基于肝脏剪切波速评价恩替卡韦联合扶正化瘀胶囊治疗慢性乙型肝炎肝纤维化疗效的研究

Evaluation of Clinical Study of Entecavir Combined with Fuzheng Huayu Capsules for Liver Fibrosis Induced by Chronic Hepatitis B Based on Liver Shear Wave Velocity

目的:探究应用肝脏剪切波速评价恩替卡韦(ETV)联合扶正化瘀胶囊治疗慢性乙型肝炎(CHB)肝纤维化的临床疗效。方法:选取CHB肝纤维化伴肝硬化患者214例,其中符合抗病毒治疗指征的186例,根据不同治疗方法分为试验组116例和对照组70例;其余未达抗病毒治疗指征28例设为未干预组作对照研究。对照组给予马来酸恩替卡韦片治疗,试验组在对照组基础给予扶正化瘀胶囊治疗。比较治疗前后行肝脏剪切波速、肝功能指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBil)、白蛋白(Alb)]及HBV-DNA转阴率。结果:治疗后,2组ALT、AST水平较治疗前降低,差异均有统计学意义(P<0.05);2组TBil、Alb水平治疗前后比较差异无统计学意义(P>0.05)。治疗后,2组ALT、AST、TBil、Alb水平比较,差异无统计学意义(P>0.05)。治疗期间,2组HBV-DNA转阴率随着时间延长逐渐增加,试验组转阴率总体略高于对照组,但组间差异无统计学意义(P>0.05)。治疗前,试验组及对照组剪切波速均较未干预组显著增高,差异有统计学意义(P<0.05);试验组与对照组比较,差异无统计学意义(P>0.05)。治疗后,试验组、对照组剪切波速均较治疗前下降(P<0.05),且试验组剪切波速较对照组下降更显著(P<0.05)。结论:肝脏剪切波速可以用来对CHB肝纤维化疗效进行评估,扶正化瘀胶囊联合ETV治疗可有效改善CHB肝纤维化,降低肝脏剪切波速数值。

Objective:To discuss the application of liver shear wave velocity in evaluating the clinical effect of Entecavir(ETV)combined with Fuzheng Huayu Capsules on liver fibrosis in chronic hepatitis B(CHB).Methods:A total of 214 patients with CHB liver fibrosis and hepatic sclerosis were selected,among which 186 patients who met the indicators of antivirus therapy were divided into the trial group and the control group according to different treatment methods,with 116 and 70 cases in each group respectively;the remaining 28 cases which did not meet the indicators of antivirus therapy were set as non-intervention group for control study.The control group was treated with Entecavir Tablets,and the trial group was additionally treated with Fuzheng Huayu Capsules based on the treatment of the control group.Before and after treatment,the liver shear wave velocity and indexes of liver function,including alanine aminotransferase(ALT),total bilirubin(TBil)and albumin(Alb),were compared,and the HBV-DNA seroconversion rates were detected.Results:There was no significant difference being found in the comparisons of levels of TBil and Alb in the two groups before and after treatment (P>0.05). Aftertreatment,the levels of ALT,AST,TBil and Alb were compared between the two groups,there being nosignificance in the difference (P>0.05). During treatment,the HBV-DNA negative conversion rates in thetwo groups were gradually increased with the prolongation of treatment time,and the negative conversionrate in the trial group was slightly higher than that in the control group on the whole, but there was nosignificant difference being found in the comparison of negative conversion rate between the two groups(P>0.05). Before treatment, the shear wave velocity in the trial group and the control group weresignificantly increased when compared with those in the non- intervention group, the difference beingsignificant (P<0.05);there was no significant difference being found in the comparison of shear wavevelocity between the trial group and the control group (P>0.05). After treatment,the shear wave velocity inthe trial group and the control group were decreased when compared with those before treatment (P<0.05), and the decrease of shear wave velocity in the trial group was more significant than that in thecontrol group (P<0.05). Conclusion:The liver shear wave velocity can be applied to evaluate the curativeeffect on CHB liver fibrosis,and the therapy of Fuzheng Huayu Capsules combined with ETV can effectivelyimprove the CHB liver fibrosis and decrease the value of liver shear wave velocity.