张立一+丁国锋

[摘要]目的 觀察恩替卡韦联合和络舒肝胶囊治疗代偿期乙肝肝硬化的临床效果。方法 选择2011年6月～2012年5月在青岛市胶州中心医院消化内科诊疗的代偿期乙肝肝硬化患者82例，随机分为治疗组41例和对照组41例，对照组给予恩替卡韦分散片0.5 mg，口服，1次/d；治疗组在对照组的基础上联合和络舒肝胶囊，5粒，口服，3次/d，连续服用和络舒肝胶囊每2个月后停用1个月，然后继续依此规律服用，总疗程均为48个月。比较两组的治疗效果。结果 两组患者的血清白蛋白（Alb）水平差异有统计学意义（t=6.351，P=0.017），治疗组优于对照组；治疗组患者的肝纤维化4项指标[透明质酸酶（HA）、层粘连蛋白（LN）、Ⅲ型前胶原（PC-Ⅲ）、Ⅳ型胶原（Ⅳ-C）]水平下降明显，均优于对照组（P<0.01）；治疗组的HBeAg阴转率为41.4%，显著高于对照组（14.6%） （P<0.01）。两组患者治疗后的门静脉内径差异有统计学意义（P<0.01），但HBV-DNA阴转率差异无统计学意义（P>0.05）。结论 恩替卡韦联合和络舒肝胶囊治疗代偿期乙肝肝硬化可改善肝功能，持续抑制病毒复制，可延缓甚至逆转肝纤维化的进展，具有临床应用价值。

[关键词]恩替卡韦；和络舒肝胶囊；代偿期；乙肝肝硬化

[中图分类号] R575.2+9 [文献标识码] A [文章编号] 1674-4721（2017）01（c）-0024-04

[Abstract]Objective To observe the clinical effect of Entecavir combined with Heluoshugan Capsules treating hepatitis B cirrhosis of compensated stage.Methods 82 patients with hepatitis B cirrhosis of compensated stage diagnosed and treated by department of gastroenterology in Central Hospital of Jiaozhou of Qingdao City from June 2011 to May 2012 were selected and they were randomly divided into treatment group of 41 cases and control group of 41 cases.Control group was treated with oral Entecavir Disket 0.5 mg，once a day，while the treatment group was treated with oral Heluoshugan Capsules for 5 capsules，three times a day，and taking Heluoshugan Capsules for 2 months and stopping 1 month and then continued to take according to the law，and both groups received 48 months treatment.Treatment effect between two groups was compared.Results Albumin （Alb） level in two groups were significantly different （t=6.351，P=0.017），the treatment group was better than the control group；the level of serum hyaluronie acid （HA），Laminin （LN），procollagen type Ⅲ （PC-Ⅲ） and collagen type Ⅳ-C （Ⅳ-C） were decreased significantly in treatment group than in control group，and the above-mentioned indexes were better than those in control group （P<0.01）.The negative conversion rate of treatment group （41.4%） was significantly higher than that of control group （14.6%） （P<0.01）.There was a statistical difference of the portal vein diameter between two groups （P<0.01），but there was no significant difference in negative conversion rate of HBV-DNA （P>0.05）.Conclusion Entecavir combined with Heluoshugan Capsules treating hepatitis B cirrhosis of compensated stage can improve liver function，suppress viral replication persistently，and can delay or even reverse the progression of liver fibrosis，and it has clinical application value.

[Key words]Entecavir；Heluoshugan Capsules；Compensated stage；Hepatitis B cirrhosis

我国乙肝病毒慢性感染者可达9000万人，肝硬化病因中乙型肝炎病毒感染占90%以上，乙肝肝硬化患者5年生存率为55%～84%[1]。慢性乙肝患者起病隐匿，早期无明显不适症状，得不到及时有效治疗，大部分患者进展为肝硬化甚至肝癌。肝硬化进展与患者乙肝病毒复制密切相关，因而抗乙肝病毒治疗对于乙肝肝硬化的预后有极其重要的意义[2-3]，不过单纯西药抗病毒治疗疗效较为局限，而许多中药有抗肝纤维化的作用。……