中西医结合治疗慢性乙型肝炎肝纤维化60例

目的：探讨中药复方联合拉米夫定治疗慢性乙型肝炎（CHB）肝纤维化的临床疗效。方法：将160例CHB患者随机分为西药组50例，中药组50例和中西医结合组（简称结合组）60例。西药组患者口服拉米夫定，中药组采用自拟中药复方汤剂，结合组采用两种药物联合应用。在治疗3个月和6个月时分别观察病毒标志物（HB—sAg、HBeAg、HBVDNA）和非创伤性肝纤维化指标（HA、LN、PC—Ⅲ、C-Ⅳ）的变化情况。结果：治疗6个月时结合组和西药组HBeAg、HBVDNA转阴率显著高于中药组（P〈0．01），结合组的HBVDNA转阴率显著高于西药组（P〈0．05）；治疗3个月和6个月时中药组和结合组患者肝纤维化指标与治疗前比较，差异有显著性意义（P〈0．01）；与西药组患者治疗后比较，差异亦有显著性意义（P〈0．01）。结论：自拟中药复方汤剂能有效降低CHB患者肝纤维化指标，和抗病毒药物联合应用能明显提高抗病毒的疗效。     

复方鳖甲软肝片治疗慢性乙型肝炎肝纤维化疗效观察

目的:观察复方鳖甲软肝片治疗慢性乙型肝炎肝纤维化的临床疗效.方法:将135例乙型肝炎肝纤维化患者随机分成两组,对照组用常规中西药治疗如维生素和护肝类药物,治疗组在对照组用药基础上服用复方鳖甲软肝片治疗,疗程均为6个月.结果:治疗组总有效率明显优于对照组(78.57% vs 55.38%,P＜0.05);复方鳖甲软肝片能明显改善患者的肝区疼痛、腹胀、乏力、纳差等症状、体征;ALT、AST、TBil下降显著,两组间比较差异有显著性意义(P＜0.05);血清纤维化指标的改善明显,与对照组比较,其差异均有显著性意义(P＜0.05).结论:复方鳖甲软肝片治疗慢性乙型肝炎肝纤维化有较好的疗效.     

肝苏颗粒治疗慢性乙型肝炎肝纤维化的临床研究

目的：观察肝苏颗粒治疗慢性乙型肝炎肝纤维化的疗效。方法：选择慢性乙型肝炎肝纤维化患者160例,随机分为两组,对照组（78例）采用常规保肝治疗,治疗组（82例）在常规治疗的基础上加用肝苏颗粒,观察治疗后两组患者临床症状、体征、肝功能以及肝纤维化相关指标如PGA指数、肝纤3项（HA、LN、CⅣ）和肝血流动力学变化。结果：两组均能明显改善患者临床症状,但以治疗组为优（P〈0.01）;治疗组患者ALT、AST、γ-GT、TBil和肝纤3项、PGA指数均明显降低,且显著优于对照组（P〈0.01或0.05）;同时彩色多谱勒显示治疗组患者门、脾静脉内径、血流量值皆明显下降（P〈0.01）。结论：肝苏颗粒能较好地改善慢性乙型肝炎肝纤维化患者临床症状,具有降酶、退黄、促进肝功能恢复作用,且对阻断及逆转肝纤维化进程有一定疗效。     

强肝软坚丸治疗气虚血瘀型慢性乙型肝炎肝纤维化临床观察

目的：观察强肝软坚九治疗慢性乙型肝炎肝纤维化（气虚血瘀型）的临床疗效。方法：将所选病例随机分为两组，其中治疗组80例，对照组40例，治疗组患者口服强肝软坚丸。对照组患者口服大黄座虫丸，两组疗程均为3个月，同时查患者血清肝纤维化指标（HA、LN、TIMP-1、PⅢP、CⅣ）、肝功能并做肝脏彩超检测。结果：两组治疗后在疗效、症状积分、总积分、AST和GGT方面比较，差异有显著性意义（P〈0．05），HA、TIMP-1下降差异亦有显著性意义（P〈0．01），而两组患者在肝门静脉和脾厚方面比较差异无显著性意义（P〉0．05）。结论：强肝软坚丸能明显改善患者的症状、体征、肝功能及血清肝纤维化指标，疗效较对照组明显。     

补肾柔肝方治疗慢性乙型肝炎肝纤维化的临床观察

目的:观察补肾柔肝方治疗慢性乙型肝炎(CHB)肝纤维化的临床疗效。方法:CHB肝纤维化患者60例,分为治疗组30例,对照组30例,疗程均为3个月,分别于治疗前后检测两组患者的肝功能和肝纤维化4项指标,并进行比较。结果:疗程结束后两组患者ALT、AST、TBil均有不同程度下降,同时Alb升高,以治疗组明显。治疗组患者HA、PCⅢ、LN、C-Ⅳ亦明显下降,优于对照组(P<0.05)。结论:补肾柔肝方具有显著的抗肝纤维化作用。     

慢性乙型肝炎肝纤维化辨证分型与肝纤维化病理及血清学指标的相关性研究

目的:探讨慢性乙型肝炎(CHB)肝纤维化证型分布与血清肝纤维化指标及肝纤维化病理分期的相关性.方法:对确诊的171例CHB肝纤维化患者进行辨证分型,并观察肝纤维化病理分期、肝纤维化4项与辨证分型的关系.结果:肝郁脾虚型主要见于在肝纤维化早期(S1),瘀血阻络型主要见于肝纤维化中晚期(S3～S4),两者比较,各病理期的分布有显著性差异(P＜0.01);脾肾阳虚型、瘀血阻络型HA含量显著高于肝郁脾虚型,差异有显著性意义(P＜0.05或P＜0.01);瘀血阻络型HA含量高于肝肾阴虚型和湿热中阻型,差异有显著性意义(P＜0.05);瘀血阻络组LN和Ⅳ-C含量明显高于肝郁脾虚型,差异有显著性意义(P＜0.05);各证型患者血清PCⅢ含量差异无显著性意义(P＞0.05).结论:CHB肝纤维化不同病理阶段,证型分布发生相应变化,并与肝纤维化指标具有显著相关性.     

软肝健脾丸治疗慢性乙型肝炎肝纤维化的临床研究

目的：观察自制中药软肝健脾丸对慢性乙型肝炎肝纤维化的临床疗效。方法：将87例慢性乙型肝炎肝纤维化患者随机分为两组：治疗组44例,服用软肝健脾丸,对照组43例,服用安络化纤丸;治疗前后检测患者血清透明质酸（HA）、层粘蛋白（LN）、Ⅲ型前胶原（PCⅢ）、Ⅳ型胶原（Ⅳ-C）的水平,并观察主要症状、肝功能相关指标及肝脏B超声像图情况。结果：两组临床疗效比较,治疗组的显效率和总有效率分别为52.27%和88.63%;对照组分别为25.58%和67.44%,差异均有显著性意义（P〈0.01、P〈0.05）。HA、LN、PCⅢ、Ⅳ-C的水平治疗组患者治疗前后比较,差异有显著性意义（P〈0.01）;与对照组治疗后比较,差异均有显著性意义（P〈0.01、P〈0.05）。治疗组患者治疗前后ALT、AST、TBil、Alb比较差异有显著性意义（P〈0.01）,但与对照组治疗后比较差异无显著性意义（P〉0.05）。两组间在改善主要症状、脾脏回缩、肝脏声像图改变方面比较,差异有显著性意义（P〈0.05）。结论：软肝健脾丸对慢性乙型肝炎患者有较好的抗肝纤维化作用。     

慢性乙型肝炎患者肝纤维化程度与肝功能指标关系分析

目的 探讨慢性乙型肝炎肝纤维化程度与血清HBV DNA水平及肝功能的关系.方法 采用肝脏活体组织检查确定肝组织炎症活动度及纤维化程度,同时检测血清HBV DNA水平及肝功能.结果 肝组织病理的肝纤维化分级与炎症活动分期有关,肝脏炎症程度与纤维化程度呈正相关,P=0.000,rs=0.657.肝脏炎症分期与HBV DNA...     

复方鳖甲软肝片联合聚乙二醇干扰素α-2a治疗慢性乙型肝炎的疗效观察

目的探讨复方鳖甲软肝片联合聚乙二醇干扰素α-2a治疗慢性乙型肝炎(慢乙肝)患者的肝组织学变化.方法选取60例慢乙肝随机分为治疗组和对照组,每组30例.治疗组给予口服复方鳖甲软肝片4片/次,3次/d,同时皮下注射聚乙二醇干扰素α-2a 180 μg/次,1次/周;对照组给予皮下注射聚乙二醇干扰素α-2a 180 μg/次,1次/周,同时服用一般保肝药物(如甘草甜素等).2组均使用维生素B4和鲨肝醇行升白细胞治疗,疗程为48周.结果肝脏穿刺活体组织检查结果显示,治疗组肝纤维化及透明质酸程度有改善,均优于对照组(P＜0.05).2组炎症活动度改善无明显差异.结论复方鳖甲软肝片联合聚乙二醇干扰素α-2a治疗慢乙肝效果较聚乙二醇干扰素α-2a联合普通护肝药物好,值得进一步深入研究.     

苦参素联合核糖核酸治疗慢性乙型肝炎肝纤维化30例

采用苦参素联合核糖核酸治疗2001年6月-2004年6月在我院住院的慢性乙型肝炎肝纤维化30例,效果较好,报告如下.     

Multicenter clinical study on Fuzhenghuayu capsule against liver fibrosis due to chronic hepatitis B

AIM: To study the efficacy and safety of Fuzhenghuayu capsule (FZHY capsule, a capsule for strengthening body resistance to remove blood stasis) against liver fibrosis due to chronic hepatitis B. METHODS: Multicenter, randomized, double blinded and parallel control experiment was conducted in patients (aged from 18 to 65 years) with liver fibrosis due to chronic hepatitis B. Hepatic histologic changes and HBV markers were examined at wk 0 and 24 during treatment. Serologic parameters (HA, LM, P-Ⅲ-P, Ⅳ-C) were determined and B ultrasound examination of the spleen and liver was performed at wk 0,12 and 24. Liver function (liver function and serologic parameters for liver fibrosis) was observed at wk 0, 6, 12, 18 and 24. Blood and urine routine test, renal function and ECG were examined before and after treatment. RESULTS: There was no significant difference between experimental group (110 cases) and control group (106 cases) in demographic features, vital signs, course of illness, history for drug anaphylaxis and previous therapy, liver function, serologic parameters for liver fibrosis, liver histologic examination (99 cases in experimental group, 96 cases in control group), HBV markers, and renal function. According to the criteria for liver fibrosis staging, mean score of fibrotic stage(s) in experimental group after treatment (1.80) decreased significantly compared to the previous treatment (2.33, P<0.05), but there was no significant difference in mean score of fibrotic stage(s) (2.11 and 2.14 respectively). There was a significant difference in reverse rate between experimental group (52%) and control group (23.3%) in liver biopsy. With marked effect on decreasing the mean value of inflammatory activity and score of inflammation (P<0.05), Fuzhenghuayu capsule had rather good effects on inhibiting inflammatory activity and was superior to that of Heluoshugan capsule. Compared to that of pretreatment, there was a significant decrease in HA, LM, P-Ⅲ-P and Ⅳ-C content in experimental group after 12 and 24 wk of treatment. The difference in HA, LM, P-Ⅲ-P and Ⅳ-C content between 12 and 24 wk of treatment and pretreatment in experimental group was significantly greater than that in control group (P<0.01-0.05). The effect, defined as two of four parameters lowering more than 30% of the baseline, was 72.7% in experimental group and 27.4% in control group (P<0.01). Obvious improvement in serum Alb, ALT, AST and GGT was seen in two groups. Compared to that of control group, marked improvement in GGT and Alb was seen in experimental group (P<0.05). The effective rate of improvement in serum ALT was 72.7% in experimental group and 59.4% in control group. No significant difference was seen in blood and urine routine and ECG before and after treatment. There was also no significant difference in stable rate in ALT and serologic parameters for liver fibrosis between experimental group and control group after 12 wk of withdrawal. CONCLUSION: Fuzhenghuayu capsule has good therapeutic effects on alleviating liver fibrosis due to chronic hepatitis B without any adverse effect and is superior to that of Heluoshugan capsule.     

壮肝逐瘀煎治疗慢性乙型肝炎肝纤维化临床观察

[目的]观察扶正逐瘀解毒法之复方中药壮肝逐瘀煎治疗慢性病毒性乙型肝炎(CHB)肝纤维化(HF)患者的疗效。[方法]将110例患者完全随机非盲法分为2组,各55例,观察组口服壮肝逐瘀煎,每日1剂;对照组口服大黄蟅虫丸,每次6 g,每日2次。3个月为1个疗程,2组均观察2个疗程。治疗前、后检测血清透明质酸(HA)、层黏连蛋白(LN)、Ⅳ型胶原(ⅣC)、Ⅲ型前胶原(PCⅢ)。[结果]观察组总有效率显著高于对照组(P0.05);观察组治疗后HA、LN、ⅣC、PCⅢ明显下降(P0.01)。[结论]壮肝逐瘀煎治疗CHB HF有较好的疗效。     

双环醇治疗慢性乙型病毒性肝炎肝纤维化的临床研究

目的研究双环醇对慢性乙型病毒性肝炎(乙肝)肝纤维化的治疗作用。方法以双环醇治疗慢性乙肝患者20例,疗程6个月。分别于治疗前后检测患者血清丙氨酸氨基转移酶(ALT)、γ谷氨酰转肽酶(GGT)及血清纤维化指标层粘连蛋白(LN)、Ⅳ型胶原(CⅣ)、Ⅲ型前胶原肽(PⅢP)和透明质酸(HA)水平。同时经皮肝活检观察治疗前后肝脏组织病理学变化。结果双环醇可以显著降低慢性乙肝患者血清ALT和GGT水平,复常率分别达95%和70%,同时可以明显降低慢性乙肝患者血清LN、CⅣ和PⅢP水平,尤其PⅢP和CⅣ水平与肝组织纤维化程度呈明显正相关(相关系数分别为0.653和0.530,P<0.01)。结论双环醇可以减轻慢性乙肝患者肝脏炎症反应,保护肝细胞和抑制肝纤维化。     

复方鳖甲软肝片联合用药治疗乙型肝炎肝硬化疗效观察

目的观察复方鳖甲软肝片联合用药治疗乙型肝炎肝硬化的临床疗效。方法选取乙型肝炎肝硬化患者共67例,随机分为对照组34例,治疗组33例。对照组给予阿德福韦酯(代丁)、甘草酸二铵注射液、阿托莫兰及对症支持治疗;治疗组在对照组治疗的基础上加用复方鳖甲软肝片(4片/次,3/d),治疗6个月。结果治疗组患者在肝功能改善、血清肝纤维化指标等方面疗效明显优于对照组(P﹤0.05)。结论复方鳖甲软肝片联合阿德福韦酯等治疗乙型肝炎肝硬化患者疗效显著,具有协同作用。     

肝硬度检测联合APRI指数对慢性乙型肝炎患者肝纤维化程度的诊断价值

目的评价肝硬度（LS）联合APRI指数对慢性乙型肝炎肝纤维化的诊断价值。方法收集2009年8月-2013年1月本院收治的慢性乙型肝炎患者147例,按肝纤维化病理分期分组,利用声脉冲辐射力技术（ARFI）检测LS,并化验肝功能及血常规计算APRI指数。组间比较采用方差分析,采用Spearman相关性进行相关性检验。利用受试者工作特征曲线（ROC）分析LS对肝纤维化程度的诊断价值,并比较LS、APRI及两者联合诊断S≥1（存在肝纤维化）及S≥12（显著肝纤维化）的ROC曲线下面积。结果不同分组之间年龄、LS、AST、血小板（PLT）、APRI各组差异均有统计学意义（P〈0．05）,Ls及APRI与病理分期具有良好的相关性,相关系数（rs）分别为0．793,0．699（P〈0．05）;病理分期与AST,PLT的rs分别为0．292,-0．230（P〈0．05）。单独LS、APRI、联合Ls与APRI评价S≥1及S≥2的ROC曲线下面积分别为0．843、0．818、0．909和0．916、0．846、0．943;联合诊断ROC曲线下面积均大于单独LS或APRI诊断（P〈0．05）。结论LS联合APRI有助于提高早期肝纤维化程度的诊断。     

瞬时弹性扫描检测慢性乙型肝炎患者肝纤维化的临床研究

目的:研究肝脏瞬时弹性检测仪(Fibroscan)在慢性乙型肝炎患者中的应用.方法:收集诊断为慢性乙型肝炎患者310例,其中包括23例慢性重型肝炎及65例肝硬化患者,使用Fibroscan检测肝脏硬度值,同时检测乙肝标志物HBV DNA、丙氨酸氨基转移酶、总胆红素水平.结果:慢性乙肝肝硬化患者的肝脏硬度值显著高于非肝硬化患者.肝脏重度炎症如重型肝炎,也可导致肝脏硬度值增大.年龄和性别因素可能对肝脏硬度值有影响.结论:Fibfroscan是评价慢性乙肝患者肝脏纤维化程度和诊断肝硬化的有效方法.在对个体病例进行分析时,需要考虑年龄和性别、肝脏炎症因素对肝脏硬度值的影响.     

Antiviral therapy in advanced chronic liver disease due to hepatitis C virus infection: pilot study

Background: Antiviral therapy has not been adequately evaluated in patients with hepatitis C virus (HCV)-related advanced liver disease due to apprehensions of adverse events and intolerance. The titrable dose of interferon (IFN)-alpha and ribavirin was evaluated in a flexible regimen in a pilot study. METHODS: Twenty-five patients with HCV-related advanced chronic liver disease received IFN-alpha 1-3 MIU daily with ribavirin 200-600 mg daily for 9 months-3 years. Careful assessment of safety, tolerability and efficacy was made. RESULTS: Improvement in Child-Pugh score (8.4 +/- 1.2 to 7.4 +/- 2.0; P = 0.010) and serum albumin (3.0 +/- 0.5 g/dL to 3.6 +/- 0.5 g/dL; P = 0.007) occurred at follow up after antiviral therapy (median dose and duration: IFN-alpha 1.5 MIU/day for 12 months and ribavirin 400 mg/day for 7.5 months) as compared to baseline. Ascites regressed in 53% of patients (11/21). Thirteen patients (52%) lost HCV-RNA on therapy and eight (32%) achieved sustained virological response (SVR). Death occurred in three patients (12%) while on therapy, in two due to infection. No patient died in the responder group compared to five deaths (29%) in the non-responder group. However, there was no difference in the cumulative probability of survival in the sustained virological responder versus non-responder (P = 0.09). Adverse events were common (92%), but permanent withdrawal was required in only five patients (20%). CONCLUSIONS: Low and titrable dose IFN-alpha and ribavirin therapy in patients with HCV-related advanced chronic liver disease achieves improvement in hepatic synthetic function, Child-Pugh score and ascites. However, close monitoring for serious adverse events is warranted.     

病毒因素及其防治在慢性乙型肝炎肝硬化中的地位

自然史研究证明慢性乙型肝炎（chronic hepatitis B,CHB）肝硬化的发生和发展与HBV复制密切相关。临床研究已证实核苷类似物特别是拉米夫定抑制CHB失代偿性肝硬化是安全有效的,表现在近期可阻断病毒复制所诱导的炎症反应,远期则可减少疾病发作及失代偿。临床治疗的过程需要3～6个月,这提示应在病程早期开始应用核苷类似物治疗。通过抗病毒治疗会使部分患者疾病好转或恢复,生活质量乃至存活率提高而无须进行原位肝移植。对于必须进行肝移植者,可显著降低移植后HBV再感染率。随着阿德福韦、恩替卡韦、替比夫定、替诺福韦及恩曲他滨等核苷类似物的出现,相关治疗的选择逐渐增多,联合治疗的选择也相应增多,但选用时应充分考虑疾病进展、病毒载量、经济条件及长期用药的可持续性（耐药后的处理）等多种影响因素。