本文關(guān)鍵詞：健脾活血解毒法聯(lián)合恩替卡韋治療HBeAg陰性慢性乙型肝炎66例臨床觀察　出處：《山東中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 慢性乙型病毒性肝炎 健脾活血解毒法 中醫(yī)證候 恩替卡韋

【摘要】：背景:我國(guó)慢性HBV感染者約9300萬(wàn)人,其中慢性乙型肝炎患者約2000萬(wàn)例。自1992年我國(guó)實(shí)行新生兒接種乙肝疫苗以來(lái),乙肝感染率已大幅下降,但我國(guó)乙肝發(fā)病人口基數(shù)大,鄉(xiāng)村醫(yī)療條件差,這都制約著乙肝預(yù)防治療工作的開(kāi)展,故有效防治乙肝仍是我國(guó)醫(yī)療衛(wèi)生的難題之一�，F(xiàn)代醫(yī)學(xué)治療乙肝主要以干擾素及核苷(酸)類似物抗病毒為主。但有其嚴(yán)格的臨床應(yīng)用指征,且存在病毒學(xué)不應(yīng)答、病毒變異、病毒學(xué)突破等問(wèn)題。中成藥種類繁多,主要以甘草酸制劑、水飛薊素等藥物為主,但由于缺乏臨床辨證的精確性及循證醫(yī)學(xué)的Ⅰ級(jí)證據(jù),目前《慢性乙型肝炎防治指南》(2015年版),已不再推薦。中醫(yī)藥作為中華的瑰寶,經(jīng)久而不衰,在疾病治療方面有著獨(dú)道的優(yōu)勢(shì),深入挖掘中醫(yī)藥治療慢性乙肝的方法,并探索中西醫(yī)聯(lián)合治療的思路,是我們今后研究乙肝的重中之重。近年國(guó)內(nèi)外不少文獻(xiàn)接踵報(bào)道在慢性乙型肝炎的防治中,應(yīng)用中醫(yī)藥辨證用藥聯(lián)合抗病毒治療其療效明顯優(yōu)于單用抗病毒藥,為我們防治慢乙肝開(kāi)拓了新思路。目的:觀察健脾活血解毒法聯(lián)合恩替卡韋治療HBe Ag陰性慢性乙型肝炎的臨床療效,探索提出中西醫(yī)結(jié)合治療HBe Ag陰性慢性乙型肝炎有效方案。方法:66例就診于山東中醫(yī)藥大學(xué)附屬醫(yī)院肝病科門診HBe Ag陰性慢性乙型肝炎患者,隨機(jī)分成兩組,即試驗(yàn)組和對(duì)照組。試驗(yàn)組采用健脾活血解毒法,予以中藥復(fù)方肝榮湯聯(lián)合恩替卡韋;對(duì)照組單用恩替卡韋。各進(jìn)行為期96周的臨床研究,觀察肝功能復(fù)常率、腹部超聲圖像改善情況、病毒學(xué)指標(biāo)情況及中醫(yī)證候改善情況。結(jié)果:1.試驗(yàn)組患者病毒變異0例,對(duì)照組患者病毒變異1例。2.用藥12周、24周時(shí)兩組腹部超聲圖像無(wú)明顯差異;用藥48周、96周時(shí),試驗(yàn)組明顯優(yōu)于對(duì)照組。3.分別用藥12周、24周、48周時(shí),試驗(yàn)組肝功能復(fù)常率均優(yōu)于對(duì)照組,用藥96周時(shí)兩組肝功能復(fù)常率無(wú)明顯差異。4.12周、24周病毒載量改善情況及24周、48周HBs Ag定量改善情況試驗(yàn)組優(yōu)于對(duì)照組。5.臨床癥狀和體征的改善,試驗(yàn)組明顯優(yōu)于對(duì)照組。結(jié)論:運(yùn)用健脾活血解毒法聯(lián)合恩替卡韋治療HBe Ag陰性慢性乙型肝炎,在改善臨床癥狀體征、改善肝組織炎性損傷、降低HBV-DNA載量、降低HBs Ag定量等療效明顯優(yōu)于單用恩替卡韋。
[Abstract]:Background: there are about 93 million people with chronic HBV infection in China, of which about 20 million cases of chronic hepatitis B patients. Since 1992, China's implementation of neonatal hepatitis B vaccination, hepatitis B infection rate has fallen sharply, but the number of incidence of hepatitis B in population in our country, the rural poor medical conditions, which are restricting the hepatitis B prevention treatment of work carried out, one of the effective prevention and treatment of hepatitis B is still our health problem. The treatment of hepatitis B in modern medicine is mainly based on interferon and nucleoside (acid) analogues. But it has strict clinical indications, and there are virology non response, virus variation, virology breakthrough and other problems. There are many kinds of Chinese patent medicines, mainly based on Glycyrrhizic acid preparation, silymarin and other drugs. But due to the lack of accuracy in clinical diagnosis and first-degree evidence of evidence-based medicine, the guideline for chronic hepatitis B Prevention (2015 Edition) is no longer recommended. Traditional Chinese medicine, as a treasure of China, is enduring and has a unique advantage in disease treatment. It is the most important thing for us to explore the way of treating chronic hepatitis B with Chinese medicine and explore the way of integrated traditional Chinese and Western medicine. In recent years, many domestic and foreign literatures have been reported in the prevention and treatment of chronic hepatitis B, is better than the single use of antiviral drugs application of traditional Chinese medicine combined with antiviral treatment efficacy, to explore new ideas for our prevention and control of chronic hepatitis B. Objective: To observe the clinical efficacy of Jianpi Huoxue Jiedu method combined with entecavir in the treatment of HBe Ag negative chronic hepatitis B, and explore the effective plan of treating HBe Ag negative chronic hepatitis B with integrated traditional Chinese and Western medicine. Methods: a total of 66 HBe Ag negative chronic hepatitis B patients in the outpatient department of Hepatology clinic affiliated to Shandong University of Traditional Chinese Medicine were randomly divided into two groups, the experimental group and the control group. The experimental group adopted the method of invigorating spleen and activating blood and detoxifying, and giving Chinese medicine compound liver Rong Tang and enteca Cave, and the control group was alone with enteca Cave. 96 weeks of clinical study were carried out to observe the recurrence rate of liver function, the improvement of abdominal ultrasonic image, the condition of Virology and the improvement of TCM syndrome. Results: there were 0 cases of virus variation in the 1. test group, and 1 cases in the control group. There was no significant difference in the ultrasound images between the two groups at 12 weeks and 24 weeks, and the test group was significantly better than the control group at the time of 48 weeks and 96 weeks at 2.. 3. for 12 weeks, 24 weeks and 48 weeks, the rate of liver function recovery was better than that of the control group. There was no significant difference between the two groups of liver function at 96 weeks. The improvement of viral load in 4.12 weeks and 24 weeks and the quantitative improvement of HBs Ag in 24 weeks and 48 weeks were better than those in the control group. 5. the improvement of clinical symptoms and signs in the experimental group was obviously better than that of the control group. Conclusion: Jianpi Huoxue Jiedu method combined with entecavir in the treatment of HBe Ag negative chronic hepatitis B is superior to entecavir alone in improving clinical symptoms and signs, improving inflammatory injury in liver tissue, decreasing HBV-DNA load and decreasing HBs Ag.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R512.62

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