标题：疏肝理气方联合恩替卡韦治疗慢性乙型肝炎疗效观察

      作者：詹怀勇 1，梁平 1，秦东平 2    1.大荔县医院感染性疾病科，陕西 渭南 715100；2.蒲城县中医医院内科，陕西 渭南 715500

      卷次： 2021年32卷13期

      【摘要】 目的 观察疏肝理气方联合恩替卡韦治疗慢性乙型肝炎的临床效果。方法 回顾性选取大荔县医院于2015年4月至2020年4月收治的慢性乙型肝炎患者60例，根据治疗方法分为对照组和观察组，每组30例。对照组采用恩替卡韦治疗，观察组采用自拟疏肝理气方联合恩替卡韦治疗，两组均连续治疗6个月。比较两组患者治疗前后的中医症候积分、肝脾影像学指标、丙氨酸转移酶(ALT)、天冬氨酸氨基转移酶(AST)、HBeAg及淋巴细胞穿孔素(PRF)、颗粒酶B (GrzB)阳性细胞率变化，并统计两组患者的乙型肝炎e抗原(HBeAg)血清应答率。结果 观察组患者的的HBeAg血清总应答率为93.33%，明显高于对照组的73.33%，差异有统计学意义(P<0.05)；治疗后，观察组患者的中医症候积分为(4.78±0.81)分，明显低于对照组的(6.34±0.57)分，差异有统计学意义(P<0.05)；治疗后，观察组和对照组患者的门静脉直径[(11.17±1.05) mm vs (12.85±1.23) mm]、脾静脉直径[(9.66±0.57) mm vs (10.13±1.13) mm]、脾厚[(37.25±3.16) mm vs (41.17±3.23) mm]比较，观察组明显优于对照组，差异均有统计学意义(P<0.05)；治疗后，观察组和对照组患者的血清ALT [(41.25±8.33) U/L vs (54.85±12.24) U/L]、AST [(34.02±5.96) U/L vs (48.36±6.89) U/L]、HBeAg [(321.69±85.17) s/co vs (472.25±124.02) s/co]水平比较，观察组明显低于对照组，差异均有统计学意义(P<0.05)，而外周血淋巴细胞 PRF阳性细胞率[(19.86±3.68)% vs (15.89±3.47)%]、GrzB阳性细胞率[(34.12±3.68)% vs (30.67±4.79)%]比较，观察组明显高于对照组，差异均有统计学意义(P<0.05)。结论 疏肝理气方联合恩替卡韦治疗慢性乙型肝炎可改善患者的肝功能，降低外周血淋巴细胞 PRF、GrzB阳性细胞率，减轻症状，提高HBeAg血清学应答率。
      【关键词】 疏肝理气方；恩替卡韦；慢性乙型肝炎；肝功能；乙型肝炎e抗原；症状
      【中图分类号】 R512.6+2 【文献标识码】 A 【文章编号】 1003—6350（2021）13—1648—04

Effect of Shugan Liqi prescription combined with entecavir in the treatment of patients with chronic hepatitis B.ZHAN Huai-yong 1, LIANG Ping 1, QIN Dong-ping 2.
1. Department of Infectious Diseases, Dali County Hospital, Weinan715100, Shaanxi, CHINA; 2. Department of Internal Medicine, Pucheng County Hospital of Traditional Chinese Medicine,Weinan 715500, Shaanxi, CHINA
【Abstract】 Objective To observe the effect of Shugan Liqi prescription (recipe for soothing the liver and regu-lating Qi) combined with entecavir in the treatment of chronic hepatitis B. Methods Sixty patients with chronic hepati-tis B admitted to Dali County Hospital from April 2015 to April 2020 were selected and divided into control group andobservation group according to the treatment method, with 30 patients in each group. The control group was treated withentecavir, and the observation group was treated with self-made Shugan Liqi prescription combined with entecavir. Bothgroups were treated for 6 months continuously. The TCM syndrome scores, liver and spleen imaging indicators, alaninetransferase (ALT), aspartate aminotransferase (AST), hepatitis B e antigen (HBeAg), lymphocyte perforin (PRF), andchanges of granzyme B (GrzB)-positive cell rate before and after treatment were compared between the two groups. Theserum response rate of HBeAg was recorded in the two groups. Results The total serum response rate of HBeAg inthe observation group was 93.33%, which was significantly higher than 73.33% of the control group (P<0.05); aftertreatment, the TCM syndrome score of the observation group was (4.78±0.81) points, significantly lower than (6.34±0.57) points of the control group (P<0.05); after treatment, the portal vein diameter, splenic vein diameter, splenic thick-ness of the observation group were significantly better than those in the control group (P<0.05): (11.17±1.05) mm vs(12.85±1.23) mm; (9.66±0.57) mm vs (10.13±1.13) mm; (37.25±3.16) mm vs (41.17±3.23) mm. After treatment, serumALT, AST, HBeAg levels in the observation group was significantly lower than those in the control group (P<0.05):ALT, (41.25±8.33) U/L vs (54.85±12.24) U/L; AST, (34.02±5.96) U/L vs (48.36±6.89) U/L; HBeAg, (321.69±85.17) s/covs (472.25±124.02) s/co, while the PRF-positive cell rate of peripheral blood lymphocytes and the GrzB-positive cell ratewere significantly higher than those in the control group (P<0.05): (19.86±3.68)% vs (15.89±3.47)%; (34.12±3.68)% vs(30.67±4.79)%. Conclusion Shugan Liqi prescription combined with entecavir in the treatment of chronic hepatitis Bcan improve the liver function of patients, reduce the rate of PRF- and GrzB-positive cells in peripheral blood lympho-cytes, relieve symptoms, and increase the HBeAg serological response rate.
      【Key words】 Shugan Liqi prescription; Entecavir; Chronic hepatitis B; Liver function; Hepatitis B e antigen(HBeAg); Symptoms