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目的:探讨凉血解毒法为主配合激素治疗慢性乙型肝炎(CHB)自身抗体阳性的临床疗效及可能的作用机制。方法:91例患者分为中西医结合组30例,西药组29例,基础组32例。基础组给予常规保肝降酶治疗,西药组在保肝降酶的基础上增加生理剂量激素治疗,中西医结合组在保肝降酶和加用生理剂量激素的基础上,采用凉血解毒中药治疗。结果:3组患者治疗后纳减、腹胀、肝区不适、乏力等症状均有不同程度缓解,3组间比较,差异无显著性意义(P>0.05)。中西医结合组及基础组治疗后尿黄例数减少,西药组则增多,前两者与后者比较,差异有显著性意义(P<0.05)。西药组有11例、中西医结合组有3例出现面部痤疮或原有痤疮加重,基础组则无变化,中西医结合组、基础组与西药组比较,差异有显著性意义(P<0.05)。3组治疗后,ALT、AST均较治疗前显著下降,与治疗前比较,差异有显著性意义(P<0.05)。3组治疗后LN(层粘连蛋白)、PCⅢ(Ⅲ前胶原)、Ⅳ-C(Ⅳ胶原)3项肝纤维指标均有不同程度下降,但3组间比较,差异无显著性意义(P>0.05)。HA(透明质酸)中西医结合组治疗后下降最为明显,与西药组和基础组比较,差异有显著性意义(P<0.05)。治疗后5项自身抗体总阳性率、BLys(B淋巴细胞刺激因子)0D值中西医结合组和西药组均低于基础组,差异有显著性意义(P<0.05)。结论:凉血解毒法为主与生理剂量激素联合能有效降低自身抗体阳性CHB患者BLvs水平,抑制自身抗体的产生,促进肝功能更快恢复。
Objective: To investigate the clinical efficacy and possible mechanism of the method of cooling blood and removing detoxification combined with hormones in treating chronic hepatitis B (CHB) autoantibodies. Methods: 91 patients were divided into 30 cases of Integrative Medicine Group, 29 cases of Western medicine group, 32 cases of basic group. The basal group was treated with conventional treatment of protecting the liver and reducing enzyme concentration. The western medicine group was given physiologic dose of hormone therapy on the basis of protecting the liver and reducing the enzyme. On the basis of protecting the liver and reducing the enzyme and adding physiological hormone, treatment. Results: The symptoms of nausea, abdominal distension, liver discomfort and fatigue in the three groups were relieved to varying degrees. There was no significant difference between the three groups (P> 0.05). Integrative Medicine group and the basic group after treatment, urinary yellow number decreased, the western medicine group increased, the former two compared with the latter, the difference was significant (P <0.05). There were 11 cases in western medicine group, 3 cases in acupuncture combined with traditional Chinese medicine and western medicine group had facial acne or acne exacerbation, while there was no change in basic group. There was significant difference between TCM group and western medicine group (P <0.05) . After treatment, ALT and AST decreased significantly compared with before treatment, and there was significant difference between before and after treatment (P <0.05). The three indexes of liver fibrosis such as LN (laminin), PCⅢ (Ⅲ procollagen) and Ⅳ-C (Ⅳ collagen) decreased to some degree after treatment, but there was no significant difference between the three groups (P> 0.05). HA (hyaluronic acid) combination of traditional Chinese and Western medicine group after treatment the most obvious decline, compared with the Western medicine group and the basic group, the difference was significant (P <0.05). After treatment, the total positive rate of 5 autoantibodies, BLys (B lymphocyte stimulating factor) 0D value of Western medicine group and Western medicine group were lower than the basic group, the difference was significant (P <0.05). Conclusion: The combination of cooling blood detoxification and physiological hormone can effectively reduce the level of BLvs in autoantibodies positive CHB patients, inhibit the production of autoantibodies and promote the recovery of liver function.