健脾活血解毒法联合恩替卡韦治疗HBeAg阴性慢性乙型肝炎66例临床观察

发布时间：2017-12-27 11:45

本文关键词：健脾活血解毒法联合恩替卡韦治疗HBeAg阴性慢性乙型肝炎66例临床观察　出处：《山东中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：背景:我国慢性HBV感染者约9300万人,其中慢性乙型肝炎患者约2000万例。自1992年我国实行新生儿接种乙肝疫苗以来,乙肝感染率已大幅下降,但我国乙肝发病人口基数大,乡村医疗条件差,这都制约着乙肝预防治疗工作的开展,故有效防治乙肝仍是我国医疗卫生的难题之一。现代医学治疗乙肝主要以干扰素及核苷(酸)类似物抗病毒为主。但有其严格的临床应用指征,且存在病毒学不应答、病毒变异、病毒学突破等问题。中成药种类繁多,主要以甘草酸制剂、水飞蓟素等药物为主,但由于缺乏临床辨证的精确性及循证医学的Ⅰ级证据,目前《慢性乙型肝炎防治指南》(2015年版),已不再推荐。中医药作为中华的瑰宝,经久而不衰,在疾病治疗方面有着独道的优势,深入挖掘中医药治疗慢性乙肝的方法,并探索中西医联合治疗的思路,是我们今后研究乙肝的重中之重。近年国内外不少文献接踵报道在慢性乙型肝炎的防治中,应用中医药辨证用药联合抗病毒治疗其疗效明显优于单用抗病毒药,为我们防治慢乙肝开拓了新思路。目的:观察健脾活血解毒法联合恩替卡韦治疗HBe Ag阴性慢性乙型肝炎的临床疗效,探索提出中西医结合治疗HBe Ag阴性慢性乙型肝炎有效方案。方法:66例就诊于山东中医药大学附属医院肝病科门诊HBe Ag阴性慢性乙型肝炎患者,随机分成两组,即试验组和对照组。试验组采用健脾活血解毒法,予以中药复方肝荣汤联合恩替卡韦;对照组单用恩替卡韦。各进行为期96周的临床研究,观察肝功能复常率、腹部超声图像改善情况、病毒学指标情况及中医证候改善情况。结果:1.试验组患者病毒变异0例,对照组患者病毒变异1例。2.用药12周、24周时两组腹部超声图像无明显差异;用药48周、96周时,试验组明显优于对照组。3.分别用药12周、24周、48周时,试验组肝功能复常率均优于对照组,用药96周时两组肝功能复常率无明显差异。4.12周、24周病毒载量改善情况及24周、48周HBs Ag定量改善情况试验组优于对照组。5.临床症状和体征的改善,试验组明显优于对照组。结论:运用健脾活血解毒法联合恩替卡韦治疗HBe Ag阴性慢性乙型肝炎,在改善临床症状体征、改善肝组织炎性损伤、降低HBV-DNA载量、降低HBs Ag定量等疗效明显优于单用恩替卡韦。
[Abstract]:Background: there are about 93 million people with chronic HBV infection in China, of which about 20 million cases of chronic hepatitis B patients. Since 1992, China's implementation of neonatal hepatitis B vaccination, hepatitis B infection rate has fallen sharply, but the number of incidence of hepatitis B in population in our country, the rural poor medical conditions, which are restricting the hepatitis B prevention treatment of work carried out, one of the effective prevention and treatment of hepatitis B is still our health problem. The treatment of hepatitis B in modern medicine is mainly based on interferon and nucleoside (acid) analogues. But it has strict clinical indications, and there are virology non response, virus variation, virology breakthrough and other problems. There are many kinds of Chinese patent medicines, mainly based on Glycyrrhizic acid preparation, silymarin and other drugs. But due to the lack of accuracy in clinical diagnosis and first-degree evidence of evidence-based medicine, the guideline for chronic hepatitis B Prevention (2015 Edition) is no longer recommended. Traditional Chinese medicine, as a treasure of China, is enduring and has a unique advantage in disease treatment. It is the most important thing for us to explore the way of treating chronic hepatitis B with Chinese medicine and explore the way of integrated traditional Chinese and Western medicine. In recent years, many domestic and foreign literatures have been reported in the prevention and treatment of chronic hepatitis B, is better than the single use of antiviral drugs application of traditional Chinese medicine combined with antiviral treatment efficacy, to explore new ideas for our prevention and control of chronic hepatitis B. Objective: To observe the clinical efficacy of Jianpi Huoxue Jiedu method combined with entecavir in the treatment of HBe Ag negative chronic hepatitis B, and explore the effective plan of treating HBe Ag negative chronic hepatitis B with integrated traditional Chinese and Western medicine. Methods: a total of 66 HBe Ag negative chronic hepatitis B patients in the outpatient department of Hepatology clinic affiliated to Shandong University of Traditional Chinese Medicine were randomly divided into two groups, the experimental group and the control group. The experimental group adopted the method of invigorating spleen and activating blood and detoxifying, and giving Chinese medicine compound liver Rong Tang and enteca Cave, and the control group was alone with enteca Cave. 96 weeks of clinical study were carried out to observe the recurrence rate of liver function, the improvement of abdominal ultrasonic image, the condition of Virology and the improvement of TCM syndrome. Results: there were 0 cases of virus variation in the 1. test group, and 1 cases in the control group. There was no significant difference in the ultrasound images between the two groups at 12 weeks and 24 weeks, and the test group was significantly better than the control group at the time of 48 weeks and 96 weeks at 2.. 3. for 12 weeks, 24 weeks and 48 weeks, the rate of liver function recovery was better than that of the control group. There was no significant difference between the two groups of liver function at 96 weeks. The improvement of viral load in 4.12 weeks and 24 weeks and the quantitative improvement of HBs Ag in 24 weeks and 48 weeks were better than those in the control group. 5. the improvement of clinical symptoms and signs in the experimental group was obviously better than that of the control group. Conclusion: Jianpi Huoxue Jiedu method combined with entecavir in the treatment of HBe Ag negative chronic hepatitis B is superior to entecavir alone in improving clinical symptoms and signs, improving inflammatory injury in liver tissue, decreasing HBV-DNA load and decreasing HBs Ag.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R512.62

【参考文献】