【作者】 楼建国； 傅智敏； 龚启明； 傅跃娟； 郑海文；

【Author】 LOU Jian-guo,FU Zhi-min,GON Qi-ming,et al.The Tradition Medical Hospital of Jinhua City

【机构】 金华市中医院消化科； 上海瑞金医院传染科； 金华市中心医院传染； 金华市职业技术学院；

【摘要】 目的 :观察温阳化瘀汤和拉米夫定序贯治疗免疫耐受期慢性乙型肝炎的临床疗效。方法 :60例免疫耐受期慢性乙型肝炎患者随机分为治疗组和对照组,治疗组先予温阳化瘀汤(冬虫夏草3克,生黄芪30克,制附片10-30克,砂仁3-10克,地鳖虫5-10克,冬虫夏草以百令胶囊每次5粒,每日3次替代,余药水煎服,制附片先煎20分钟,每日2次。)口服,每周查一次肝功能至ALT>200U/L后再改为口服拉米夫定,100mg/d,对照组仅口服拉米夫定,100mg/d。口服拉米夫定后观察时间为6个月。观察指标:口服拉米夫定前及6个月后各查一次肝功能、乙肝三系、HBV-DNA及IV-C、HA、LN、PCⅢ;口服拉米夫定前及6个月后各肝穿一次,作肝组织病理学检查。结果 :治疗组口服温阳化瘀汤后,ALT有一个先降后升的过程,一般经过3周至3个月ALT可达到正常值上限的5倍以上并控制在10倍以内,患者阳虚证候明显好转,血清HA水平明显升高,肝脏炎症程度分级均值接近3级,显著高于对照组(p<0.001)。口服拉米夫定6个月后治疗组HbeAg/HbeAb血清转换率明显高于对照组;治疗组HBV-DNA阴转率显著高于对照组;各组肝脏炎症程度分级均较服拉米夫定前显著下降,治疗组下降趋势更明显但两组之间没有显著差异;治疗组服拉米夫定6个月后肝纤维化程度分期有下降的趋势但各组间均无显著差异。结论 :温阳化瘀汤可清除免疫耐受,温阳化瘀汤和拉米大定序贳治疗可提高HBV标志物的阴转率,提高拉米夫定对肝纤维化的改善。更多还原

【Abstract】 Objective:Inorder to obstract the clinical effect of sequential using Wenyang Huayu Decoction and lamivudine on the patients with chronic hepatitis B,which was in immune tolerance period. Methods:Totally 60 patients with chronic hepatitis B were randomly divided into two groups:30 cases as therapy group and 30 cases as control group.The therapy group was administered Wenyang Huayu Decoction,tested liver function once a week,after serum alanine aminotransferase(ALT) up to 200U/L,then retook lamivudine tablet 100 mg once daily and followed-up for 6 months.The control group were only prescribed lamivudine 100 mg once daily.The liver function and hepatitis B(HBV) virology including HBV-DNA level,HBV marker,and hepatic fibrosis related indexes(HA、LM、PCⅢ、Ⅳ-C) were tested at pre-therapy with Wenyang Huayu Decoction,before and after 6 months treatment with lamivudine. Pathologic examination of liver biopsy were performed before and after 6 months treatment with lamivudine. Results:After Wenyang Huayu Decoction was taken for 3 weeks to 3 months,the serum ALT of the therapy group had a reduction at first,then had an improvement,up as high as 5×ULN to 10×ULN.When the serum ALT of the therapy group up to 5×ULN to 10×ULN,symptoms of lacking in vital yang had improved obviously,the HA concentration of the therapy group was improved obviously,the mediam of the grade of inflammation of hepatic tissue was around grade 3,and was distinct different from that of the control group at pre-therapy with lamivudine.After treatment with lamivudine 6 months,the grading scores of inflammation of hepatic tissue were decreased obviously but there was indistinct different in the two groups,the rats of undetectable HBV-DNA level and HbeAg/HbeAb sero-conversion were distinct different in the two group; The hepatic fibrosis related indexes(HA、LM、PCⅢ、Ⅳ-C)were indistinct different in the two groups at pre-therapy,and were distinct different after 6 months treatment with lamivudine;The fibrotic stage scores were decreased at various degrees in the two groups after 6 months treatment with lamivudine,but there was indistinct different in the two groups at before and after 6 months treatment with lamivudine.Conclusion: Wenyang Huayu Decoction could break immune tolerance to HBV antigen.Significant improvement of negative rat of HBV makers、HBV-DNA as well as Significant decrease in hepatic fibrosis related indexes (HA、LM、PCⅢ、Ⅳ-C) could be obtained by sequential treatment with Wenyang Huayu Decoction and lamivudine on patients with chronic hepatitis B than only by treatment with lamivudine.更多还原