目的 探讨清热利湿化浊方联合富马酸替诺福韦二吡呋酯片治疗慢性乙型肝炎病毒(乙肝)(Hepatitis B virus，HBV)肝硬化的疗效及对肝功能和乙肝病毒定量的影响。方法 选择医院于2020年5月-2022年5月慢性乙肝肝硬化患者82例，运用随机表法分为观察组41例与对照组41例。对照组给予富马酸替诺福韦二吡呋酯片治疗，观察组在富马酸替诺福韦二吡呋酯片基础上结合清热利湿化浊方治疗。两组治疗疗程24周。比较两组治疗24周临床疗效;治疗前后肝功能，肝纤维化，乙肝病毒脱氧核糖核酸(hepatitis B virus deoxyribonucleic acid，HBV DNA)载量，炎性因子，Toll样受体 4(Toll-like receptor4，TLR4)和 c-Jun 氨基末端激酶(c-Jun N-terminal kinase Messenger RNA，JNK)mRNA 表达。结果 观察组总有效率高于对照组(P＜0。05)。两组治疗后天冬氨酸氨基转移酶(Aspartate aminotransferase，AST)、总胆红素(Total bilirubin，TBIL)和丙氨酸氨基转移酶(Alanine aminotransferase，ALT)水平低于治疗前(P＜0。05);观察组治疗后AST、TBIL和ALT水平低于对照组(P＜0。05)。两组治疗后透明质酸(Hyaluronic acid，HA)、层黏连蛋白(Laminin，LN)、Ⅲ型前胶原(Procollagen type Ⅲ，PC Ⅲ)和Ⅳ型胶原(Collagen type Ⅳ，C Ⅳ)水平低于治疗前(P＜0。05);观察组治疗后HA、LN、PC Ⅲ和C Ⅳ水平低于对照组(P＜0。05)。两组治疗后HBV DNA载量低于治疗前(P＜0。05);观察组治疗后HBV DNA载量低于对照组(P＜0。05)。两组治疗后白介素(interleukin，IL)-6、IL-8和肿瘤坏死因子-α(tumor necrosisfactor-α，TNF-α)水平低于治疗前(P＜0。05);观察组治疗后IL-6、IL-8和TNF-α水平低于对照组(P＜0。05)。两组治疗后TLR4和JNK mRNA表达低于治疗前(P＜0。05);观察组治疗后TLR4和JNK mRNA表达低于对照组(P＜0。05)。结论 清热利湿化浊方联合富马酸替诺福韦二吡呋酯片治疗慢性乙肝肝硬化患者疗效显著，且可改善患者肝功能，降低乙肝病毒载量，减轻炎症反应，及下调TLR4/JNK信号传导通路。
Effect of Qingre Lishi Huazhuo Recipe(清热利湿化浊方)on Chronic Hepatitis B Cirrhosis and Its Influence on Liver Function and Hepatitis B Virus Quantification
Objective To explore the therapeutic effect of Qingre Lishi Huazhuo Recipe(清热利湿化浊方)combined with Tenofovir Disoproxil Fumarate Tablets in the treatment of chronic hepatitis B cirrhosis and its influence on liver function and hep-atitis B virus quantification.Methods Eighty-two patients with chronic hepatitis B cirrhosis in the hospital from May 2020 to May 2022 were divided into the observation group(41 cases)and the control group(41 cases).The control group were treated with Tenofovir Disoproxil Fumarate Tablets,while the patients in the observation group were treated with Qingre Lishi Huazhuo Recipe on the basis of Tenofovir Disoproxil Fumarate Tablets.The treatment course of the two groups was 24 weeks.The clinical efficacy of the two groups was compared after 24 weeks of treatment.The liver function,liver fibrosis,hepatitis B virus deoxyribo-nucleic acid(HBV DNA)load,inflammatory factors,Toll-like receptor4(TLR4)and c-Jun N-terminal kinase messenger RNA(JNK mRNA)expression before and after treatment of the two groups were compared.Results The effective rate of the ob-servation group was higher than that of the control group(P＜0.05).After treatment,the levels of aspartate aminotransferase(AST),total bilirubin(TBIL)and alanine aminotransferase(ALT)of the two groups were lower than those before treatment(P＜0.05).The levels of the observation group were lower than those of the control group(P＜0.05).After treatment,the levels of hyaluronic acid(HA),laminin(LN),procollagen type Ⅲ(PC Ⅲ)andcollagen type Ⅳ(CⅣ)of the two groups were lower than those before treatment(P＜0.05).The levels of the observation group were lower than those of the control group(P＜0.05).Af-ter treatment,the HBV DNA load of the two groups was lower than that before treatment(P＜0.05).The HBV DNA load of the observation group was lower than that of the control group(P＜0.05).After treatment,the levels of interleukin-6(IL-6),in-terleukin-8(IL-8)and tumor necrosis factor-α(TNF-α)of two groups were lower than those before treatment(P＜0.05).The levels of the observation group were lower than those of the control group(P＜0.05).After treatment,the expressions of TLR4 and JNK mRNA of two groups were lower than those before treatment(P＜0.05).The expressions of TLR4 and JNK mR-NA in the observation group were lower than those of the control group(P＜0.05).Conclusion Qingre Lishi Huazhuo Recipe combined with Tenofovir Disoproxil Fumarate Tablets can significantly improve the liver function of patients with chronic hepatitis B cirrhosis,reduce the HBV DNA load and inflammatory reaction,and down-regulate the expression of TLR4/JNK signal trans-duction pathway.
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