芪参二莲汤联合拉米夫定治疗高病毒载量慢性乙型病毒性肝炎的随机平行对照研究

发布时间：2018-02-24 00:03

本文关键词： 芪参二莲汤拉米夫定慢性乙型病毒性肝炎免疫因子水平耐药率　出处：《中华中医药学刊》2017年05期 　论文类型：期刊论文

【摘要】：目的:观察芪参二莲汤联合拉米夫定对高病毒载量慢性乙型病毒性肝炎患者病毒学、血清学、肝功能、免疫因子及对核苷类抗病毒药耐药性的影响。方法:将纳入标准的87例慢性乙型病毒性肝炎患者按照随机数字表法分为治疗组(44例)和对照组(43例),其中治疗组给予芪参二莲汤联合拉米夫定治疗,对照组给予拉米夫定治疗,两组患者均治疗48周。观察两组患者治疗前、后症状体征,病毒血清学及肝功能改变,免疫因子水平变化,及耐药率比较,并观察记录两组患者的不良反应。结果:治疗组总有效率为84.09%,对照组总有效率为67.44%,两组疗效比较差异有统计学意义(P0.05)。治疗组经12、24、48周治疗后HBeAg转阴数、HBeAg转换数、HBsAg转阴数、HBV-DNA转阴例数与治疗前比较,差异均具有统计学意义(P0.05)。两组治疗后ALT、AST、TBIL、ALB均较治疗前下降,治疗组治疗12周、48周较治疗前比较差异均具有明显有统计学意义(P0.01),两组治疗后CD_3~+、CD_4~+、CD_4~+/CD_8~+、NK较前均上升,治疗12周时较治疗前均无明显统计学差异(P0.05),治疗48周时较治疗前差异具有统计学意义(P0.05),两组治疗后12周时CD_8~+较治疗前无明显变化,不具统计学差异(P0.05),且组间比较差异无统计学意义(P0.05),两组48周时CD_8~+较治疗前下降,差异具有统计学意义(P0.05),治疗组总耐药率为11.31%;对照组总耐药率为32.56%。两组耐药率比较差异具有统计学意义(P0.05)。结论:芪参二莲汤联合拉米夫定不仅能够更加显著的抑制HBV-DNA复制,提高HBsAg、HBeAg转阴率,有效改善肝功能,还能调节免疫功能、减少HBV耐药变异,值得临床进一步大推广应用。
[Abstract]:Objective: to observe the effect of Qishen Erlian decoction combined with lamivudine on virology, serology and liver function in patients with chronic viral hepatitis B with high viral load. Immune factors and their effects on drug resistance of nucleoside antiviral poisons. Methods: 87 patients with chronic viral hepatitis B were randomly divided into treatment group (n = 44) and control group (n = 43). Qishen Erlian decoction combined with lamivudine was given. The patients in the control group were treated with lamivudine for 48 weeks. The symptoms and signs, the changes of viral serology and liver function, the level of immune factor and the rate of drug resistance were observed before and after treatment. Results: the total effective rate of the treatment group was 84.09, and the total effective rate of the control group was 67.44.The difference between the two groups was statistically significant (P 0.05). The number of negative cases of HBV-DNA conversion was compared with that before treatment. All the differences were statistically significant (P 0.05). After treatment, the levels of ALB in both groups were lower than those before treatment, and there were significant differences between the treatment group at 12 weeks and 48 weeks after treatment compared with those before treatment (P 0.01). After treatment, the levels of CD3 ~ +, CD4 ~ +, CD4 ~ +, CD8 ~ + -NK in the treatment group were higher than those before treatment, and there was no significant difference between the two groups after treatment. There was no significant difference between the two groups at 12 weeks after treatment (P 0.05), but at 48 weeks after treatment, the difference was statistically significant (P 0.05). There was no significant difference between the two groups at 12 weeks after treatment, and there was no significant difference between the two groups at 12 weeks after treatment compared with that before treatment, and there was no significant difference between the two groups at 12 weeks after treatment. There was no statistical difference (P 0.05), and there was no significant difference between the two groups (P 0.05). CD8 ~ + decreased at 48 weeks after treatment in the two groups. The difference was statistically significant (P 0.05), the total drug resistance rate was 11.31 in the treatment group and 32.56 in the control group. The difference between the two groups was statistically significant (P 0.05). Conclusion: Qishen Erlian decoction combined with lamivudine can significantly inhibit HBV-DNA replication. Improving HBeAg conversion rate, improving liver function, regulating immune function and reducing drug resistance variation of HBV are worthy of further popularizing in clinic.
【作者单位】：武汉大学中南医院中西医结合科;黑龙江省中医药科学院南岗分院;
【基金】：黑龙江省科技厅科技攻关项目(GC12C120)
【分类号】：R512.62

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