中西医结合治疗对慢性乙型肝炎患者肝纤维化指标的影响

目的 观察阿德福韦酯联合安络化纤丸治疗慢性乙型肝炎（CrHB）肝纤维化的疗效.方法 选取115例CHB患者,随机分为中药组（38例）,西药组（38例）和结合组（39例）.中药组口服安络化纤丸;西药组单用阿德福韦酯（ADV）;结合组给予两种药物联合使用.检测治疗前和治疗24周后3组的血清Ⅲ型前胶原（PCⅢ）、血清透明质酸（HA）、血清层粘连蛋白（LN）和血清Ⅳ型胶原（C-Ⅳ）的含量变化.结果 疗程结束后,结合组谷丙转氨酶（ALT）、谷草转氨酶（AST）和血清总胆红素（TBil）均显著低于中药组和西药组,白蛋白（Alb）显著高于中药组和西药组（P＜0.05）;结合组患者HBV-DNA转阴率为61.54％（24/39）,与中药组和西药组比较,差异有统计学意义（P＜0 05）;3组的血清肝纤维化四项指标（PCⅢ、C-Ⅳ、LN及HA）均有不同程度地下降,与中药组和西药组比较,结合组治疗后肝纤维化四项指标显著下降（P＜0.05或P＜0.01）.结论 中西医结合治疗可促进CHB患者肝功能恢复,降低肝纤维化程度,其疗效优于单用中药或单用西药治疗.

Influence of combined treatment of traditional Chinese medicine and western medicine on indicators of hepatic fibrosis of patients with chronic hepatitis B

Objective To explore the clinical efficacy of adefovir dipivoxil （ADV） combined Anluo Huaxian Pill on patients with chronic hepatitis B （CHB） and its influence on indicators of hepatic fibrosis.Methods A total of 115 patients with CHB were selected as study objects and randomly divided into Chinese medicine group （38 cases）,western medicine group （38 cases） and combination group （39 cases）.Anluo Huaxian Pill was given to Chinese medicine group,ADV was given to western medicine group and combined treatment of the two drugs was given to combination group.Changes of type Ⅲ procollagen （PCⅢ）,hyaluronic acid （HA）,laminin （LN） and type Ⅳ collagen （C-Ⅳ） levels in serum were observed.Results Alanine aminotransferase （ALT）,glutamic oxalacetic transaminase （AST） and serum total bilirubin （TBil） in combination group after treatment were significantly lower than in Chinese medicine group and western medicine group,while albumin （Alb） in combination group was significantly higher （P 〈 0.05）.The negative conversion ratio of HBV-DNA in combination group was 61.54 % （24/39）,evidently higher than in the other two groups （P 〈 0.05）.Four indicators of hepatic fibrosis in serum were decreased in different degrees after treatment and these indicators in combination group were significantly decreased compared with the other two groups （P〈0.05 或 P〈0.01）.Conclusion Combined treatment of traditional Chinese medicine and western medicine can promote the recovery of liver function in CHB patients,decrease the degree of hepatic fibrosis and get a better clinical effect.