李月翠　胡伟跃　徐象威　陈豪

[摘要] 目的 探討活血软坚扶正方联合抗病毒治疗气虚血瘀证型HBeAg阴性慢性乙型肝炎（CHB）患者肝纤维化的疗效。 方法 选取2019年1—12月我院感染科收治的80例HBeAg阴性CHB患者进行研究。采用随机数字表法分为观察组和对照组，每组各40例。对照组采用抗病毒治疗，观察组在对照组基础上加用活血软坚扶正方治疗。治疗36周，观察两组中医证候积分、临床疗效、肝纤维化、肝功能及不良反应。 结果 治疗后，观察组中医证候积分低于对照组，差异有统计学意义（P<0.05）。观察组治疗总有效率为92.50%（37/40），明显高于对照组的72.50%（29/40），差异有统计学意义（P<0.05）。治疗后，观察组血清透明质酸（HA）、Ⅲ型前胶原（PⅢP）水平低于对照组，差异有统计学意义（P<0.05）。治疗后，观察组丙氨酸氨基转移酶（ALT）水平低于对照组，差异有统计学意义（P<0.05）。治疗后，观察组乙型肝炎病毒HBV DNA 阴转率为92.50%（37/40），高于对照组的72.50%（29/40），壳多糖酶3样蛋白1（CHI3L1）水平低于对照组，差异有统计学意义（P<0.05）。观察组有4例患者发生恶心、头痛、眩晕3例，均较轻无需特殊治疗。 结论 活血软坚扶正方联合抗病毒治疗气虚血瘀证型HBeAg阴性CHB患者的临床疗效较好，可有效改善临床症状和肝纤维化指标，缓解肝功能，且不良反应较小。

[关键词] 活血软坚扶正方;抗病毒;气虚血瘀证型;HBeAg阴性;CHB;肝纤维化

[中图分类号] R259          [文献标识码] A          [文章编号] 1673-9701（2021）06-0023-05

Therapeutic effect of Huoxue Ruanjian Fuzheng Recipe combined with antiviral therapy on liver fibrosis in patients with HBeAg-negative CHB of qi deficiency and blood stasis syndrome

LI Yuecui   HU Weiyue   XU Xiangwei   CHEN Hao

Department of Infection， Yongkang First People′s Hospital in Zhejiang Province， Yongkang   321300， China

[Abstract] Objective To explore the therapeutic effect of Huoxue Ruanjian Fuzheng Recipe combined with antiviral therapy on liver fibrosis in patients with HBeAg-negative hepatitis B （CHB） syndrome of qi deficiency and blood stasis syndrome. Methods Eighty HBeAg-negative CHB patients admitted to our hospital′s Department of Infection from January to December 2019 were studied. According to the random number table method， the patients were divided into the observation group and the control group，with 40 cases in each group. The control group was treated with antiviral therapy， and the observation group was treated with Huoxue Ruanjian Fuzheng Recipe based on the treatment of the control group. After 36 weeks of treatment， the TCM syndrome scores，clinical efficacy， liver fibrosis，liver function and adverse reactions between the two groups were observed. Results After treatment， the TCM syndrome score in the observation group was lower than that in the control group，and the difference was significant（P<0.05）. The total effective rate of treatment in the observation group was 92.50%（37/40）， which was significantly higher than that of 72.50%（29/40） in the control group， the difference was significant（P<0.05）. The levels of serum hyaluronic acid （HA） and type Ⅲ procollagen（PⅢP） in the observation group were significantly lower than those in the control group（P<0.05）. The level of alanine aminotransferase（ALT） in the observation group was lower than that in the control group， and the difference was significant（P<0.05）. After treatment， the negative conversion rate of hepatitis B virus （HBV） DNA in the observation group was 92.50%（37/40）， which was higher than that of 72.50%（29/40） in the control group. The level of chitinase 3 like protein 1 （CHI3L1） was lower than that of the control Group， and the difference was significant（P>0.05）. In the observation group，there were 4 patients with nausea and 3 patients with headache and dizziness，all of whom were mild and no special treatment was needed. Conclusion Huoxue Ruanjian Fuzheng Recipe combined with antiviral treatment for patients with HBeAg-negative CHB patients with qi deficiency and blood stasis syndrome has a good clinical effect， which can effectively improve clinical symptoms and liver fibrosis indicators， relieve liver function，and has fewer adverse reactions.

[Key words] Huoxue Ruanjian Fuzheng Recipe; Antiviral; Qi deficiency and blood stasis syndrome; HBeAg negative; CHB; Liver fibrosis

乙型肝炎病毒（Hepatitis B virus，HBV）感染导致的慢性乙型肝炎（Chronic hepatitis B，CHB）是全球性的公共卫生问题。CHB血清HBeAg是病毒复制的敏感指标。流行病学研究显示，相较于HBeAg阳性者，HBeAg阴性CHB 更多反复活动，病理炎症分级较低，而纤维化分期高于前者，同时肝脏功能损害和肝纤维化指标总体上均高于阳性者，因此，及早诊断治疗HBeAg阴性CHB肝纤维化具有重要意义[1-3]。常规西药抗病毒治疗，起效快，但容易存在耐药性。中医认为，病机为湿热郁结、肝脾肾损伤，主要诱因为血瘀，湿热瘀毒为持续影响因素，正气亏虚是内因和转归，肝络瘀阻是病理基础，肝肾阴虚及肝肾损伤是本病结局[4]。故治疗遵循益气健脾、补血养肝、活血化瘀原则。活血软坚扶正方主要为益气养阴、活血化瘀，在补脾的同时加强疏肝散郁[5]。故将抗病毒治疗和活血软坚扶正方联合治疗理论上能够体现优势互补，发挥协同作用。……