调肝化纤丸对乙型肝炎肝纤维化的防治临床疗效及对弥散加权成像的影响

Efficacy of Tiaogan Huaxian Pills in Prevention and Treatment of Hepatic Fibrosis in Hepatitis B and Its Effect on Diffusion-weighted Imaging

目的:探讨调肝化纤丸联合恩替卡韦对肝郁脾虚兼血瘀证型慢性乙型肝炎肝纤维化的防治疗效及对弥散加权成像(DWI)的影响。方法:回顾性分析2021年1月至2022年4月广西中医药大学第一附属医院肝病科门诊117例患者的临床数据资料,根据不同治疗方案分为对照组(59例)和观察组(58例)。2组患者均采用恩替卡韦基础病因治疗,观察组在基础治疗上加用中药调肝化纤丸,均治疗24周。治疗前后记录两组患者丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBil)、乙型肝炎病毒(HBV)-DNA阴转率、肝脏硬度值(LSM)、肝纤四项(透明质酸酶、Ⅲ型前胶原、Ⅳ型胶原、层粘连蛋白)、基于4因子的肝纤维化指数(FIB-4)、AST和血小板比率指数(APRI)、磁共振成像(MRI)中表观弥散系数值(ADC)及中医症状积分情况,比较两组患者用药效果。结果:治疗前两组患者ALT、AST、TBil、LSM、肝纤四项、FIB-4指数、APRI指数、HBVDNA阴转率、ADC值及中医症状积分比较差异无统计学意义。与本组治疗前比较,治疗后两组患者ALT、AST、TBil、LSM、透明质酸酶、Ⅲ型前胶原、Ⅳ型胶原、层粘连蛋白、FIB-4指数、APRI指数均明显降低(P<0.05),ADC值明显升高(P<0.05),HBVDNA阴转率显著升高(P<0.01),观察组患者中医症状积分明显下降(P<0.05)。与对照组治疗后比较,观察组患者中医临床有效率为91.38%(53/58),明显优于对照组的54.23%(32/59)(Z=−4.325,P<0.01)。观察组患者ALT、AST、TBil、LSM、透明质酸酶、Ⅲ型前胶原、Ⅳ型胶原、层粘连蛋白、FIB-4指数、APRI指数、中医症状积分均明显下降(P<0.05),ADC值升高更明显(P<0.05),HBV-DNA阴转率差异无统计学意义。两组患者均未出现严重不良反应或不良事件。结论:调肝化纤丸联合恩替卡韦治疗慢性乙型肝炎肝纤维化临床疗效显著,可减轻肝脏炎症活动并延缓肝纤维化进展,降低中医症状积分,值得临床推广应用。

Objective:To investigate the preventive and therapeutic effects of Tiaogan Huaxian pills combined with entecavir on hepatic fibrosis in chronic hepatitis B with liver Qi stagnation,spleen deficiency,and blood stasis syndrome and its effect on diffusion-weighted imaging(DWI).Method:Clinical data of 117 patients with liver disease who visited the Department of Hepatology at the First Affiliated Hospital of Guangxi University of Chinese Medicine from January 2021 to April 2022 were retrospectively analyzed.According to different treatment plans,they were divided into a control group(59 cases)and a treatment group(58 cases).Both groups of patients received entecavir-based etiology treatment,and the treatment group added Tiaogan Huaxian pills on the basis of basic treatment.Both groups were treated for 24 weeks.Before and after treatment,the two groups were compared in terms of alanine aminotransferase(ALT),advanced surgical technologies(AST),total bilirubin(TBil),hepatitis B virus(HBV)-DNA conversion rate,liver stiffness measurement(LSM),four items of liver fibrosis(hyaluronidase,typeⅢpro-collagen,typeⅣcollagen,and laminin),the fibrosis index based on four factors(FIB-4),the aspartate aminotransferase to platelet ratio index(APRI),the apparent diffusion coefficient(ADC)value in magnetic resonance imaging(MRI),and traditional Chinese medicine symptom scores,so as to analyze the efficacy of the two groups.Result:Before treatment,there was no significant difference in ALT,AST,TBil,LSM,four items of liver fibrosis,FIB-4,APRI,HBVDNA conversion rate,ADC value,and traditional Chinese medicine symptom scores between the two groups.After treatment,both groups of patients showed significant reductions in ALT,AST,TBil,LSM,hyaluronidase,typeⅢpro-collagen,typeⅣcollagen,laminin,FIB-4,and APRI(P<0.05)and a significant increase in ADC value(P<0.05)and HBV-DNA conversion rate(P<0.01).The traditional Chinese medicine symptom score of the treatment group decreased significantly(P<0.05).Compared with the control group after treatment,the effective rate of clinical traditional Chinese medicine in the treatment group was 91.38%(53/58),which was significantly higher than that of the control group(54.23%,32/59)(Z=−4.325,P<0.01).In the treatment group,ALT,AST,TBil,LSM,hyaluronidase,typeⅢpro-collagen,typeⅣcollagen,laminin,FIB-4,APRI,and traditional Chinese medicine symptom scores all decreased significantly(P<0.05),and the increase in ADC values was more significant(P<0.05),while the difference in HBV-DNA conversion rate was not statistically significant.There were no serious adverse reactions or events in either group.Conclusion:Tiaogan Huaxian pills combined with entecavir have significant clinical efficacy in the treatment of hepatic fibrosis in chronic hepatitis B,which can reduce liver inflammation activity,delay hepatic fibrosis progression,and reduce traditional Chinese medicine symptom scores.It is worthy of clinical promotion and application.