赵艳

[摘要] 目的 觀察拉米夫定联合安络化纤丸治疗乙肝肝硬化的临床效果。 方法 选取2013年8月～2014年11月唐山市传染病医院收治的乙肝肝硬化患者86例作为研究对象，按随机数字表法将其分为治疗组和对照组，每组各43例。对照组患者口服拉米夫定片，100 mg/次，1次/d。治疗组在对照组治疗的基础上加用安络化纤丸，6 g/次，2次/d。两组患者均连续服用1年。观察比较两组患者治疗前后肝功能指标[谷丙转氨酶（ALT）、总胆红素（TBil）、凝血酶原活动度（PTA）、白球比（A/G）]水平、Child-Pugh评分及HBV-DNA定量，记录两组患者治疗前后肝纤维化指标[透明质酸（HA）、层粘连蛋白（LN）、Ⅲ型前胶原（PC-Ⅲ）、Ⅳ型胶原（Ⅳ-C）]水平。 结果 治疗后，对照组和治疗组ALT、TBil均较治疗前显著下降，PTA、A/G均较治疗前显著上升，差异均有统计学意义（P < 0.05）。两组治疗后ALT、TBil、PTA、A/G组间比较差异均无统计学意义（P > 0.05）。治疗后，对照组和治疗组Child-Pugh评分及HBV-DNA定量均较治疗前显著降低，差异均有统计学意义（P < 0.05）。两组治疗后Child-Pugh评分及HBV-DNA定量组间比较，差异均无统计学意义（P > 0.05）。治疗后，对照组和治疗组HA、LN、PC-Ⅲ、Ⅳ-C水平均较治疗前显著下降，差异均有统计学意义（P < 0.05），且治疗组治疗后HA、LN、PC-Ⅲ、Ⅳ-C水平显著低于对照组，差异均有统计学意义（P < 0.05）。两组患者治疗期间均未见明显不良反应。 结论 拉米夫定联合安络化纤丸治疗乙肝肝硬化能有效改善肝功能，抑制肝纤维化，其疗效优于单用拉米夫定，且安全可靠，值得临床进一步推广应用。

[关键词] 拉米夫定；安络化纤丸；乙肝肝硬化

[中图分类号] R575.2 [文献标识码] A [文章编号] 1673-7210（2016）02（c）-0170-04

Clinical observation of Lamivudine combined with Anluohuaxian Pills in the treatment of hepatitic cirrhosis

ZHAO Yan

Department of Infectious Diseases， Tangshan Infectious Disease Hospital， Hebei Province， Tangshan 063000， China

[Abstract] Objective To observe the clinical effect of Lamivudine combined with Anluohuaxian Pills in the treatment of hepatitic cirrhosis. Methods Eighty six cases of patients with hepatitic cirrhosis admitted to Tangshan Infectious Disease Hospital from August 2013 to November 2014 were selected as research objects， and they were divided into treatment group and control group by random number table， with 43 cases in each group. The control group was given Lamivudine Tablets orally， 100 mg/time， once a day， on basis of control group， the treatment group was added with Anluohuaxian Pills， 6 g/time， twice a day. Both groups were taken the medicine for one year continuously. The levels of liver function indexes [alanine transaminase （ALT）， total bilirubin （TBil）， prothrombin activity （PTA）， albumin/globulin （A/G）]， Child-Pugh scores and HBV-DNA of the two groups before and after treatment were observed and compared， the levels of the hepatic fibrosis indexes [hyaluronic acid （HA）， laminin （LN）， procollagen of type Ⅲ （PC-Ⅲ）， collagen of type Ⅳ （Ⅳ-C）] of the two groups before and after treatment were recorded. Results After treatment， the levels of ALT， TBil of control group and treatment group were all decreased compared with those before treatment， PTA， A/G were all increased compared with those before treatment， the differences were all statistically significant （P < 0.05）. The levels of ALT， TBil， PTA， A/G after treatment between the two groups had no statistically significant differences （P > 0.05）. After treatment， the Child-Pugh scores and HBV-DNA of control group and treatment group were all decreased compared with those before treatment， the differences were all statistically significant （P < 0.05）. There were no statistically significant differences of Child-Pugh scores and HBV-DNA after treatment between the two groups （P > 0.05）. After treatment， the levels of HA， LN， PC-Ⅲ， Ⅳ-C of control group and treatment group were all decreased compared with those before treatment， the differences were all statistically significant （P < 0.05）， and the levels of HA， LN， PC-Ⅲ， Ⅳ-C after treatment in the treatment group were all obviously lower than those of control group， the differences were statistically significant （P < 0.05）. Both groups had no obvious adverse reactions. Conclusion Lamivudine combined with Anluohuaxian Pills in the treatment of hepatitic cirrhosis can significantly improve liver function， inhibit liver fibrosis， the efficacy is better than application of Lamivudine alone， and it is safe， reliable and worthy of clinical further promotion and application.

[Key words] Lamivudine； Anluohuaxian Pills； Hepatitic cirrhosis

慢性乙肝病毒感染是我国肝硬化发生的主要原因，乙肝病毒活动会反复损害肝脏，最终导致肝硬化，甚至可能发展为肝硬化失代偿期或肝癌[1-2]。持续抑制病毒复制有利于延缓肝硬化患者的病情进展，早期抗病毒治疗能有效改善肝功能，延长患者生存期[3]。核苷类似物具有疗效强、见效快、耐药基因屏障高的特点，乃乙肝肝硬化抗病毒治疗的优选。拉米夫定属于核苷类似物，为临床治疗乙肝肝硬化公认有效的抗病毒药，其在阻止乙肝病程进展方面有着不可低估的作用[4]。……