正肝化瘀方联合恩替卡韦治疗乙肝肝纤维化疗效及对IL-6、TNF-α的影响

Effect of Zhenggan Huayu Decoction(正肝化瘀方) Combined with Entecavir on Hepatitis B Fibrosis and Its Effect on IL-6 and TNF-α

目的 评价在口服恩替卡韦的基础上采用正肝化瘀方辅助治疗乙肝肝纤维化的疗效及对白细胞介素6(IL-6)、肿瘤坏死因子(TNF-α)的影响。方法 以2019年11月—2020年11月医院收治的乙肝肝纤维化患者112例为研究对象,依据随机对照法将患者分为研究组和参照组,每组56例。参照组患者口服恩替卡韦0.5 mg/次,1次/d。研究组采用正肝化瘀方联合恩替卡韦,恩替卡韦治疗方式同参照组,正肝化瘀方1剂/d,水煎后分早晚2次服用。两组连续治疗12周。比较两组治疗前后相关症状的改善情况,肝纤维化指标HA、LN、PⅢNP、COLIV和血清IL-6、TNF-α水平,比较治疗总有效率。结果 研究组治疗疗效优于参照组(P<0.05);两组治疗后两肋疼痛、神疲乏力、食欲不振、口干口苦、蜘蛛痣肝掌等中医证候积分较治疗前降低,研究组治疗后两肋疼痛、神疲乏力、食欲不振、口干口苦、蜘蛛痣肝掌等中医证候积分均低于参照组(P<0.05);两组治疗后肝纤维化指标HA、LN、PⅢNP和COLIV水平均较治疗前降低,研究组治疗后肝纤维化指标HA、LN、PⅢNP和COLIV水平均低于参照组(P<0.05);研究组治疗后血清IL-6、TNF-α水平低于参照组(P<0.05)。结论 在口服恩替卡韦的基础上采用正肝化瘀方辅助治疗可显著降低乙肝肝纤维化患者的中医证候积分,改善临床症状,降低炎症损伤程度,降低血清肝纤维化指标水平,提高治疗疗效。

Objective To evaluate the efficacy of Zhenggan Huayu Decoction(正肝化瘀方) combined with entecavir in the treatment of hepatitis B fibrosis and its effects on interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α).Methods A total of 112 patients with hepatitis B fibrosis admitted to the hospital from November 2019 to November 2020 were selected as the research subjects.According to the randomized control method,the patients were divided into study group and control group,with 56 cases in each group.Control group was treated with entecavir orally,0.5 mg/time,once a day.The study group was treated with Zhenggan Huayu Decoction combined with entecavir.The dose of entecavir was the same as that of the control group.Zhenggan Huayu Decoction was taken once a day,and then taken twice in the morning and evening.Two groups were treated continuously for 12 weeks.The scores of TCM symptoms were compared between the two groups before and after treatment.The total effective rate,liver fibrosis indexes[hyaluronic acid(HA),laminin(LN),type III procollagen peptide(PⅢNP),collage typeⅣ(COLⅣ)] and serum IL-6 and TNF-α levels were compared between the two groups before and after treatment.Results The therapeutic effect of the study group was better than that of the control group(P<0.05).After treatment,the scores of costal pain,fatigue,anorexia,dry mouth bitter,spider nevus liver and palm syndrome of TCM in the two groups were lower than those before treatment(P<0.05).Those of the study group were lower than those of the control group.The levels of liver fibrosis indexes(HA,LN,P Ⅲ NP and COLⅣ) were reduced after treatment in two groups and those of the study group were lower than those of the control group(P<0.05).The levels of IL-6 and TNF-α in serum in the study group were lower than those of the control group(P<0.05).Coclusions:Zhenggan Huayu Decoction combined with entecavir can significantly reduce the TCM symptom scores of patients with hepatitis B liver fibrosis,relieve the clinical symptoms,reduce the degree of inflammation injury and the levels of serum liver fibrosis indicators,and improve the therapeutic effect.