本文關(guān)鍵詞： 芪參二蓮湯 拉米夫定 慢性乙型病毒性肝炎 免疫因子水平 耐藥率　出處：《中華中醫(yī)藥學(xué)刊》2017年05期 　論文類型：期刊論文

【摘要】：目的:觀察芪參二蓮湯聯(lián)合拉米夫定對高病毒載量慢性乙型病毒性肝炎患者病毒學(xué)、血清學(xué)、肝功能、免疫因子及對核苷類抗病毒藥耐藥性的影響。方法:將納入標(biāo)準(zhǔn)的87例慢性乙型病毒性肝炎患者按照隨機數(shù)字表法分為治療組(44例)和對照組(43例),其中治療組給予芪參二蓮湯聯(lián)合拉米夫定治療,對照組給予拉米夫定治療,兩組患者均治療48周。觀察兩組患者治療前、后癥狀體征,病毒血清學(xué)及肝功能改變,免疫因子水平變化,及耐藥率比較,并觀察記錄兩組患者的不良反應(yīng)。結(jié)果:治療組總有效率為84.09%,對照組總有效率為67.44%,兩組療效比較差異有統(tǒng)計學(xué)意義(P0.05)。治療組經(jīng)12、24、48周治療后HBeAg轉(zhuǎn)陰數(shù)、HBeAg轉(zhuǎn)換數(shù)、HBsAg轉(zhuǎn)陰數(shù)、HBV-DNA轉(zhuǎn)陰例數(shù)與治療前比較,差異均具有統(tǒng)計學(xué)意義(P0.05)。兩組治療后ALT、AST、TBIL、ALB均較治療前下降,治療組治療12周、48周較治療前比較差異均具有明顯有統(tǒng)計學(xué)意義(P0.01),兩組治療后CD_3~+、CD_4~+、CD_4~+/CD_8~+、NK較前均上升,治療12周時較治療前均無明顯統(tǒng)計學(xué)差異(P0.05),治療48周時較治療前差異具有統(tǒng)計學(xué)意義(P0.05),兩組治療后12周時CD_8~+較治療前無明顯變化,不具統(tǒng)計學(xué)差異(P0.05),且組間比較差異無統(tǒng)計學(xué)意義(P0.05),兩組48周時CD_8~+較治療前下降,差異具有統(tǒng)計學(xué)意義(P0.05),治療組總耐藥率為11.31%;對照組總耐藥率為32.56%。兩組耐藥率比較差異具有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:芪參二蓮湯聯(lián)合拉米夫定不僅能夠更加顯著的抑制HBV-DNA復(fù)制,提高HBsAg、HBeAg轉(zhuǎn)陰率,有效改善肝功能,還能調(diào)節(jié)免疫功能、減少HBV耐藥變異,值得臨床進(jìn)一步大推廣應(yīng)用。
[Abstract]:Objective: to observe the effect of Qishen Erlian decoction combined with lamivudine on virology, serology and liver function in patients with chronic viral hepatitis B with high viral load. Immune factors and their effects on drug resistance of nucleoside antiviral poisons. Methods: 87 patients with chronic viral hepatitis B were randomly divided into treatment group (n = 44) and control group (n = 43). Qishen Erlian decoction combined with lamivudine was given. The patients in the control group were treated with lamivudine for 48 weeks. The symptoms and signs, the changes of viral serology and liver function, the level of immune factor and the rate of drug resistance were observed before and after treatment. Results: the total effective rate of the treatment group was 84.09, and the total effective rate of the control group was 67.44.The difference between the two groups was statistically significant (P 0.05). The number of negative cases of HBV-DNA conversion was compared with that before treatment. All the differences were statistically significant (P 0.05). After treatment, the levels of ALB in both groups were lower than those before treatment, and there were significant differences between the treatment group at 12 weeks and 48 weeks after treatment compared with those before treatment (P 0.01). After treatment, the levels of CD3 ~ +, CD4 ~ +, CD4 ~ +, CD8 ~ + -NK in the treatment group were higher than those before treatment, and there was no significant difference between the two groups after treatment. There was no significant difference between the two groups at 12 weeks after treatment (P 0.05), but at 48 weeks after treatment, the difference was statistically significant (P 0.05). There was no significant difference between the two groups at 12 weeks after treatment, and there was no significant difference between the two groups at 12 weeks after treatment compared with that before treatment, and there was no significant difference between the two groups at 12 weeks after treatment. There was no statistical difference (P 0.05), and there was no significant difference between the two groups (P 0.05). CD8 ~ + decreased at 48 weeks after treatment in the two groups. The difference was statistically significant (P 0.05), the total drug resistance rate was 11.31 in the treatment group and 32.56 in the control group. The difference between the two groups was statistically significant (P 0.05). Conclusion: Qishen Erlian decoction combined with lamivudine can significantly inhibit HBV-DNA replication. Improving HBeAg conversion rate, improving liver function, regulating immune function and reducing drug resistance variation of HBV are worthy of further popularizing in clinic.
【作者單位】： 武漢大學(xué)中南醫(yī)院中西醫(yī)結(jié)合科;黑龍江省中醫(yī)藥科學(xué)院南崗分院;
【基金】：黑龍江省科技廳科技攻關(guān)項目(GC12C120)
【分類號】：R512.62

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