中西药结合治疗妊娠合并乙型病毒性肝炎43例疗效观察

Clinical Observation on Integrated Chinese and Western Medicine in Treating Pregnancy Complicating Viral Hepatitis B in 43 Cases

目的观察中西药结合治疗妊娠合并乙型病毒性肝炎(简称乙肝)的临床疗效。方法选取妊娠合并乙肝患者43例,给予抗病毒中草药蚤休和保肝药物还原型谷胱甘肽治疗,同时联用保胎中草药白术、杜仲、川续断。分析对比治疗前后临床表现、肝功能、乙肝五项,观察治疗后的药品不良反应,孕妇、胎儿(新生儿)孕围期监测指标。结果治疗后(12个月)临床表现(发热、乏力、纳差、腹胀、便溏、肝区疼痛)消失(P<0.05);肝功能的丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)恢复正常(P<0.05);乙肝五项定量测定与治疗前对比,乙肝表面抗原(HBsAg)恢复正常,乙肝表面抗体(HBsAb)升高,乙肝e抗原(HBeAg)和乙肝e抗体(HBeAb)正常或略高,乙肝核心抗体(HBcAb)略高。治疗12个月期间未发现明显不良反应,孕妇及胎儿生理指标正常,未发现胎儿畸形、缺陷,产后出血1例、早产2例,无孕妇围生儿死亡,3例(早期妊娠)于肝功能恢复后自愿终止妊娠,余在治疗后都能顺利完成妊娠、分娩,新生儿情况良好。依据疗效判定标准,基本治愈29例(67.44%),显效8例(18.60%),好转6例(13.95%)。结论中西药结合治疗妊娠合并乙肝的临床效果良好。

Objective To observe the clinical effect of integrated Chinese and Western medicine in treating pregnancy complicating viral hepatitis B(hepatitis B). Methods 43 cases of pregnancy complicating hepatitis B were selected and given the treatment of antiviral Chinese herbal medicine Rhizoma Paridis and the liver - protecting drug reduced glutathione,at the same time combined with fetus -protecting Chinese herbal medicine Rhizoma Atractylodis,eucommia ulmoides and Dipsacus asper. The clinical manifestations,liver func-tion and five indexes of hepatitis B were analyzed and compared between before and after treatment. The drug adverse reactions after treatment the periconceptional monitoring indexes of pregnant women and fetuses(newborns)were observed. Results The clinical mani-festations(fever,fatigue,anorexia,abdominal distension,loose stool and hepatalgia)after 12 - month treatment disappeared compared with before treatment( P<0.05);in the liver function,glutamic pyruvic transaminase(GPT)and total bilirubin(TBIL)recovered to normal level( P<0.05);in the quantitative detection of 5 indexes of hepatitis B after treatment,hepatitis B surface antigen(HBsAg)re-turned to normal,hepatitis B surface antibody(HBsAb)was increased,hepatitis Be antigen(HBeAg)and e antibody(HBeAb)were normal or slightly increased and hepatitis B core antibody(HBcAb)was slightly higher. No obvious adverse reactions were found during 12 - month treatment period. The physiological indexes of pregnant women and fetuses were normal. No fetal abnormalities and defects were found,postpartum bleeding occurred in 1 case and premature delivery was in 2 cases. No death of pregnant women and perinatal infants occurred,3 cases of early pregnancy voluntarily terminated the pregnancy after the recovery of the liver function,the other preg-nant women smoothly completed pregnancy and delivery after treatment,newborns was in good condition. According to the curative effect standard,29 cases (67. 44% ) were basically cured,8 cases(18. 60% ) were markedly improved and 6 cases (13. 95% ) were im-proved. Conclusion The combination of Chinese and Western medicine has better effect for treating pregnancy complicating hepatitis B.