申广文　刘颖　李强　郑华飞

摘要 目的：探討丹鸡活血汤辅助治疗慢性乙型肝炎肝纤维化对患者肝功能及血清炎性反应介质的影响。方法：选取2015年3月至2017年3月邯郸市传染病医院收治的慢性乙型肝炎肝纤维化患者160例，随机分为观察组与对照组，每组80例。对照组采用常规护肝治疗，观察组在对照组的基础上给予丹鸡活血汤治疗，3个月为1个疗程，2组均连续治疗2个疗程。比较2组治疗前后中医证候积分、肝功能指标、肝纤维化指标及血清炎性反应介质变化。结果：与治疗前比较，治疗后2组肝部不适或疼痛、舌质暗红、面色晦暗、食欲衰退与乏力等主要中医证候积分均显著下降（P<0.05），且观察组显著低于对照组（P<0.05）；与治疗前比较，治疗后2组血清丙氨酸转氨酶（ALT）、总胆红素（TBIL）、天门冬氨酸转氨酶（AST）均显著下降（P<0.05），且观察组显著低于对照组（P<0.05）；白蛋白（ALB）显著升高（P<0.05），且观察组显著高于对照组（P<0.05）；与治疗前比较，治疗后2组血清透明质酸（HA）、层粘连蛋白（LN）、Ⅲ型前胶原肽（PC-Ⅲ）、Ⅳ型胶原（Ⅳ-C）、基质金属蛋白酶-1（MMP-1）、白细胞介素-6（IL-6）及肿瘤坏死因子-α（TNF-α）及观察组丙二醛（MDA）水平均显著下降（P<0.05），且观察组均显著低于对照组（P<0.05）。结论：丹鸡活血汤辅助治疗慢性乙型肝炎肝纤维化可有效改善患者临床症状，改善其肝功能的同时抑制肝纤维化进展，其作用机制可能与其降低炎性反应介质水平有关。

关键词 慢性乙型肝炎；肝纤维化；丹鸡活血汤；肝功能；炎性反应介质

Abstract Objective：To explore the effects of adjuvant therapy with Danji Huoxue Decoction on liver function and serum inflammatory factors in patients with chronic hepatitis B liver fibrosis.Methods：A total of 160 patients with chronic hepatitis B liver fibrosis treated in Handan Hospital of Infectious Disease from March 2015 to March 2017 were selected and randomly divided into observation group and control group，with 80 cases in each group.Control group was treated with routine liver protection while observation group was treated with Danji Huoxue Decoction on the basis of the same treatment.Both groups were continuously treated for 2 courses （3 months as a course）.The changes of Traditional Chinese Medicine （TCM） syndromes scores，liver function index，liver fibrosis index and serum inflammatory factor level in both groups were compared before and after treatment.Results：Compared with before treatment，the scores of major TCM syndromes such as liver discomfort or pain，dark red tongue，dark complexion，loss of appetite and fatigue of both groups were significantly decreased after treatment （P<0.01），and observation group decreased more significantly than control group （P<0.05 or P<0.01）.Compared with before treatment，the serum ALT，TBILN，AST levels decreased significantly in both groups after treatment （P<0.01），and the levels of observation group decreased more significantly than control group （P<0.05 or P<0.01）.ALB levels increased significantly （P<0.01），and observation group increased more significantly than control group （P<0.05 or P<0.01）.Compared with before treatment，the serum HA，LN，PC-Ⅲ，Ⅳ-C，MMP-1，IL-6，TNF-α of both groups and the MDA level of observation group were significantly decreased （P<0.05 or P<0.01），and the levels of MDA in the observation group significantly decreased after treatment.The observation group decreased more significantly than control group （P<0.05 or P<0.01）.Conclusion：The adjuvant therapy with Danji Huoxue Decoction in the treatment of chronic hepatitis B liver fibrosis can effectively improve the clinical symptoms，improve the liver function and inhibit the progress of liver fibrosis.Its mechanism may be related to the reduction of inflammatory factors level.

Key Words Chronic hepatitis B liver fibrosis； Danji Huoxue Decoction； Liver function； Inflammatory factor

中图分类号：R289.5；R512.6文献标识码：Adoi：10.3969/j.issn.1673-7202.2018.09.011

目前我國慢性乙型肝炎病毒携带者高达3 000万人，且随着病情的发展，患者发生肝纤维化比例较高，这是由肝脏受到损伤后激发的愈合反应所致，因此如何阻止或逆转肝纤维化成为临床治疗的关键[1]。目前西医在抗乙肝肝纤维化方面侧重于抗病毒治疗，如干扰素、拉米呋定等，虽取得一定疗效，但也有报道称其可造成HBeAg/抗HBe血清转换率低下；此外单纯的抗病毒治疗虽可有效清除病毒，但未能完全治愈疾病[2-3]。中医辨证看待慢性乙型肝炎，认为该病主要由血瘀所致，湿热肝郁、脾虚阴虚等皆为其致病之机，故常采用活血化瘀类方剂进行治疗，在改善患者肝细胞炎性反应程度与阻止肝纤维化方面具有独到优势[4]。……