疏肝健脾方联合恩替卡韦治疗肝郁脾虚证乙肝肝硬化患者的临床效果

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摘要目的探讨疏肝健脾方联合恩替卡韦治疗肝郁脾虚证乙肝肝硬化患者的临床效果。方法回顾性分析湖南中医药高等专科学校附属第一医院2018年10月至2020年10月收治的76例肝郁脾虚证乙肝肝硬化患者，根据治疗方案分为常规组（n=36）与联合组（n=40）。常规组给予恩替卡韦，联合组在常规组的基础上给予疏肝健脾方。比较两组的疗效及治疗前、治疗3个月后的中医证候积分、肝功能、肝纤四项、细胞免疫功能、乙肝病毒DNA含量（HBV DNA）阴性率及不良反应总发生率。结果联合组的治疗总有效率高于常规组，差异有统计学意义（P＜0.05）。治疗后，两组的中医证候积分均低于治疗前，差异有统计学意义（P＜0.05）；且联合组的中医证候积分低于常规组，差异有统计学意义（P＜0.05）。治疗后，两组的总胆红素（TBil）、天门冬氨酸氨基转移酶（AST）、透明质酸（HA）、层粘连蛋白（LN）、Ⅲ前型胶原肽（PC-Ⅲ）、Ⅳ型胶原（Ⅳ-C）、细胞毒性 T 细胞（CD8+）水平均低于治疗前，且联合组的 TBil、AST、HA、LN、PC-Ⅲ、Ⅳ-C、CD8+水平均低于常规组，差异有统计学意义（P＜0.05）。治疗后，两组的白蛋白（ALB）、成熟 T 淋巴细胞（CD3+）、辅助性 T 细胞（CD4+）水平均高于治疗前，且联合组的 ALB、CD3+、CD4+水平高于常规组，差异有统计学意义（P＜0.05）。治疗后联合组的HBV DNA阴性占比高于常规组，差异有统计学意义（P＜0.05）。两组的不良反应总发生率比较，差异无统计学意义（P＞0.05）。结论疏肝健脾方联合恩替卡韦片治疗肝郁脾虚证乙肝肝硬化患者的临床效果较理想，能够缓解患者临床症状，保护肝功能，提高细胞免疫功能。

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关键词 ：疏肝健脾方, 恩替卡韦, 肝郁脾虚证, 乙肝肝硬化

Abstract：Objective To explore the clinical effect of Shugan Jianpi Recipe combined with Entecavir in the treatment of hepatitis B cirrhosis patients with syndrome of of liver depression and spleen deficiency.Methods A retrospective analysis of 76 cases of hepatitis B cirrhosis patients with syndrome of of liver depression and spleen deficiency from October 2018 to October 2020 in the First Affiliated Hospital of Hunan College of Chinese Medicin was conducted.The patients were divided into the conventional group (n=36)and the combined group (n=40)according to the treatment plan.The conventional group was given Entecavir,and the combined group was given Shugan Jianpi Recipe on the basis of the conventional group.The treatment efficacy,the scores of traditional Chinese medicine syndrome,liver function,liver fibrosis,cellular immune function before and 3 months after treatment,hepatitis B virus DNA content(HBV DNA)negative rate and the total incidence of adverse reactions of the two groups were compared.Results The total effective rate of the combined group was higher than that of the conventional group,the difference was statistically significant(P＜0.05).After treatment,the scores of traditional Chinese medicine syndromes in the two groups were lower than those before treatment,the differences were statistically significant(P＜0.05).And the scores of traditional Chinese medicine syndromes in the combined group after treatment was lower than the conventional group,the differences were statistically significant(P＜0.05).The levels of total bilirubin (TBIL),aspartate aminotransferase(AST),hyaluronic acid(HA),laminin(LN),pre-Ⅲ collagen peptide(PC-Ⅲ),type Ⅳ collagen(Ⅳ-C),cytotoxic T cell(CD8＋)after treatment in the two groups were lower than those before treatment,and the levels of TBIL,AST,HA,LN,PC-Ⅲ,Ⅳ-C,CD8＋of the combined group after treatment were lower than those of the conventional group,the differences were statistically significant(P＜0.05).After treatment,the levels of albumin(ALB),mature T lymphocytes(CD3＋),and helper T cells(CD4＋)after treatment in the two groups were higher than those before treatment,and the levels of ALB、CD3＋、CD4＋of the combined group after treatment were higher than those of the conventional group,the differences were statistically significant(P＜0.05).After treatment,the HBV DNA negative ratio in the combined group was higher than that in the conventional group,the difference was statistically significant(P＜0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P＞0.05).Conclusion Shugan Jianpi Recipe combined with Entecavir tablets in the treatment of liver depression and spleen deficiency syndrome of hepatitis B cirrhosis patients has ideal clinical effect,which can alleviate the clinical symptoms of patients,protect liver function,improve cellular immune function.

Key words： Shugan Jianpi Recipe Entecavir Syndrome of liver depression and spleen deficiency Hepatitis B cirrhosis

通讯作者: 袁通立（1969-），男，湖南株洲人，硕士，主任医师，肝胆胰脾外科科室主任，研究方向：肝胆胰脾外科。

作者简介: 刘峰（1993-），男，贵州遵义人，2019 年湖南中医药大学在读硕士研究生，研究方向：肝胆胰脾外科。

引用本文:

刘峰；李明；陈凯锋；袁通立. 疏肝健脾方联合恩替卡韦治疗肝郁脾虚证乙肝肝硬化患者的临床效果[J]. 中国当代医药, 2021, 28(31): 173-176转180.
LIU Feng；LI Ming；CHEN Kai-feng；YUAN Tong-li. Clinical efficacy of Shugan Jianpi Recipe combined with Entecavir in the treatment of hepatitis B cirrhosis patients with syndrome of liver depression and spleen deficiency. 中国当代医药, 2021, 28(31): 173-176转180.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2021/V28/I31/173

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