恩替卡韦分别联合软肝颗粒、复方鳖甲软肝片治疗乙型肝炎肝硬化代偿期活动期效果研究

目的探讨恩替卡韦分别联合软肝颗粒、复方鳖甲软肝片治疗乙型肝炎肝硬化代偿期活动期效果。方法前瞻性选取2017年1月至2019年1月期间秦皇岛市第三医院和秦皇岛市第一医院收治的200例乙型肝炎肝硬化代偿期活动期患者,依照双盲法将患者分为对照组110例,研究组90例。对照组采用恩替卡韦联合复方鳖甲软肝片治疗,研究组采用恩替卡韦联合软肝颗粒治疗。比较2组患者临床疗效、治疗前和治疗6个月后肝功能指标丙氨酸转移酶(ALT)、天门冬氨酸转移酶(AST)、血清白蛋白(Alb)、总胆红素(TBIL)、白蛋白/球蛋白比值(A/G)]、血清肝纤维化指标透明质酸(HA)、Ⅲ型前胶原(PcⅢ)、Ⅳ型胶原(Ⅳ-C)、层粘蛋白(LN)]、乙型肝炎病毒相关指标乙型肝炎表面抗原(HBsAg)、乙型肝炎e抗原(HBeAg)、乙型肝炎病毒脱氧核糖核酸(HBV-DNA)]及肝脏弹性硬度指标的变化。结果研究组与对照组患者治疗总有效率比较(98.18%vs.98.89%),差异无统计学意义(P>0.05)。治疗前2组患者肝功能指标、血清肝纤维化指标、乙型肝炎病毒相关指标和肝脏弹性硬度值水平比较,差异均无统计学意义(P>0.05)。治疗6个月后2组患者ALT、AST、TBIL、HA、Ⅳ-C、LN、PCⅢ、HBsAg、HBeAg、HBV-DNA和肝脏弹性硬度均显著低于治疗前,Alb、A/G水平高于治疗前,差异有统计学意义(P<0.05);治疗6个月后研究组与对照组患者ALT、AST、TBIL、Alb、A/G、HBsAg、HBeAg、HBV-DNA水平比较,差异均无统计学意义(P>0.05),研究组患者HA、Ⅳ-C、LN、PCⅢ水平、肝脏弹性硬度显著低于对照组,差异有统计学意义(P<0.05)。结论恩替卡韦联合软肝颗粒与恩替卡韦复方鳖甲软肝片治疗乙型肝炎肝硬化代偿期活动期临床疗效相当,2组患者经过治疗6个月后乙型肝炎病毒相关指标均显著下降,肝功能好转。但恩替卡韦联合软肝颗粒在改善肝纤维化与肝脏弹性方面效果显著优于恩替卡韦复方鳖甲软肝片,可在临床中根据患者症状进行选择应用。

Study on the effect of Entecavir combined with Ruangan Granules and Compound Biejia Ruangan Tablets in the treatment of hepatitis B cirrhosis during the active phase of compensation.

Objective To investigate the effect of Entecavir combined with Ruangan Granules and Compound Biejia Ruangan Tablets in the treatment of hepatitis B cirrhosis during the active phase of compensation.Methods From January 2017 to January 2019,200 patients with hepatitis B and liver cirrhosis in the active phase of the compensation stage admitted to the Qinhuangdao Third Hospital and Qinhuangdao First Hospital were prospectively selected,and the patients were divided into the control group 110 cases,90 cases in the study group according to the double-blind method.The control group was treated with Entecavir combined with Compound Biejia Ruangan Tablets,and the study group was treated with Entecavir combined with Ruangan Granules.Liver function indexesalanine transferase(ALT),aspartate transferase(AST),serum albumin(Alb),total bilirubin(TBIL),albumin/globulin(A/G)],serum liver fibrosis indicatorshyaluronic acid(HA),typeⅢprocollagen(PcⅢ),typeⅣcollagen(Ⅳ-C),laminin(LN)],hepatitis B virus related IndicatorsHepatitis B surface antigen(HBsAg),Hepatitis B e antigen(HBeAg),Hepatitis B deoxyribonucleic acid(HBV-DNA)]and liver elasticity and stiffness indicators before treatment and 6 months after treatment were compared.Results The total effective rate of treatment between the study group and the control group was compared(98.18%vs.98.89%),and the difference was not statistically significant(P>0.05).Before treatment,there were no statistically significant differences in liver function indexes,serum liver fibrosis indexes,hepatitis B virus related indexes,and liver elastic stiffness values between the two groups of patients(P>0.05).After 6 months of treatment,the ALT,AST,TBIL,HA,IV-C,LN,PCⅢ,HBsAg,HBeAg,HBV-DNA and liver elasticity of the two groups were significantly lower than those before treatment,and the levels of Alb and A/G were higher than those before treatment,the differences were statistically significant(P<0.05);after 6 months of treatment,the differences of the levels of ALT,AST,TBIL,Alb,A/G,HBsAg,HBeAg and HBV-DNA in the two groups were not statistically significance(P>0.05).After 6 months of treatment,the HA,Ⅳ-C,LN,PCⅢ,liver elasticity and hardness levels of patients in the study group were significantly lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion Entecavir combined with Ruangan Granules and Entecavir Compound Biejia Ruangan Tablets have similar clinical effects in the treatment of hepatitis B cirrhosis during the active phase of compensation.After treatment,the two groups of patients have significantly decreased hepatitis B virus related indicators and improved liver function.However,the effect of Entecavir combined with Ruangan Granules in improving liver fibrosis and liver elasticity is significantly better than Entecavir Compound Biejia Ruangan Tablets,which can be selected and applied in clinic according to the patient's symptoms.