安络化纤丸和恩替卡韦联合治疗对乙型肝炎肝硬化代偿期患者肝纤维化和炎性因子的影响
|
摘要
目的探讨安络化纤丸和恩替卡韦联合治疗对乙型肝炎肝硬化代偿期患者肝纤维化和炎性因子的影响。方法选择2016年1月至2017年12月新乡医学院第三附属医院收治的124例乙型肝炎肝硬化代偿期患者为研究对象,根据治疗方法将患者分为观察组64例和对照组60例,所有患者给予常规保肝治疗,在常规治疗基础上,对照组患者给予恩替卡韦治疗,观察组患者给予安络化纤丸联合恩替卡韦治疗,疗程均为24周。2组患者分别于治疗前、后采用酶联免疫吸附试验法检测血清透明质酸(HA)、层黏蛋白(LN)、Ⅲ型前胶原肽(PⅢP)、Ⅳ型胶原蛋白(Ⅳ-C)、肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)水平,采用胶乳免疫比浊法检测血清超敏C反应蛋白(hs-CRP)水平,应用Fibro Scan~?502型无创肝纤维化诊断仪测定肝脏硬度(LS)。结果治疗前2组患者血清HA、PⅢP、LN、Ⅳ-C、TNF-α、IL-6及hs-CRP水平比较差异均无统计学意义(P>0.05),2组患者治疗后血清HA、PⅢP、LN、Ⅳ-C、TNF-α、IL-6及hs-CRP水平显著低于治疗前(P<0.05);治疗后,观察组患者血清HA、PⅢP、LN、Ⅳ-C、TNF-α、IL-6及hs-CRP水平显著低于对照组(P<0.05)。治疗前2组患者LS比较差异无统计学意义(P>0.05),2组患者治疗后LS显著低于治疗前(P<0.05);治疗后,观察组患者LS显著低于对照组(P<0.05)。结论安络化纤丸联合恩替卡韦治疗乙型肝炎肝硬化代偿期患者可有效减轻炎症反应和肝纤维化。
Objective To investigate the effect of Anluo Huaxian Wan combined with entecavir on the liver fibrosis and inflammatory factors in patients with compensatory hepatitis B cirrhosis. Methods A total of 124 patients with compensatory hepatitis B cirrhosis admitted to the Third Affiliated Hospital of Xinxiang Medical University from January 2016 to December2017 were selected as the research objects,and the patients were divided into observation group( n = 64) and control group( n = 60) according to the treatment methods. All patients were given routine hepatoprotective treatment. On the basis of routine treatment,the patients in the control group were treated with entecavir,while the patients in the observation group were treated with Anluo Huaxian Wan and entecavir for 24 weeks. The levels of serum hyaluronic acid( HA),laminin( LN),type III procollagen( PⅢP),type IV collagen( IV-C),tumor necrosis factor-α( TNF-α) and interleukin-6( IL-6) of the patients in the two groups were detected by enzyme linked immunosorbent assay before and after treatment. The level of serum hypersensitive C-reactive protein( hs-CRP) were detected by latex immunoturbidimetry,and the liver stiffness( LS) was measured by Fibro Scan ~? 502 ultrasonic diagnostic equipment. Results There was no significant difference in the levels of serum HA,PⅢP,LN,IV-C,TNF-α,IL-6 and hs-CRP between the two groups before treatment( P > 0. 05). The levels of serum HA,PⅢP,LN,IV-C,TNF-α,IL-6 and hs-CRP after treatment were significantly lower than those before treatment in the two groups( P < 0. 05). The levels of serum HA,P Ⅲ P,LN,IV-C,TNF-α,IL-6 and hs-CRP in the observation group were significantly lower than those in the control group after treatment( P < 0. 05). There was no significant difference in LS between the two groups before treatment( P > 0. 05). The LS after treatment was significantly lower than that before treatment in the two groups( P < 0. 05). The LS in the observation group was significantly lower than that in the control group after treatment( P < 0. 05). Conclusion Anluo Huaxian Wan combined with entecavir can effectively alleviate inflammation reaction and liver fibrosis in patients with compensatory hepatitis B cirrhosis.
Objective To investigate the effect of Anluo Huaxian Wan combined with entecavir on the liver fibrosis and inflammatory factors in patients with compensatory hepatitis B cirrhosis. Methods A total of 124 patients with compensatory hepatitis B cirrhosis admitted to the Third Affiliated Hospital of Xinxiang Medical University from January 2016 to December2017 were selected as the research objects,and the patients were divided into observation group( n = 64) and control group( n = 60) according to the treatment methods. All patients were given routine hepatoprotective treatment. On the basis of routine treatment,the patients in the control group were treated with entecavir,while the patients in the observation group were treated with Anluo Huaxian Wan and entecavir for 24 weeks. The levels of serum hyaluronic acid( HA),laminin( LN),type III procollagen( PⅢP),type IV collagen( IV-C),tumor necrosis factor-α( TNF-α) and interleukin-6( IL-6) of the patients in the two groups were detected by enzyme linked immunosorbent assay before and after treatment. The level of serum hypersensitive C-reactive protein( hs-CRP) were detected by latex immunoturbidimetry,and the liver stiffness( LS) was measured by Fibro Scan ~? 502 ultrasonic diagnostic equipment. Results There was no significant difference in the levels of serum HA,PⅢP,LN,IV-C,TNF-α,IL-6 and hs-CRP between the two groups before treatment( P > 0. 05). The levels of serum HA,PⅢP,LN,IV-C,TNF-α,IL-6 and hs-CRP after treatment were significantly lower than those before treatment in the two groups( P < 0. 05). The levels of serum HA,P Ⅲ P,LN,IV-C,TNF-α,IL-6 and hs-CRP in the observation group were significantly lower than those in the control group after treatment( P < 0. 05). There was no significant difference in LS between the two groups before treatment( P > 0. 05). The LS after treatment was significantly lower than that before treatment in the two groups( P < 0. 05). The LS in the observation group was significantly lower than that in the control group after treatment( P < 0. 05). Conclusion Anluo Huaxian Wan combined with entecavir can effectively alleviate inflammation reaction and liver fibrosis in patients with compensatory hepatitis B cirrhosis.
引文
[1]周文红,颜华东.乙型肝炎肝硬化流行病学调查及预后影响因素分析[J].中国预防医学杂志,2018,19(12):3-6.
[2]恩替卡韦临床应用专家委员会.恩替卡韦临床应用专家共识:2015年更新[J].中国肝脏病杂志:电子版,2015,7(2):19-25.DOI:10.3969./j.issn.1674-7380.2015.02.003.
[3]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南:2015年更新版[J].中华肝脏病杂志,2015,23(12):888-905.
[4]雷蕾,李良平,李琴,等.乙型肝炎肝硬化患者肝脏病变的相关因素研究[J].中国现代医学杂志,2016,26(4):54-57.
[5]魏占芳,武永萍,马莉莎,等.彩色多普勒超声半定量评分对慢性乙型病毒性肝炎早期肝硬化的诊断价值[J].新乡医学院学报,2017,34(1):47-49.
[6]ZACHARIAE H,HEICKENDORFF L,SOGAARD H.The value of aminoterminal propeptide of type III procollageninroutine screening for methotrexate induced liver fibrosis:a 10-year follow-up[J].Br J Dermatol,2001,144(1):100-103.
[7]DULTZ G,GERBER L,FARNIK H,et al.Soluble CD163 is an indicator of liver inflammation and fibrosis in patients chronically infected with the hepatitis B virus[J].J Viral Hepat,2015,22(4):427-432.
[8]王贺,王千钧,孙风波,等.恩替卡韦联合扶正化瘀胶囊对代偿期慢性乙型肝炎肝硬化患者炎性因子及纤维化指标的影响[J].临床肝胆病杂志,2016,32(9):1734-1738.
[9]张影,童霞,许晓梅.血清hs-CRP联合肝硬度检查在老年肝硬化合并肝癌患者中的诊断价值[J].实用老年医学,2016,30(6):472-474.
[10]GERBER L,FRIEDRICH-RUST M.Non-invasive evaluation of liver fibrosis:2-D shear wave elastogrphy,transient elastography or acoustic radiation force impulse imaging[J].Ultrasound Med Biol,2016,42(12):3053.
[11]孙鑫,彭渊,吕靖,等.中西医结合有效逆转乙肝肝纤维化的目标人群特征和作用机制[J].世界中医药,2018,13(11):2906-2910.
[12]刘桃,宋启琴,孔红言,等.愈肝龙胶囊联合恩替卡韦治疗慢性乙型肝炎肝纤维化30例[J].医药导报,2018,37(11):1352-1355.
[13]KIM J H,PARK Y K,PARK E S,et al.Molecular diagnosis and treatment of drug-resistant hepatitis B virus[J].World J Gastroenterol,2014,20(19):5708-5720.
[14]聂红明,王灵台.安络化纤丸抗肝纤维化的研究进展[J].中西医结合肝病杂志,2016,26(3):185-187.
[15]谭行华,李常青,邹尚荣,等.安络化纤丸对二甲基亚硝胺诱导大鼠肝纤维化的抑制作用[J].中华肝脏病杂志,2010,18(1):9-12.
[2]恩替卡韦临床应用专家委员会.恩替卡韦临床应用专家共识:2015年更新[J].中国肝脏病杂志:电子版,2015,7(2):19-25.DOI:10.3969./j.issn.1674-7380.2015.02.003.
[3]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南:2015年更新版[J].中华肝脏病杂志,2015,23(12):888-905.
[4]雷蕾,李良平,李琴,等.乙型肝炎肝硬化患者肝脏病变的相关因素研究[J].中国现代医学杂志,2016,26(4):54-57.
[5]魏占芳,武永萍,马莉莎,等.彩色多普勒超声半定量评分对慢性乙型病毒性肝炎早期肝硬化的诊断价值[J].新乡医学院学报,2017,34(1):47-49.
[6]ZACHARIAE H,HEICKENDORFF L,SOGAARD H.The value of aminoterminal propeptide of type III procollageninroutine screening for methotrexate induced liver fibrosis:a 10-year follow-up[J].Br J Dermatol,2001,144(1):100-103.
[7]DULTZ G,GERBER L,FARNIK H,et al.Soluble CD163 is an indicator of liver inflammation and fibrosis in patients chronically infected with the hepatitis B virus[J].J Viral Hepat,2015,22(4):427-432.
[8]王贺,王千钧,孙风波,等.恩替卡韦联合扶正化瘀胶囊对代偿期慢性乙型肝炎肝硬化患者炎性因子及纤维化指标的影响[J].临床肝胆病杂志,2016,32(9):1734-1738.
[9]张影,童霞,许晓梅.血清hs-CRP联合肝硬度检查在老年肝硬化合并肝癌患者中的诊断价值[J].实用老年医学,2016,30(6):472-474.
[10]GERBER L,FRIEDRICH-RUST M.Non-invasive evaluation of liver fibrosis:2-D shear wave elastogrphy,transient elastography or acoustic radiation force impulse imaging[J].Ultrasound Med Biol,2016,42(12):3053.
[11]孙鑫,彭渊,吕靖,等.中西医结合有效逆转乙肝肝纤维化的目标人群特征和作用机制[J].世界中医药,2018,13(11):2906-2910.
[12]刘桃,宋启琴,孔红言,等.愈肝龙胶囊联合恩替卡韦治疗慢性乙型肝炎肝纤维化30例[J].医药导报,2018,37(11):1352-1355.
[13]KIM J H,PARK Y K,PARK E S,et al.Molecular diagnosis and treatment of drug-resistant hepatitis B virus[J].World J Gastroenterol,2014,20(19):5708-5720.
[14]聂红明,王灵台.安络化纤丸抗肝纤维化的研究进展[J].中西医结合肝病杂志,2016,26(3):185-187.
[15]谭行华,李常青,邹尚荣,等.安络化纤丸对二甲基亚硝胺诱导大鼠肝纤维化的抑制作用[J].中华肝脏病杂志,2010,18(1):9-12.