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[目的]观察清热利湿、疏肝健脾中药联合聚乙二醇干扰素-α2a(IFN-α2a)对慢性乙型肝炎(CHB)肝纤维化指标及病毒复制的影响。[方法]治疗组60例HBeAg阳性CHB患者,予聚乙二醇IFN-α2a 180μg皮下注射,每周1次,疗程48周,同时服用清热利湿、疏肝健脾中药每日1剂,疗程24周;对照组62例仅予聚乙二醇IFN-α2a,用法同治疗组。荧光定量PCR检测乙肝病毒核酸(HBV-DNA),放射免疫法检测血清肝纤维化指标。[结果]治疗24周时,治疗组HBeAg血清转换率、HBV-DNA定量下降值高于对照组(P<0.05),而治疗48周时,虽高于对照组,但差异无统计学意义(P>0.05);治疗组血清透明质酸、层黏连蛋白、Ⅳ型胶原、Ⅲ型前胶原肽,较治疗前显著改善(P<0.01),且在治疗24周时显著低于对照组(P<0.05,<0.01);治疗48周时肝纤维化指标改善优于对照组,但差异无统计学意义(P>0.05);治疗组不良反应轻于对照组(P<0.05)。[结论]清热利湿、疏肝健脾中药联合聚乙二醇IFN-α2a,可更好抑制乙肝病毒复制,改善血清肝纤维化指标,同时减轻聚乙二醇IFN-α2a的不良反应,使患者更好地坚持治疗。
[Objective] To observe the effect of Qingre Lishi, Shuganjianpi combined with pegylated interferon-α2a (IFN-α2a) on liver fibrosis index and virus replication in chronic hepatitis B (CHB). [Method] The treatment group of 60 patients with HBeAg-positive CHB, polyethylene glycol IFN-α2a 180μg subcutaneously once a week for 48 weeks, while taking heat and dampness, Liver and spleen medicine 1 day, the course of treatment 24 weeks; control group, 62 cases only given polyethylene glycol IFN-α2a, with the same treatment group. Fluorescence quantitative PCR was used to detect hepatitis B virus DNA (HBV-DNA), and radioimmunoassay was used to detect serum liver fibrosis index. [Results] At 24 weeks, the HBeAg seroconversion rate and HBV-DNA quantitative decrease in the treatment group were higher than those in the control group (P <0.05), but the difference was not statistically significant at 48 weeks (P <0.01). The levels of serum hyaluronic acid, laminin, type Ⅳ collagen and type Ⅲ procollagen peptide in the treatment group were significantly improved (P <0.01), and were significantly lower than those in the control group at 24 weeks P <0.05, <0.01). The improvement of hepatic fibrosis indicators at 48 weeks was better than that of the control group, but the difference was not statistically significant (P> 0.05). The adverse reaction of the treatment group was lighter than that of the control group (P <0.05). [Conclusion] Qingre Lishi and Shuganjianpi combined with PEG-IFN-α2a can inhibit hepatitis B virus replication better, improve serum liver fibrosis indexes and relieve the adverse reaction of IFN-α2a. Patients adhere better to treatment.