龙胆泻肝汤加减对慢性乙型肝炎低病毒血症期抗纤维化改善、病毒载量及血清HBsAg、ADA的影响

Effects of addition and reduction of Longdan Xiegan Decoction on anti-fibrosis improvement，viral load，serum HBsAg and ADA in chronic hepatitis B hypoviriemia

关键词:  龙胆泻肝汤加减  慢性乙型肝炎  低病毒血症  免疫功能  抗纤维化  病毒载量

Key words:  Longdan Xiegan Decoction  chronic hepatitis B  hypoviremia  immune function  anti-fibrosis  viral load

摘要:

[目的] 观察龙胆泻肝汤加减对慢性乙型肝炎低病毒血症期抗纤维化改善、病毒载量及血清乙型肝炎表面抗原（HBsAg）、腺苷脱氨酶（ADA）的影响。[方法] 选择2020年1月——2023年1月于医院治疗的102例慢性乙型肝炎患者，随机数字表法分为西医组和中西医组。西医组52例，给予患者恩替卡韦片治疗，中西医组50例，西医组治疗同时给予患者龙胆泻肝汤加减治疗，比较西医组及中西医组临床疗效，治疗前、后给予患者身目俱黄、脘闷腹胀、胁肋疼痛、小便黄赤、烦热、口干而苦、困倦乏力、食欲不振、皮肤瘙痒、恶心呕吐、大便秘结或稀溏评价，检测患者乙型肝炎病毒（HBV）-DNA、HBsAg、ADA、总胆红素、CD4⁺/CD8⁺、Ⅲ型胶原、透明质酸、白细胞介素-27（IL-27）水平，计算HBV-DNA、HBsAg转阴率。[结果] 中西医组患者总有效率为96.00%，西医组总有效率为80.77%，中西医组患者总有效率较西医组高（P＜0.05）；中西医组身目俱黄、脘闷腹胀、胁肋疼痛、小便黄赤、烦热、口干而苦、困倦乏力、食欲不振、皮肤瘙痒、恶心呕吐、大便秘结或稀溏评分较西医组降低（P＜0.05）；中西医组HBV-DNA、HBsAg水平较西医组低（P<0.05），中西医组HBV-DNA、HBsAg转阴率较西医组高（P<0.05）；中西医组ADA、总胆红素、Ⅲ型胶原、透明质酸水平较西医组低（P＜0.05）；中西医组CD4⁺/CD8⁺较西医组高（P<0.05），中西医组IL-27水平较西医组低（P<0.05）。[结论] 龙胆泻肝汤加减治疗慢性乙型肝炎低病毒血症患者，可改善免疫功能，抑制炎症，提升抗纤维化能力，减少病毒载量及血清HBsAg、ADA水平，缓解病情，提升临床疗效。

Abstract:

[Objective] To observe the effects of Longdan Xiegan Decoction on anti-fibrosis improvement,viral load,serum HBsAg,and ADA in chronic hepatitis B hypoviremia. [Methods] A total of 102 patients with chronic hepatitis B treated in the hospital were selected,and all patients were enrolled from January 2020 to January 2023. The patients were grouped by the random number table method. The 52 cases in the Western medicine group were given entecavir tablets,and 50 cases in the Chinese and Western medicine group were given Longdan Xiegan Decoction plus subtraction treatment,comparing the clinical efficacy of the Western medicine group and the Chinese and Western medicine group. The clinical efficacy of the Western medicine group and the Chinese and Western medicine group was compared. Before and after treatment,the patients were evaluated for yellowing of body and eyes,epigastric depression and abdominal distension,hypochondriac pain,yellow urine,irritability and heat,dry and bitter mouth,drowsiness and fatigue,loss of appetite,itchy skin,nausea and vomiting,constipation or loose stool. The levels of hepatitis B virus(HBV)-DNA,Hepatitis B surface antigen(HBsAg),adenosine deaminase(ADA),total bilirubin,HbsAg,CD4⁺/CD8⁺,type Ⅲ collagen,hyaluronic acid,interleukin-27(IL-27) were detected,and the negative conversion rate of HBV-DNA and HBsAg were calculated. [Results] The total effective rate of the Chinese and Western medicine group was 96.00%,the total effective rate of Western medicine group was 80.77%,and the total effective rate of the Chinese and Western medicine group was higher than that of Western medicine group(P<0.05). Compared with Western medicine group,the scores of the Chinese and Western medicine group were lower than those of the Western medicine group(P<0.05). The levels of HBV-DNA and HBsAg in the Chinese and Western medicine group were lower than those in Western medicine group(P<0.05),and the negative conversion rates of HBV-DNA and HBsAg in the Chinese and Western medicine group were higher than those in Western medicine group(P<0.05). The levels of ADA,total bilirubin,type Ⅲ collagen,and hyaluronic acid in the Chinese and Western medicine group were lower than those in the Western medicine group(P<0.05);CD4⁺/CD8⁺ in the Chinese and Western medicine group was higher than that in Western medicine group(P<0.05),and IL-27 level in Chinese and Western medicine group was lower than that in Western medicine group(P<0.05). [Conclusion] In the treatment of patients with chronic hepatitis B hypoviraemia,Longdan Xiegan Decoction can improve immune function,inhibit inflammation,enhance anti-fibrosis ability,reduce viral load and serum HBsAg and ADA levels,alleviate disease,and improve clinical efficacy.