康氏抗纤方治疗慢性乙型肝炎肝纤维化的临床研究

发布时间：2018-01-01 12:31

本文关键词：康氏抗纤方治疗慢性乙型肝炎肝纤维化的临床研究　出处：《中国中西医结合杂志》2017年10期 　论文类型：期刊论文

【摘要】：目的观察康氏抗纤方治疗慢性乙型肝炎肝纤维化的临床疗效,探讨其对肝组织N-花生四烯酸氨基乙醇(arachidonoylethanolamine,AEA)、2-花生四烯酸甘油(2-arachidonoylglycerol,2-AG)、大麻素受体1(cannabinoid receptor 1,CBR1)mRNA、大麻素受体2(cannabinoid receptor 1,CBR2)mRNA含量变化的影响。方法将110例慢性乙型肝炎肝纤维化患者按随机数字表法分为治疗组和对照组,每组55例。治疗组予中药康氏抗纤方联合恩替卡韦分散片治疗,对照组用恩替卡韦分散片单药治疗,两组均治疗48周。判定两组临床疗效,检测血清ALT水平,HBV DNA、HBsAg、HBs Ab定量,肝组织病理、肝硬度变化,肝组织AEA、2-AG含量和CBR1、CBR2 mRNA表达水平。结果与对照组比较,治疗组的临床总有效率、HBsAg阴转率、肝组织纤维化分期疗效有效率均高于对照组(χ2=4.453,4.152,6.364,均P0.05)。与本组治疗前比较,治疗后两组患者肝纤维化瞬时弹性测定值、AEA、2-AG含量及CBR1、CBR2 mRNA表达均降低(均P0.05),且治疗组降低更明显(均P0.05)。肝组织病理显示:治疗后治疗组肝小叶结构基本完整,肝细胞轻度水样变性,汇管区纤维组织无增生,局部少量淋巴细胞浸润,炎症及纤维化较对照组明显改善。结论康氏抗纤方具有提高慢性乙型肝炎肝纤维化患者的临床总有效率、HBsAg阴转率、肝组织纤维化分期疗效有效率,其作用机制可能与调节内源性大麻素系统有关。
[Abstract]:Objective to observe the clinical effect of Kangxianfang on chronic hepatitis B liver fibrosis. Objective: to study the effect of arachidonoylethanolamine (AEAA) on N-arachidonic acid aminoethanol (AEAA) in liver tissue. 2-arachidonoylglycerol (2-AGN), cannabinoid receptor 1 (cannabinoid 1). CBR1 mRNAs, cannabinoid receptor 1 receptor 2 cannabinoid. Methods 110 patients with chronic hepatitis B liver fibrosis were randomly divided into treatment group and control group. 55 cases in each group. The treatment group was treated with Kangshinxianfang combined with entecavir dispersible tablets, while the control group was treated with entecavir dispersible tablets for 48 weeks. The levels of serum ALT were measured in order to determine the quantity of HBsAb, the pathological changes of liver tissue, the changes of liver hardness, the content of AEA2-AG and CBR1 in liver tissue. Results compared with the control group, the total effective rate of the treatment group was higher than that of the control group. The effective rate of hepatic fibrosis staging was higher than that of the control group (蠂 2 / 4.453 / 4.152 / 6.364, P < 0.05). After treatment, the instantaneous elastic value of hepatic fibrosis and the expression of CBR1 and CBR2 mRNA were decreased in both groups (all P 0.05). The liver histopathology of the treatment group showed that the hepatic lobule structure was basically intact, the liver cells were slightly watery degeneration, and the fibrous tissue in the catchment area was not proliferated. Local small amount of lymphocytes infiltration inflammation and fibrosis were significantly improved compared with the control group. Conclusion Kangxianfang can improve the total effective rate of chronic hepatitis B patients with liver fibrosis and HBsAg negative rate. The effective rate of hepatic fibrosis staging may be related to the regulation of endogenous cannabinoid system.
【作者单位】：厦门大学医学院;厦门市中医院肝病中心;甘肃中医院临床教学部;厦门市第一医院中医科;福建中医药大学中医系;
【基金】：国家自然科学基金资助项目(No.81503529,No.81673660) 福建省科技计划引导性项目(No.2015D007,No.2016D012) 厦门市科技惠民项目(No.3502Z20174028) 福建中医药大学临床专项校管课题基金(No.XB2016080)
【分类号】：R259
【正文快照】： 慢性乙型肝炎肝纤维化是指由于各同原因引起的肝脏慢性、进行性、弥漫性病变,其特点是在肝细胞坏死的基础上发生纤维化,并代之以纤维包绕的异常肝细胞结节(假小叶)。我国慢性乙型肝炎肝纤维化以乙型肝炎病毒(hepatitis B virus,HBV)的长期感染为主[1],同时慢性乙型肝炎肝纤维

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