恩替卡韦联合复方鳖甲软肝片治疗慢性乙型病毒性肝炎肝纤维化的临床疗效观察
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摘要
目的探讨恩替卡韦联合复方鳖甲软肝片治疗慢性乙型病毒性肝炎肝纤维化患者的临床疗效。方法收集慢性乙型病毒性肝炎肝纤维化患者资料100例,随机分为对照组和观察组,各50例,对照组口服恩替卡韦片,观察组在对照组基础上予以复方鳖甲软肝片进行治疗。观察两组患者治疗前后Th17细胞表面CXC亚族趋化因子受体3(CXCR3)、CC趋化因子受体6(CCR6)、CC趋化因子受体4(CCR4)表达水平及脾脏厚度、门静脉内径、人Ⅲ型前胶原(PC-Ⅲ)、Ⅳ型胶原(Ⅳ-C)、层粘连蛋白(LN)、透明质酸(HA)、谷氨酸转氨酶(ALT)、总胆红素(TBil)、乙肝病毒的脱氧核糖核酸(HBV-DNA)水平。结果治疗后,观察组患者的CXCR3、CCR6、CCR4表达百分率及TBil、ALT水平均明显低于对照组(均P<0.05);治疗后,观察组血清PC-Ⅲ、Ⅳ-C、LN、HA水平均明显低于对照组(均P<0.05);治疗后,观察组患者脾脏厚度、门静脉内径均明显低于对照组(均P<0.05);治疗后,两组患者HBV-DNA水平比较差异无统计学意义(P>0.05)。结论复方鳖甲软肝片联合恩替卡韦治疗慢性乙型病毒性肝炎肝纤维化可显著减轻肝纤维化病变程度,改善肝功能,下调CXCR3、CCR6、CCR4表达。
Objective To explore the clinical effects of entecavir combined with Compound Biejia Ruangan Tablet(复方鳖甲软肝片) in the treatment of chronic hepatitis B with hepatic fibrosis. Methods A total of 100 patients with chronic hepatitis B liver fibrosis were randomly divided into the control group and the observation group, with 50 cases in each group. The control group was given oral administration of entecavir tablets, and the observation group, on the basis of the control group, was given Compound Biejia Ruangan Tablet(复方鳖甲软肝片) treatment. The Th17 cell surface CXC chemokine receptor 3(CXCR3) and CC chemokine receptor 6(CCR6) and CC chemokine receptor 4(CCR4) expression level and the thickness of spleen, portal vein diameter, human procollagen type Ⅲ(PC-Ⅲ), collagen Ⅳ(Ⅳ-C), laminin(LN), hyaluronic acid(HA), alanine aminotransferase(ALT), total bilirubin Hormone(TBil), hepatitis B virus deoxyribonucleic acid(HBV-DNA) level of two groups before and after treatment were observed. Results After treatment, the CXCR3, CCR6, TBil, ALT and CCR4 expression percentage in the observation group were significantly lower than the control group(P<0.05); after treatment, the serum levels of PC-Ⅲ, LN, Ⅳ-C and HA were significantly lower than control group(P<0.05); after treatment, the spleen thickness, diameter of portal vein in the observation group were significantly lower than the control group(P<0.05); after treatment, there were no statistically significant differences in the levels of HBV-DNA in the two groups after treatment(P >0.05). Conclusion Compound Biejia Ruangan Tablet(复方鳖甲软肝片) combined with entecavir in the treatment of chronic hepatitis B liver fibrosis can significantly reduce the degree of liver fibrosis, improve liver function, down-regulate the percentage of CXCR3, CCR6, CCR4 expression.
Objective To explore the clinical effects of entecavir combined with Compound Biejia Ruangan Tablet(复方鳖甲软肝片) in the treatment of chronic hepatitis B with hepatic fibrosis. Methods A total of 100 patients with chronic hepatitis B liver fibrosis were randomly divided into the control group and the observation group, with 50 cases in each group. The control group was given oral administration of entecavir tablets, and the observation group, on the basis of the control group, was given Compound Biejia Ruangan Tablet(复方鳖甲软肝片) treatment. The Th17 cell surface CXC chemokine receptor 3(CXCR3) and CC chemokine receptor 6(CCR6) and CC chemokine receptor 4(CCR4) expression level and the thickness of spleen, portal vein diameter, human procollagen type Ⅲ(PC-Ⅲ), collagen Ⅳ(Ⅳ-C), laminin(LN), hyaluronic acid(HA), alanine aminotransferase(ALT), total bilirubin Hormone(TBil), hepatitis B virus deoxyribonucleic acid(HBV-DNA) level of two groups before and after treatment were observed. Results After treatment, the CXCR3, CCR6, TBil, ALT and CCR4 expression percentage in the observation group were significantly lower than the control group(P<0.05); after treatment, the serum levels of PC-Ⅲ, LN, Ⅳ-C and HA were significantly lower than control group(P<0.05); after treatment, the spleen thickness, diameter of portal vein in the observation group were significantly lower than the control group(P<0.05); after treatment, there were no statistically significant differences in the levels of HBV-DNA in the two groups after treatment(P >0.05). Conclusion Compound Biejia Ruangan Tablet(复方鳖甲软肝片) combined with entecavir in the treatment of chronic hepatitis B liver fibrosis can significantly reduce the degree of liver fibrosis, improve liver function, down-regulate the percentage of CXCR3, CCR6, CCR4 expression.
引文
[1]梅玉峰,熊钻,刘萍,等.慢性乙肝患者HBVDNA载量及肝纤维化相关性分析[J].临床血液学杂志(输血与检验), 2015, 28(2):309-311.
[2]蒋淑莲,吴民祥,文剑.虎踞乙肝胶囊联合阿德福韦酯抗慢性乙肝肝纤维化的临床研究[J].辽宁中医杂志, 2015, 42(5):1031-1033.
[3]陈衍秋,陈卫庆,梁伟峰,等.恩替卡韦治疗对慢性乙型肝炎肝纤维化指标和血浆细胞因子的影响[J].中华临床感染病杂志,2012, 5(3):167-169.
[4]倪艳,邓存良.复方鳖甲软肝片联合阿德福韦酯治疗慢性乙肝纤维化的临床观察[J].国外医药抗生素分册, 2012, 33(4):163-165.
[5]赵静,王政医.复方甘草酸苷注射液联合丹参粉针治疗慢性乙肝肝纤维化的疗效观察[J].世界中西医结合杂志, 2016, 11(7):999-1001.
[6]中国中西医结合学会肝病专业委员会, LiverDiseaseCommittee.肝纤维化中西医结合诊疗指南[J].药品评价, 2007,(4):260-264.
[7]金磊,张纪元,孙红启,等. Th 17细胞在乙肝肝硬化患者中的免疫致病机制研究[J].解放军医学杂志, 2013, 38(1):62-65.
[8]刘艳琼,杨小安,邹勇,等.慢乙肝患者外周血中Th17细胞趋化因子受体的表达水平[J].中华实验和临床病毒学杂志, 2014, 28(3):161-163.
[9]孙立华,朱斌,周艳彩,等. Th17细胞表面CCR4、CCR6、CXCR3表达量检测对慢性乙型肝炎患者病情评估的价值[J].中国现代医学杂志, 2017, 27(3):69-73.
[10]朱琼香,李小丹.阿德福韦酯联合复方鳖甲软肝片治疗慢性乙型肝炎患者临床疗效观察[J].实用肝脏病杂志, 2015, 18(3):258-261.
[11]张弦,蒋伟,甘建和,等.恩替卡韦治疗慢性乙型肝炎的疗效及其对外周血调节性T细胞水平的影响[J].山东医药, 2016, 56(34):42-44.
[12]夏建萍,应豪.复方丹参片联合恩替卡韦对乙型肝炎肝硬化患者血清降钙素原及肝纤维化标志物影响研究[J].中国生化药物杂志, 2016, 36(3):122-124.
[13]杨年欢,袁国盛,周宇辰,等.恩替卡韦联合复方鳖甲软肝片治疗慢性乙型肝炎肝纤维化96周的临床疗效[J].南方医科大学学报, 2016, 36(6):775-779.
[14]段雪琳,黎桂玉,李树民,等.复方鳖甲软肝片联合恩替卡韦对慢性乙型肝炎血清肝纤维化标志物影响的Meta分析[J].中国医院药学杂志, 2015, 35(19):1762-1765.
[15]吴刚,何鸿雁,李烨,等.复方鳖甲软肝片联合恩替卡韦对HBV相关肝硬化患者的临床疗效观察[J].中华肝脏病杂志, 2014,22(8):604-608.
[2]蒋淑莲,吴民祥,文剑.虎踞乙肝胶囊联合阿德福韦酯抗慢性乙肝肝纤维化的临床研究[J].辽宁中医杂志, 2015, 42(5):1031-1033.
[3]陈衍秋,陈卫庆,梁伟峰,等.恩替卡韦治疗对慢性乙型肝炎肝纤维化指标和血浆细胞因子的影响[J].中华临床感染病杂志,2012, 5(3):167-169.
[4]倪艳,邓存良.复方鳖甲软肝片联合阿德福韦酯治疗慢性乙肝纤维化的临床观察[J].国外医药抗生素分册, 2012, 33(4):163-165.
[5]赵静,王政医.复方甘草酸苷注射液联合丹参粉针治疗慢性乙肝肝纤维化的疗效观察[J].世界中西医结合杂志, 2016, 11(7):999-1001.
[6]中国中西医结合学会肝病专业委员会, LiverDiseaseCommittee.肝纤维化中西医结合诊疗指南[J].药品评价, 2007,(4):260-264.
[7]金磊,张纪元,孙红启,等. Th 17细胞在乙肝肝硬化患者中的免疫致病机制研究[J].解放军医学杂志, 2013, 38(1):62-65.
[8]刘艳琼,杨小安,邹勇,等.慢乙肝患者外周血中Th17细胞趋化因子受体的表达水平[J].中华实验和临床病毒学杂志, 2014, 28(3):161-163.
[9]孙立华,朱斌,周艳彩,等. Th17细胞表面CCR4、CCR6、CXCR3表达量检测对慢性乙型肝炎患者病情评估的价值[J].中国现代医学杂志, 2017, 27(3):69-73.
[10]朱琼香,李小丹.阿德福韦酯联合复方鳖甲软肝片治疗慢性乙型肝炎患者临床疗效观察[J].实用肝脏病杂志, 2015, 18(3):258-261.
[11]张弦,蒋伟,甘建和,等.恩替卡韦治疗慢性乙型肝炎的疗效及其对外周血调节性T细胞水平的影响[J].山东医药, 2016, 56(34):42-44.
[12]夏建萍,应豪.复方丹参片联合恩替卡韦对乙型肝炎肝硬化患者血清降钙素原及肝纤维化标志物影响研究[J].中国生化药物杂志, 2016, 36(3):122-124.
[13]杨年欢,袁国盛,周宇辰,等.恩替卡韦联合复方鳖甲软肝片治疗慢性乙型肝炎肝纤维化96周的临床疗效[J].南方医科大学学报, 2016, 36(6):775-779.
[14]段雪琳,黎桂玉,李树民,等.复方鳖甲软肝片联合恩替卡韦对慢性乙型肝炎血清肝纤维化标志物影响的Meta分析[J].中国医院药学杂志, 2015, 35(19):1762-1765.
[15]吴刚,何鸿雁,李烨,等.复方鳖甲软肝片联合恩替卡韦对HBV相关肝硬化患者的临床疗效观察[J].中华肝脏病杂志, 2014,22(8):604-608.