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[目的]探讨慢性乙型肝炎(CHB)的有效治疗方法及其对肝纤维化指标的影响和可能的机制。[方法]60例阳虚证慢性乙型肝炎患者随机分为治疗组和对照组。治疗组先口服温阳化瘀汤,后改口服拉米夫定;对照组仅口服拉米夫定,观察治疗前后ALT、AST、HA、LN、PCⅢ、Ⅳ-C及HBV-DNA。[结果]治疗组阳虚证候明显改善,血清ALT有一个先降后升的过程,一般经过3周到3个月ALT可达到正常值上限的5倍以上并控制在10倍以内;血清HA显著升高;口服拉米夫定后两组血清HA、LN、PCⅢ、Ⅳ-C均明显下降,其中治疗组下降更显著,与对照组比较有显著差异。治疗组和对照组的HBV-DNA阴转率分别为86.7%和56.7%,有显著差异。[结论]温阳化瘀汤对阳虚证慢性乙型肝炎的免疫耐受有清除作用,温阳化瘀汤和拉米夫定序贯治疗较单纯拉米夫定治疗有更好的抗肝纤维化作用。
[Objective] To explore the effective treatment of chronic hepatitis B (CHB) and its effect on liver fibrosis indicators and possible mechanisms. [Method] 60 cases of chronic hepatitis B patients with Yang deficiency syndrome were randomly divided into treatment group and control group. The treatment group was treated with Wenyang Huayu Decoction first and then oral lamivudine. In the control group, only lamivudine was given orally, and ALT, AST, HA, LN, PCⅢ, Ⅳ-C and HBV-DNA were observed before and after treatment. [Results] The treatment group, Yang deficiency syndrome improved significantly, serum ALT has a process of first drop and then rise, usually after 3 weeks to 3 months ALT up to 5 times the upper limit of normal and controlled within 10 times; serum HA significantly And the levels of serum HA, LN, PCⅢ, Ⅳ-C in the two groups decreased significantly after oral lamivudine treatment, and the treatment group decreased more significantly than the control group. HBV-DNA negative conversion rates of the treatment group and the control group were 86.7% and 56.7%, respectively, with significant differences. [Conclusion] Wenyang Huayu Decoction has clear effect on immunological tolerance of chronic hepatitis B in Yang Deficiency Syndrome. Wenyang Huayu Decoction and Lamivudine sequential therapy have better anti-liver than Lamivudine alone Fibrosis.