbeAg转阴率)]、影像学指标(门静脉直径、门静脉血流速度、脾脏厚度、脾脏长度、门脉血流量)、免疫功能(CD3+、CD4+、CD8+、CD4+/CD8+)变化,并记录两组治疗过程中的不良反应发生情况。结果:治疗前,两组ALT、AST、TBIL、ALB、HA、LN、PCⅢ、Ⅳ-C、门静脉直径、门静脉血流速度、脾脏厚度、脾脏长度、门脉血流量、CD3+、CD4+、CD8+、CD4+/CD8+水平比较无统计学意义(P均>0.05),治疗24周后,两组患者ALT、AST、TBIL、HA、LN、PCⅢ、Ⅳ-C、门脉血流量、CD8+水平较治疗前均有显著下降(P均<0.05),而ALB水平、门静脉血流速度、CD3+、CD4+及CD4+/CD8+水平较治疗前均有显著上升(P均<0.05),两组患者ALT、AST、TBIL、ALB水平治疗前后差值比较均无统计学意义(P均>0.05),观察组治疗前后HA、LN、PCⅢ、Ⅳ-C、门静脉血流速度、门脉血流量、CD3+、CD4+及CD4+/CD8+、CD8+水平差值明显高于对照组(P<0.05);治疗24周后,两组患者HBV DNA转阴率、HbeAg转阴率比较差异无统计学意义(P>0.05);观察组不良反应总发生率为6.67%,而对照组为4.00%,两组比较无统计学意义(χ^(2)=0.528,P=0.467)。结论:富马酸替诺福韦联合扶正化瘀不仅可有效改善乙肝肝硬化患者肝功能,缓解肝纤维化程度,促进门静脉血流速度的提高,且还可有利于免疫功能的改善,安全可靠,于其病情转归有利。

Objective:To observe the effects of tenofovir disoproxil fumarate combined with Fuzheng Huayu on liver fibrosis degree and immune status of patients with hepatitis B cirrhosis.Methods:A total of 150 patients with hepatitis B cirrhosis who were treated in our hospital from January 2018 to June 2019 were selected as subjects,and they were divided into observation group and control group according to the simple random grouping,with 75 cases in each group.Control group was treated with tenofovir disoproxil fumarate,and observation group was combined with Fuzheng Huayu on the basis of control group,and the two groups took 24 weeks as a course of treatment.The liver function[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),albumin(ALB)],liver fibrosis indicators[hyaluronic acid(HA),laminin(LN),type III procollagen(PC III),type IV collagen(IV-C)],virological indicators[negative conversion rate of hepatitis B virus gene(HBV DNA negative conversion rate),negative conversion rate of hepatitis B virus e antigen(HbeAg negative conversion rate)],imaging indicators(portal vein diameter,portal vein blood flow velocity,spleen thickness,spleen length,portal blood flow)and immune function(CD3+,CD4+,CD8+,CD4+/CD8+)were compared between the two groups before treatment and after 24 weeks of treatment,and the occurrence of adverse reactions during treatment were recorded in the two groups.Results:Before treatment,there were no statistically significant differences in the ALT,AST,TBIL,ALB,HA,LN,PC III,IV-C,portal vein diameter,portal vein blood flow velocity,spleen thickness,spleen length,portal blood flow,CD3+,CD4+,CD8+and CD4+/CD8+between the two groups(all P>0.05).After 24 weeks of treatment,the ALT,AST,TBIL,HA,LN,PC III,IV-C,portal blood flow and CD8+in the two groups were significantly lower than those before treatment(all P<0.05)while the ALB,portal vein blood flow velocity,CD3+,CD4+and CD4+/CD8+were significantly higher than those before treatment(all P<0.05).There were no statistically significant differences in the differences of ALT,AST,TBIL and ALB before and after treatment between the two groups(all P>0.05),and the differences of HA,LN,PC III,IV-C,portal vein blood flow velocity,portal blood flow,CD3+,CD4+,CD4+/CD8+and CD8+before and after treatment in observation group were significantly higher than those in control group(P<0.05).After 24 weeks of treatment,there were no statistically significant differences in the HBV DNA negative conversion rate and HbeAg negative conversion rate between the two groups(P>0.05).The total incidence rate of adverse reactions was 6.67%in observation group and was 4.00%in.control group(χ^(2)=0.528,P=0.467).Conclusion:Tenofovir disoproxil fumarate combined with Fuzheng Huayu can indeed effectively improve the liver function,alleviate the liver fibrosis degree,accelerate portal vein blood flow and help improve the immune function,and it is safe and reliable,and is beneficial to the disease outcomes.