中药汤剂治疗湿热蕴结型慢性乙型肝炎合并代谢相关脂肪性肝病患者的临床评价

Clinical evaluation of traditional Chinese medicine decoction in the treatment of damp and heat accumulation type chronic hepatitis B with metabolism-related fatty liver disease

目的:评价中药汤剂治疗湿热蕴结型慢性乙型肝炎(CHB)合并代谢相关脂肪性肝病(MAFLD)患者的临床疗效及安全性。方法:按照随机数字表法将2020年1月至12月我院收治的140例湿热蕴结型CHB合并MAFLD患者分为对照组与观察组,每组70例。对照组患者口服替诺福韦片及多烯磷脂酰胆碱胶囊,观察组患者在对照组的治疗基础上口服中药汤剂,疗程均为3个月。比较两组患者的治疗效果、肝功能[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)]、HBV DNA载量水平、腹部B超分级、代谢相关指标[三酰甘油(TG)、总胆固醇(TC)、空腹血糖(FBG)、胰岛素抵抗指数(HOMA-IR)]及不良反应。结果:观察组患者的总有效率为96.71%(67/70),明显高于对照组84.29%(59/70)(P<0.05);治疗第1、3个月时,两组患者的ALT、AST、HBV DNA、TC、TG及HOMA-IR水平均较治疗前明显降低(P<0.05);观察组患者的ALT、AST、TC、TG及HOMA-IR水平均明显低于对照组(P<0.05);治疗后3个月,观察组患者的HBV DNA水平均明显低于对照组(P<0.05);治疗后3个月,两组患者的腹部B超分级均较治疗前明显改善(P<0.05);观察组患者的腹部B超分级明显优于对照组(P<0.05);两组患者不良反应发生率的比较差异无统计学意义(P>0.05)。结论:中药汤剂联合西药治疗湿热蕴结型CHB合并MAFLD患者安全有效,能显著改善患者的肝功能、脂质代谢紊乱及胰岛功能。

Objective:To evaluate the efficacy and safety of traditional Chinese medicine(TCM)decoction in the treatment of damp and heat accumulation type chronic hepatitis B(CHB)complicated with metabolism-related fatty liver disease(MAFLD).Methods:According to the random number table method,one hundred and forty patients with CHB combined MAFLD who were divided into the control group and the observation group in our hospital from January to December 2019,with 70 patients in each group.Patients were given tenofovir tablets,polyene phosphatidylcholine capsules,and polyene phosphatidylcholine capsules in the control group.And patients were given TCM decoction on the basis of the control group in the observation group,all the patients were treated for three months.The treatment effect,liver function indexes[alanine aminotransferase(ALT),aspartate transaminase(AST),hepatitis B virus-DNA(HBV DNA)],abdominal B-ultrasound grading,metabolism-related indicators[triglyceride(TG),total cholesterol(TC),fasting blood glucose(FBG),homeostasis model assessment of insulin resistance(HOMA-IR)]and adverse reactions were compared between two groups.Results:The total effective rate in the observation group[96.71%(67/70)]was significantly higher than that of the control group[84.29%(59/70)](P<0.05).At the first and third month after treatment,the levels of ALT,AST,HBV DNA,TC,TG,and HOMA-IR in both groups were significantly lower than those before treatment(P<0.05),and the levels of ALT,AST,TC,TG and HOMA-IR in the observation group were significantly lower than those in the control group(P<0.05).At the third month after treatment,the levels of HBV DNA in the observation group were significantly lower than those in the control group(P<0.05).At the third month after treatment,the abdominal B-ultrasound grading in both groups was significantly better than those before treatment(P<0.05),and the abdominal B-ultrasound grading in the observation group was significantly better than those in the control group(P<0.05).Conclusion:TCM decoction was safe and effective in the treatment of damp and heat accumulation type CHB with MAFLD,and it could significantly improve the liver function,lipid metabolism disorder,and pancreas islet function of patients.