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葛冰景,周薏,肖铁刚,王雁翔,戴彦成,阙任烨.逍遥散联合恩替卡韦对肝郁脾虚型乙型肝炎肝硬化代偿期患者纤维化及铁代谢的影响[J].湖南中医药大学学报英文版,2021,41(2):296-302.[Click to copy
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| 逍遥散联合恩替卡韦对肝郁脾虚型乙型肝炎肝硬化代偿期患者纤维化及铁代谢的影响 |
| 葛冰景,周薏,肖铁刚,王雁翔,戴彦成,阙任烨 |
| (上海中医药大学附属上海市中西医结合医院脾胃病科, 上海 200082) |
| 摘要: |
| 目的 观察逍遥散联合恩替卡韦对肝郁脾虚型乙型肝炎肝硬化代偿期患者的肝纤维化指标、门静脉压力的影响，比较正常人及肝郁脾虚型乙型肝炎肝硬化代偿期患者治疗前后血清中铁代谢相关指标，并初步探讨联合用药的作用机制。方法 采用随机数字表法将72例患者分为两组，各36例，治疗组予逍遥散联合恩替卡韦治疗，对照组仅予恩替卡韦治疗，两组疗程均为6个月；观察患者治疗前后总体疗效、肝纤维化指标、肝纤维化评分、腹部彩超参数（包括门静脉内径、脾厚度、脾长度）以及血清铁、铁蛋白、总铁结合力、铁调素（hepcidin）等指标变化。结果 治疗组总有效率为90.00%，对照组总有效率为66.67%，治疗组总体疗效优于对照组（P<0.05）。治疗后两组纤维化指标HA、LN、IV-COL、PIIINP各项均较治疗前明显下降，且两组间比较，差异均有统计学差异（P<0.05）；治疗组患者治疗后APRI、GPR指数均较前明显下降（P<0.05）。两组治疗后APRI、FIB-4、GPR各项指数改善治疗组疗效均优于对照组（P<0.05）。与健康人比较，肝郁脾虚型乙肝肝硬化代偿期患者血清中铁、铁蛋白、hepcidin显著升高，总铁结合力显著下降（P<0.05）。治疗后治疗组血清中铁、铁蛋白、hepcidin明显下降，总铁结合力明显升高（P<0.05）；对照组血清中铁、铁蛋白、明显下降（P<0.05）；治疗组改善血清铁、总铁结合力、hepcidin的疗效优于对照组（P<0.05）。结论 逍遥散联合恩替卡韦在改善肝纤维化方面疗效优于单用恩替卡韦。联合用药能够在一定程度上改善患者铁过载水平，其作用机制可能与调节机体铁代谢平衡有关。 |
| 关键词: 乙型肝炎肝硬化代偿期 肝纤维化 铁代谢 逍遥散 肝郁脾虚 |
| DOI：10.3969/j.issn.1674-070X.2021.02.025 |
| Received:December 12, 2020 |
| 基金项目:上海市青年科技英才扬帆计划（19YF1445200）；上海市卫健委中发办青年基金（2018LQ016）；上海中医药大学项目（18LK074）。 |
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| The Effect of Xiaoyao Powder Combined with Entecavir on Fibrosis and Iron Metabolism in the Treatment of Liver Depression and Spleen Deficiency Type of Compensated Stage of Hepatitis B Cirrhosis |
| GE Bingjing,ZHOU Yi,XIAO Tiegang,WANG Yanxiang,DAI Yancheng,QUE Renye |
| (Department of Spleen and Stomach Diseases, Shanghai Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200082, China) |
| Abstract: |
| Objective To observe the effect of Xiaoyao Powder and entecavir on liver fibrosis index and portal vein pressure in the treatment of liver depression and spleen deficiency type of compensated stage of hepatitis B cirrhosis patients. To compare the related indexes of serum iron metabolism before and after treatment in normal people and patients with liver depression and spleen deficiency type of compensated stage of hepatitis B cirrhosis and explore the mechanism of combination therapy. Methods Random number table method was used to divide 72 cases of patients into two groups, with 36 patients in each group. The reatment group were treated with Xiaoyao Powder and entecavir. The control group were treated with entecavir only. Both groups were treated for 6 months. Overall efficacy, liver fibrosis indexes, liver fibrosis score and abdominal color Doppler ultrasound parameters (including diameter of portal vein, thickness of spleen and length of spleen), levels of serum iron, ferritin, total iron binding force and hepcidin were observed before and after treatment. Results The total effective rate was 90% in the treatment group and 66.67% in the control group, and the overall efficacy of the treatment group was better than that of the control group (P<0.05). After treatment, fibrosis indexes of HA, LN, IV-COL and PIIINP in the two groups were significantly lower than before treatment, and there were statistical differences between the two groups (P<0.05); APRI and GPR indexes of patients in the treatment group were significantly decreased after treatment compared with before treatment (P<0.05). The comparison between the two groups indicated that APRI, FIB-4 and GPR indexes improved the therapeutic effect of the treatment group than that of the control group after treatment (P<0.05); compared with healthy people, the level of serum iron, ferritin and hepcidin were significantly increased, and the total iron binding capacity was significantly decreased in liver depression and spleen deficiency type of compensated stage of hepatitis B cirrhosis patients (P<0.05). The level of serum iron, ferritin and hepcidin in the treatment group decreased significantly, and the level of total iron binding force increased significantly (P<0.05); the level of serum iron and ferritin in the control group decreased significantly (P<0.05); the improvement effect of the treatment group in serum iron, total iron binding force and hepcidin was better than that of the control group (P<0.05). Conclusion Xiaoyao Powder combined with entecavir is better than entecavir alone in improving liver fibrosis. The combination therapy can improve the level of iron overload to a certain extent, and the possible mechanism of Xiaoyao Powder is related to regulating the balance of iron metabolism. |
| Key words: compensated stage of hepatitis B cirrhosis liver fibrosis iron metabolism Xiaoyao Powder liver depression and spleen deficiency |
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