【摘要】 目的:探讨与分析自拟解毒散瘀软坚方联合恩替卡韦治疗慢性乙型病毒性肝炎(CHB)患者的临床疗效及机制。方法:选择CHB患者124例，随机分为中西医结合组(解毒散瘀软坚方联合恩替卡韦)与恩替卡韦组各62例，两组患者均治疗6个月，观察两组患者治疗疗效、乙型肝炎病毒裁量(HBV DNA)、肝功能、肝纤维化、趋化因子CXC配体13(CXCL13)、白介素17(IL-17)及白介素23(IL-23)等指标变化情况。结果:两组患者治疗期间均无严重不良反应发生，中西医结合组患者的总有效率为98.4%,高于恩替卡韦组的88.7%(P<0.05)。两组患者HBV DNA、ALT、AST、HA、LN、PC-Ⅲ、Ⅳ-C、CXCL13、IL-17及IL-23值都较治疗前下降(P<0.05),且中西医结合组下降明显低于恩替卡韦组，差异均有统计学意义(P<0.05);CXCL13、IL-17、IL-23表达量与肝功能和肝纤维化指标间呈正相关(P<0.05)。两组患者均随访观察3年，中西医结合组患者的复发率为3.2%,低于恩替卡韦组的12.9%(P<0.05)。结论:自拟解毒散瘀软坚汤剂联合恩替卡韦在CHB患者中的应用具有很好的安全性，能抑制HBV DNA复制，改善患者肝功能、肝纤维化，提高治疗效果，降低复发率。提示该治疗方案能够明显降低CHB患者炎症反应，可能通过降低CXCL13表达提高抗HBV病毒治疗的有效性。更多还原

【Abstract】 Objective:To explore and analyze the effect of self-made Jiedu Sanyu Ruanjian formula combined with Entecavir in patients with chronic hepatitis B(CHB).Methods:A total of 124 patients diagnosed with CHB and treated in our hospital were selected and randomly divided into integrated Chinese and Western medicine group(n=62) and an Entecavir group(n=62). The Entecavir group was treated with Entecavir, and the integrated traditional Chinese and Western medicine group was treated with self-made Jiedu Sanyu Ruanjian formula on the basis of the treatment of the control group. Both groups were treated for 6 months. The therapeutic effect and the changes of hepatitis B virus(HBV DNA), liver function, liver fibrosis, chemokine CXC ligand 13(CXCL13), interleukin 17(IL-17), interleukin 23(IL-23) were observed. Results:There were no serious adverse reactions in the two groups during the treatment. After treatment, the total effective rate of the integrated Chinese and Western medicine group was 98.4%,which was higher than the 88.7% of the Entecavir group(P<0.05). The values of HBV DNA, ALT, AST, HA, LN, PCIII, Ⅳ-C, CXCL13, IL-17 and IL-23 in the two groups were decreased compared with those before treatment(P<0.05), and the decrease in the integrated Chinese and Western medicine group was statistically significant lower than that in the Entecavir group(P<0.05).There were positive correlations between CXCL13, IL-17 and IL-23 with liver function and liver fibrosis(P<0.05).Both groups were followed up for 3 years. The recurrence rate of the integrated Chinese and Western medicine group was 3. 2%,which was lower than that of the Entecavir group(12.9%)(P<0.05).Conclusion: The self-made Jiedu Sanyu Ruanjian formula combined with Entecavir in patients with CHB is of great safety. It can inhibit the proliferation of HBV DNA and the progress of liver fibrosis,improve the liver function of patients,and reduce the recurrence rate of patients. These results suggest that this regimen can significantly reduce the inflammatory response in the treatment of CHB patients,which may indicate the effectiveness of hepatitis B virus treatment by reducing CXCL13 expression.更多还原