苦参素对慢性乙型肝炎抗病毒治疗的增效作用

Synergy effect of oxymatrine on antiviral treatment of chronic hepatitis B

目的探讨苦参素对慢性乙型肝炎(CHB)患者抗乙型肝炎病毒(HBV)治疗的增效作用,以期为CHB的后续治疗提供经验和参考。方法选取2015年8月-2018年1月浙江大学医学院附属第一医院传染科住院及门诊治疗的CHB患者,共计200例,随机分为研究组与对照组各100例。对照组口服恩替卡韦片抗HBV治疗,研究组在对照组基础上配合苦参素联合治疗,均连续治疗48周。评估应答状况与安全性,比较两组患者治疗前后肝纤维化、免疫功能、肝功能指标水平及血清HBV-DNA拷贝数变化。结果研究组应答率达92.00%,较对照组提高(P<0.05);与治疗前比较,两组治疗后血清透明质酸酶(HA)、层粘连蛋白(LN)、Ⅳ型胶原(ⅣC)、Ⅲ型前胶原(PCⅢ)四项肝纤维化指标水平及总胆红素(TBiL)、谷草转氨酶(AST)、谷丙转氨酶(ALT)三项肝功能指标水平和HBV-DNA拷贝数均降低(P<0.05),研究组低于对照组(P<0.05);CD3+、CD4+、CD4+/CD8+免疫功能指标水平均升高(P<0.05),研究组高于对照组(P<0.05)。结论苦参素可有效增加CHB患者抗HBV治疗效果,可减轻肝纤维化程度,降低血清HBV-DNA水平,改善免疫功能和肝功能。

OBJECTIVE To explore the synergy effect of oxymatrine on anti-hepatitis B virus(HBV)treatment of the patients with chronic hepatis B(CHB)so as to provide guidance for the follow-up treatment of CHB.METHODS A total of 200 patients with CHB who were hospitalized in the infectious diseases control department and treated in outpatient department of the First Affiliated Hospital,Zhejiang University from Aug 2015 to Jan 2018 were enrolled in the study and randomly divided into the study group and the control group,with 100 cases in each group.The control group was given oral administration of entecavir tablets for anti-HBV treatment,while the study group was given additional oxymatrine on basis of the treatment of the control group,and both groups were treated for 48 consecutive weeks.The response status and safety were evaluated,and the levels of liver fibrosis indexes,immune function indexes and liver function indexes as well as serum HBV-DNA copies were observed and compared between the two groups of patients before and after the treatment.RESULTS The response rate of the study group was 92.00%,significantly higher than that of the control group(P<0.05).The levels of four liver fibrosis indexes,including serum hyaluronidase(HA),laminin(LN),type IV collagen(IVC)and type III procollagen(PCIII),three liver function indexes,including total bilirubin(TBiL),aspartate aminotransferase(AST)and alanine aminotransferase(ALT),and HBV-DNA copies of the two groups of patients were significantly lower after the treatment than before the treatment(P<0.05),while the levels of the above indexes of the study group were significantly lower than those of the control group(P<0.05).The levels of immune function indexes CD3+,CD4+and CD4+/CD8+of the two groups of patients were significantly higher after the treatment than before the treatment,while the levels of the above indexes of the study group were significantly higher than those of the control group(P<0.05).CONCLUSION Oxymatrine may have synergy effect on antiviral treatment of the patients with CHB,it can alleviate the liver fibrosis,reduce the serum HBV-DNA level and improve the immune function as well as the liver function.