本文關(guān)鍵詞： 肝炎乙型慢性 肝纖維化 久病入絡(luò) 抗病毒 抗肝纖維化 免疫調(diào)節(jié)　出處：《浙江中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的觀察“逍遙散加減”對慢性乙型肝炎抗肝纖維化及抗病毒的療效,總結(jié)名老中醫(yī)學(xué)術(shù)經(jīng)驗。研究方法將符合納入標(biāo)準(zhǔn)的60名患者,采用隨機(jī)數(shù)字表法分為治療組和對照組,每組各30例,治療組采用恩替卡韋片聯(lián)合“逍遙散加減方”,對照組單用恩替卡韋片。中藥每日一劑,每劑煎200ml,早晚兩次分服;恩替卡韋片(博路定),每日0.5mg一次口服(博路定-中美上海施貴寶生產(chǎn),規(guī)格0.5mg/片)。療程為48周,對比LSM、FIB-4指數(shù)、肝纖維化四項,血清HBsAg含量、E抗原、HBV-DNA載量,ALT、C3、C4、IgG、CD19、CD3+4陽性T細(xì)胞(CD4)、CD3+8陽性T細(xì)胞(CD8)等情況。研究結(jié)果(1)生化、病毒血清、免疫學(xué)相關(guān)指標(biāo):治療48周后比較,ALT:與基線比較,兩組的ALT值均能得到顯著改善,與對照組比較,治療組在療程及療效上更突顯優(yōu)勢,差異有統(tǒng)計學(xué)意義(P0.05)。肝纖維化四項:與基線比較,兩組纖維化四項均有下降(P0.05),與對照組比較,治療組對肝纖維四項的改善更明顯(P0.05)。HBsAg含量:與基線比較,兩組均有改善(P0.05);與對照組比較差異無統(tǒng)計學(xué)意義(P0.05)。e抗原:與對照組比較,48周治療組e抗原血清學(xué)轉(zhuǎn)換率高(P0.05)。HBV-DNA載量:與基線比較,兩組HBVDNA明顯下降,差異均有統(tǒng)計學(xué)意義(P0.05),與對照組比較,治療組結(jié)果亦有統(tǒng)計學(xué)差異(P0.05)。FIB-4:與基線比較,兩組FIB-4均有改善(P0.05),與對照組比較,治療組在療程及療效上差異更明顯(P0.01)。CD4、CD8:與基線以及對照組比較,48周后治療組血清CD4、CD8水平升高,差異均有統(tǒng)計學(xué)意義(P0.05)。C3、C4:與基線比較,48周后治療組補體C3、C4、水平升高;與對照組比較,治療組C3在48周后增高,差異均有統(tǒng)計學(xué)意義(P0.05)。IgG:與對照組比較,治療后組血清IgG含量降低,差異有統(tǒng)計學(xué)意義(P0.05)。(2)影像學(xué)指標(biāo):LSM:與基線比較,48周后兩組肝臟硬度均下降,差異有統(tǒng)計學(xué)意義(P0.05),與對照組比較,治療組48周后肝硬度改善更確切,差異有統(tǒng)計學(xué)意義(P0.05)。(3)中醫(yī)量化積分判定療效:治療48周后,與對照組比較,治療組總顯效率顯著高于對照組(P0.001)。研究結(jié)論(1)逍遙散加減治療經(jīng)ETV抗病毒的CHB患者對肝纖維化有良好的改善、緩解作用。(2)“中西聯(lián)合”治療CHB患者抗肝纖維化療效及抗病毒作用較單用抗病毒藥治療優(yōu)越,更能改善CHB患者生活質(zhì)量。(3)LSM、FIB-4值與HBsAg含量、HBV-DNA載量有一定的的科學(xué)正性相關(guān)性,可以從HBsAg含量、HBV-DNA載量間接預(yù)測肝纖維化程度。(4)CD4、CD8、C3、C4水平以及IgG反映體液免疫和細(xì)胞免疫在CHB疾病過程中發(fā)揮作用,中藥可以從體液免疫和細(xì)胞免疫雙方調(diào)節(jié)機(jī)體免疫功能而發(fā)揮抗纖維化和抗病毒作用。(5)施**教授辨治慢乙肝肝纖維化的理、法、方、藥特點:病因涵蓋“邪毒、瘀、濕、滯、熱”;病位涉及中下焦氣分、血分;病機(jī)包括肝脾不調(diào)、濕瘀入絡(luò)、絡(luò)分氣血不足;方藥以逍遙散等為主隨證治之。
[Abstract]:Objective to observe the curative effect of "Xiaoyao San" on chronic hepatitis B (CHB) and to summarize the academic experience of old Chinese medicine (TCM). The research method will meet the inclusion criteria of 60 patients. The treatment group was divided into treatment group and control group with 30 cases in each group. The treatment group was treated with entecavir tablets combined with "Xiaoyao San decoction", and the control group was only treated with entecavir tablet once a day. Each dose fried 200ml, morning and evening twice divided; Entecavir tablets (Borudine, 0.5mg per day) were produced in Shanghai, China, with a specification of 0.5mg / tablet. The course of treatment was 48 weeks, compared with the LSM FIB-4 index. The contents of serum HBsAg and HBV-DNA in serum of liver fibrosis were compared with that of T cell CD19, CD34 positive T cell (CD19 + CD34). CD3 8 positive T cell CD8). The results were as follows: biochemical, viral serum and immunological indexes: after 48 weeks of treatment, alt was compared with baseline. Compared with the control group, the treatment group had more significant advantages in the course of treatment and curative effect, the difference was statistically significant (P 0.05). Four items of hepatic fibrosis: compared with baseline. Compared with the control group, the improvement of liver fiber in the treatment group was more obvious than that in the control group. The content of P0.05 + HBsAg in the treatment group was higher than that in the baseline. The improvement of P0.05 was found in both groups. Compared with the control group, there was no significant difference in P0.05. E antigen: compared with the control group. At 48 weeks, the serological conversion rate of e antigen in the treatment group was higher than that in the control group (P 0.05). HBV-DNA load: compared with the baseline, the HBVDNA of the two groups was significantly lower than that of the baseline, and the difference was statistically significant (P 0.05). Compared with the control group, the results of the treatment group were also statistically different. FIB-4: compared with the baseline, the two groups of FIB-4 improved P0.05, compared with the control group. Compared with baseline group and control group, the serum CD4 + CD8 level in treatment group was higher than that in baseline and control group after 48 weeks. The difference was statistically significant (P 0.05). C3C4: compared with baseline, the level of C3C4 in the treatment group increased after 48 weeks. Compared with the control group, C3 in the treatment group increased after 48 weeks, the difference was statistically significant (P 0.05). Compared with the control group, the serum IgG content in the treatment group was lower than that in the control group. The difference was statistically significant (P0.05n. 2) Imaging index: LSM: compared with the baseline, the liver hardness of the two groups decreased after 48 weeks, and the difference was statistically significant (P0.05). Compared with the control group, the improvement of liver hardness in the treatment group was more accurate after 48 weeks, the difference was statistically significant (P 0.05. 01. 3) the therapeutic effect was determined by the quantitative integral of TCM: after 48 weeks of treatment, the treatment group was compared with the control group. The total effective rate in the treatment group was significantly higher than that in the control group (P 0.001). Conclusion: Xiaoyao Powder has a good improvement on liver fibrosis in CHB patients treated with ETV antivirus. The effect of "Chinese and Western combination" in treating CHB patients with liver fibrosis and antiviral effects is superior to that of antiviral drugs alone, and can improve the quality of life of patients with CHB. There is a scientific positive correlation between FIB-4 and HBsAg content and HBV-DNA load, which can be derived from the content of HBsAg. The HBV-DNA load indirectly predicted the degree of hepatic fibrosis. The level of CD8C3N4 and IgG reflect the role of humoral immunity and cellular immunity in the process of CHB disease. Traditional Chinese medicine can regulate the immune function of both humoral and cellular immunity and exert anti-fibrosis and antiviral effects. Drug characteristics: the etiology covers "evil poison, stasis, dampness, stagnation, heat"; The disease location involves middle and lower pyrogas, blood; The pathogenesis includes liver and spleen unregulation, dampness and blood stasis into the collaterals, insufficient collaterals and qi and blood; Prescription to Xiaoyao Powder and other main with the treatment of syndrome.
【學(xué)位授予單位】：浙江中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R512.62

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