加味茵陈蒿汤联合恩替卡韦治疗重症化趋势乙型病毒性肝炎患者炎症指标及氧化应激水平影响
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摘要
目的:前瞻性研究加味茵陈蒿汤联合恩替卡韦对乙型病毒性肝炎患者的影响。方法:将2016年7月-2018年6月收治的50例乙型病毒性肝炎患者按单双号随机分为对照组(24例)和观察组(26例)。对照组患者给予恩替卡韦片0.5 mg,每天1次;观察组在对照组基础上给予加味茵陈蒿汤200 mL,早晚餐后温服。两组患者疗程均为4周。观察两组患者治疗后血清乙型肝炎病毒(Hepafitis B Virus,HBV)DNA、乙肝病毒e抗原(HBeAg)阴转率,比较两组患者治疗前后血清肝功能指标[胆红素(TBIL)、天冬氨酸转氨酶(Aspartate Aminotransferase,AST)、丙氨酸转氨酶(Alanine Aminotransferase,ALT)]、炎症指标[白细胞介素150(Interleu Rin-150,IL-150)、肿瘤坏死因子α(TNF-α)]水平和肝功能评分(Child-pugh)评分,以及氧化应激指标[丙二醛(Malon Dialdehyde,MDA)、超氧化物歧化酶(Super Oxide Dismutase,SOD)、一氧化氮(Nitric Oxide,NO)]水平变化,并记录其不良反应发生情况。结果:治疗前,两组患者血清肝功能指标、炎症指标和氧化应激指标水平差异均无统计学意义(P> 0.05);给药4周后,观察组患者血清HBV DNA、HBeAg阴转率高于对照组,但组间差异无统计学意义(P> 0.05)。与治疗前比较,给药4周后两组患者血清中肝功能指标水平、Child-pugh评分、炎症指标以及MDA、NO水平均显著降低(P <0.05),SOD水平显著升高(P <0.05),且观察组上述指标改善程度高于对照组(P <0.05)。对照组和观察组不良反应发生率差异无统计学意义(P> 0.05),停药后均好转。结论:加味茵陈蒿汤联合恩替卡韦可通过抑制炎症反应、减轻氧化应激反应而改善乙型病毒性肝炎患者的肝功能;且两药联用效果优于恩替卡韦单用。
Objective: To prospectively study the effects of the Yinchenhao decoction plus( 茵陈蒿汤) entecavir on inflammatory index and oxidative stress level in patients with viral hepatitis B. Methods: 50 patients were randomly divided into the control group(24 cases) and observation group(26 cases). The control group was given entecavir tablets; the observation group was treated with the Yinchenhao decoction more. Results: Before treatment, there was no significant difference in serum liver function index, inflammation index and oxidative stress level between groups(P>0.05). After 4 weeks of administration, the HBV DNA and HBeAg negative rate in the observation group were higher than the control group, with no significant difference, P>0.05. Compared with before treatment, serum levels of liver function, Child-pugh score, inflammation index, MDA and NO levels were significantly lower in two groups(P<0.05); SOD levels were significantly higher(P<0.05). The improvement of the above indicators in the observation group was higher than those in the control group, P<0.05. There was no significant difference in the incidence of adverse reactions between groups, P>0.05. Those were improved after stopping the drug. Conclusion: The Yinchenhao decoction plus entecavir can improve the liver function of patients with hepatitis B by inhibiting inflammation and reducing oxidative stress, and shows a better effect than entecavir alone.
Objective: To prospectively study the effects of the Yinchenhao decoction plus( 茵陈蒿汤) entecavir on inflammatory index and oxidative stress level in patients with viral hepatitis B. Methods: 50 patients were randomly divided into the control group(24 cases) and observation group(26 cases). The control group was given entecavir tablets; the observation group was treated with the Yinchenhao decoction more. Results: Before treatment, there was no significant difference in serum liver function index, inflammation index and oxidative stress level between groups(P>0.05). After 4 weeks of administration, the HBV DNA and HBeAg negative rate in the observation group were higher than the control group, with no significant difference, P>0.05. Compared with before treatment, serum levels of liver function, Child-pugh score, inflammation index, MDA and NO levels were significantly lower in two groups(P<0.05); SOD levels were significantly higher(P<0.05). The improvement of the above indicators in the observation group was higher than those in the control group, P<0.05. There was no significant difference in the incidence of adverse reactions between groups, P>0.05. Those were improved after stopping the drug. Conclusion: The Yinchenhao decoction plus entecavir can improve the liver function of patients with hepatitis B by inhibiting inflammation and reducing oxidative stress, and shows a better effect than entecavir alone.
引文
[1]张伟,许荣放,田锐锋,等.阿德福韦酯与替比夫定联合恩替卡韦对失代偿期乙肝肝硬化患者肝功能及血清病毒学指标的影响[J].解放军医学杂志,2016,41(12):1041-1044.
[2]朱丽,王丽,曾义岚,等.聚乙二醇干扰素α-2a联合恩替卡韦治疗高病毒载量HBeAg阳性慢性乙型肝炎的临床研究[J].实用药物与临床,2016,19(01):110-113.
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[4]郎晓林,吴立海,贾春辉,等.恩替卡韦联合复方丹参滴丸治疗慢性乙型病毒性肝炎肝硬化代偿期临床研究[J].河北医药,2013,35(12):15004-15005.
[5]杨春龙.中西医结合治疗对慢性乙肝患者血清乙肝病毒e抗原的影响[J].中医临床研究,2017,9(26):7-8.
[6]殷燕,李捷壮,聂尚燕,等.恩替卡韦与阿德福韦酯治疗乙型病毒性肝炎失代偿性肝硬化患者的临床研究[J].中国临床药理学杂志2016,32(150):1639-1624.
[7]杨帆.茵陈蒿汤联合双黄连粉针在母儿ABO血型不合治疗中的价值研究[J].中医临床研究,2016,8(13):114-115.
[8]周小平,王园,何继东,等.加味茵陈蒿汤和维生素E对维持性血液透析患者氧化应激、炎症反应及血红蛋白的影响[J].实用药物与临床,201619(03):314-317.
[9]罗小平,郭晓平.不同加味茵陈蒿汤制剂的人体药动学研究[J].中国医药导报,2013,10(19):250-30.
[10]申广文,李强.参芪益肝汤对乙肝肝硬化患者丙二醛、TNF-α及基质金属蛋白酶1表达的影响[J].中医临床研究,2016,8(20):18-20.
[11]肖苗苗.加味茵陈蒿汤联合西医常规治疗急性黄疸性肝炎临床观察[J].中国农村卫生,2016(7X):23-24.
[2]朱丽,王丽,曾义岚,等.聚乙二醇干扰素α-2a联合恩替卡韦治疗高病毒载量HBeAg阳性慢性乙型肝炎的临床研究[J].实用药物与临床,2016,19(01):110-113.
[3]沈菲,梁玉记.薄芝糖肽与胸腺五肽分别联合重组人干扰素α2b治疗HBeAg阳性的慢性乙型肝炎的临床观察[J].中国药房,2017,250(50):1120-1123.
[4]郎晓林,吴立海,贾春辉,等.恩替卡韦联合复方丹参滴丸治疗慢性乙型病毒性肝炎肝硬化代偿期临床研究[J].河北医药,2013,35(12):15004-15005.
[5]杨春龙.中西医结合治疗对慢性乙肝患者血清乙肝病毒e抗原的影响[J].中医临床研究,2017,9(26):7-8.
[6]殷燕,李捷壮,聂尚燕,等.恩替卡韦与阿德福韦酯治疗乙型病毒性肝炎失代偿性肝硬化患者的临床研究[J].中国临床药理学杂志2016,32(150):1639-1624.
[7]杨帆.茵陈蒿汤联合双黄连粉针在母儿ABO血型不合治疗中的价值研究[J].中医临床研究,2016,8(13):114-115.
[8]周小平,王园,何继东,等.加味茵陈蒿汤和维生素E对维持性血液透析患者氧化应激、炎症反应及血红蛋白的影响[J].实用药物与临床,201619(03):314-317.
[9]罗小平,郭晓平.不同加味茵陈蒿汤制剂的人体药动学研究[J].中国医药导报,2013,10(19):250-30.
[10]申广文,李强.参芪益肝汤对乙肝肝硬化患者丙二醛、TNF-α及基质金属蛋白酶1表达的影响[J].中医临床研究,2016,8(20):18-20.
[11]肖苗苗.加味茵陈蒿汤联合西医常规治疗急性黄疸性肝炎临床观察[J].中国农村卫生,2016(7X):23-24.