强肝胶囊联合恩替卡韦治疗慢性乙型肝炎肝纤维化86例临床研究

摘要

目的:观察强肝胶囊联合恩替卡韦治疗慢性乙型肝炎肝纤维化的临床疗效.方法:将我科2012年5月-2015年4月收治的86例慢性乙型肝炎肝纤维化患者,随机分成治疗组和对照组,对照组患者给予恩替卡韦片抗病毒治疗,治疗组患者在此基础上加服强肝胶囊治疗.治疗6个月后观察两组患者肝功能(ALT、AST、TBIL和ALB)、血清肝纤维化指标(HA、LN、PC-III以及IV-C)和血清TGF-β1、TIMP-1、MMP-1水平的变化,以及肝脾B超检查等.结果:治疗后与对照组比较,治疗组患者丙氨酸转氨酶(ALT),天冬氨酸氨基转氨酶(AST)及总胆红素(TBIL)水平下降(P<0.01);同时治疗组患者血清透明质酸(HA)、层粘连蛋白(LN)、III型前胶原(PC-III)以及Ⅳ型胶原(IV-C)水平也低于对照组(P<0.05);6个月后治疗组患者组血清TGF-β1和TIMP-1水平明显降低,MMP-1水平明显升高,与对照组比较有统计学意义(P<0.05);同时治疗组脾脏厚度低于对照组(P<0.05).结论:强肝胶囊能降低血清TGF-β1水平,减少TIMP-1从而使基质金属蛋白酶分解降低,升高MMP-1水平,改变ECM的降解和沉积,达到阻止肝纤维化发展、改善肝功能、减轻患者临床症状的目的.%Objective:To observed the clinical effects of Qianggan capsule combined with entecavir on 86 patients with hepatic fibrosis re-lated to chronic hepatitis B.Methods:A total of 86 patients with hepatic fibrosis related to chronic hepatitis B from May 2012 to April 2015 in our hospital were enrolled and randomly assigned into 2 groups including treatment group and control group.The patients in treatment group accepted Qianggan capsule and entecavir,but the patients in control group accepted entecavir.All patients had been treated for 24 weeks. The liver function(including ALT,AST,TBIL and ALB),markers of hepatic fibrosis in serum(including HA,LN,PC-III and IV-C)and serum levels of TGF-β1,TIMP-1 and MMP-1 were measured at the beginning and the end of 24-weeks study.Type-B ultrasonic test of liver and spleen was also completed simultaneously.Results: Compared with the control group, the levels of ALT, AST and TBIL in treatment group were significantly decreased at the end of study(P<0.05).Levels of HA,LN,Pc-III and IV-C in serum were also significantly lower in treatment group compared with placebo group respectively.After 6-month treatment,patients in treatment group had lower concentrations of TGF-β1,TIMP-1 and higher MMP-1 in serum than those in control group(P<0.05).The thickness of spleen was also lower in treatment group than those in control group(P<0.05).Conclusions:Qianggan capsule could reduce TGF-β1 and TIMP-1,increase MMP-1 by inhib-iting activation of hepatic stellate cells, which could improve degradation and deposition in patients with hepatic fibrosis related to chronic hepatitis B.It can be used to impede development of hepatic fibrosis,improve liver function and alleviate symptoms hepatic fibrosis related to chronic hepatitis B.