代偿期乙型肝炎肝硬化恩替卡韦联合中药治疗临床观察

Clinical observation of entecavir combined with herbal medicine in the treatment of compensatory hepatitis B cirrhosis

目的慢性乙型肝炎长期发展可出现肝纤维化和肝硬化,常规核苷酸类药物可有效抑制肝脏炎性反应,延缓肝纤维化进展,但单纯抗病毒治疗无法解决肝纤维化和肝硬化问题,本研究探讨恩替卡韦联合中药治疗代偿期乙型肝炎肝硬化对血清肝纤维化指标和细胞因子水平的影响。方法选取2015-08-01-2016-07-03鞍山市传染病医院收治的乙型肝炎肝硬化患者作为研究对象。根据治疗方式的不同分为对照组和观察组,按1∶1配比后,共纳入82例,每组41例。对照组予以恩替卡韦治疗,研究组在此基础上接受中药联合治疗,两组均接受为期1年的治疗,对比两组肝功能指标、血清肝纤维化指标、血清细胞因子和内毒素水平。结果治疗后,研究组血清肝纤维化指标优于对照组,研究组层粘连蛋白水平为(117.7±30.1)ng/mL,低于对照组的(161.1±52.5)ng/mL,t=4.965,P=0.001;研究组血清透明质酸水平为(106.7±25.3)ng/mL,低于对照组的(200.9±68.1)ng/mL,t=14.268,P<0.001;研究组Ⅲ型前胶原水平为(141.7±13.6)ng/mL,低于对照组的(247.6±59.1)ng/mL,t=12.594,P<0.001;研究组Ⅳ型胶原水平为(108.0±27.9)ng/mL,低于对照组的(164.0±32.3)ng/mL,t=18.253,P<0.001。研究组肝功能改善情况、血清细胞因子水平和内毒素水平均明显优于对照组,均P<0.05。结论恩替卡韦联合中药治疗代偿期乙型肝炎肝硬化可以有效抑制炎症反应,降低患者血清肝纤维化指标、血清细胞因子和内毒素水平,有效抑制患者肝纤维化发展,对患者肝功能起到良好保护作用。

OBJECTIVE Chronic Hepatitis B can lead to liver fibrosis and cirrhosis in the long term.Conventional nucleotide drugs can inhibit the inflammatory response of liver and delay the progress of liver fibrosis.But antiviral therapy alone cannot treat liver fibrosis and cirrhosis.This study is designed to investigate the effect of entecavir combined with herbal medicine on serum hepatic fibrosis index and cytokine levels of compensatory hepatitis B cirrhosis.METHODS The patients with hepatitis B cirrhosis admitted from August 2015 to July 2016 were selected as the subjects of study.According to the different treatment methods,the patients were divided into control group and study group.According to the ratio of1∶1,82 cases were included with 41 cases in each group.The study group was treated with herbal medicine on the basis of the control group.The two group was treated for 1 years.The liver function index,serum levels of hepatic fibrosis,serum cytokines and endotoxin levels were compared between the two groups.RESULTS After treatment,the index of serum hepatic fibrosis in the study group were better than those in the control group.LN in the study group was(117.7±30.1)ng/ml,lower than those in the control group(161.1±52.5)ng/ml,t=4.965,P=0.001.The HA of study group was(106.7±25.3)ng/ml,lower than that of control group(200.9±68.1)ng/ml,t=14.268,P<0.001.The PCⅢof the study group was(141.7±13.6)ng/ml,lower than that of the control group(247.6±59.1)ng/ml,t=12.594,P<0.001.The value ofⅣ-C in the study group was(108.0±27.9)ng/ml,lower than that in the control group(164.0±32.3)ng/ml,t=18.253,P<0.001.The improvement of liver function,serum cytokine level and endotoxin level in the study group were significantly better than those in the control group,all P<0.05.CONCLUSION In the treatment of compensatory hepatitis B cirrhosis,entecavir combined with herbal medicine can effectively inhibit inflammation,decrease the serum levels of hepatic fibrosis,serum cytokines and endotoxin levels,inhibit the progress of liver fibrosis and protect liver function.