目的 探討苦參堿注射液聯(lián)合富馬酸替諾福韋二吡呋酯片治療拉米夫定耐藥慢性乙型肝炎的臨床療效。方法 選取2014年2月—2016年10月赤峰市傳染病防治醫(yī)院收治的拉米夫定耐藥的慢性乙型肝炎患者92例為研究對象，按隨機數(shù)字表法將患者分為對照組和治療組，每組各46例。對照組口服富馬酸替諾福韋二吡呋酯片，300 mg/次，1次/d。治療組在對照組基礎上靜脈滴注苦參堿注射液，150 mg加入到5%葡萄糖溶液250 mL中，1次/d，連續(xù)給藥2周后休息2周。兩組均治療48周。觀察兩組的臨床療效，比較兩組的血清學指標、病毒學指標、肝功能指標、肝纖維化指標。結果 治療后，對照組和治療組的總有效率分別為76.09%、91.30%，兩組比較差異有統(tǒng)計學意義（P < 0.05）。治療24、48周后，兩組乙肝病毒的脫氧核糖核酸（HBV-DNA）陰轉率、乙型肝炎E抗原（HBeAg）陰轉率、HBeAg血清轉換率均明顯升高，與同組治療12周后比較差異有統(tǒng)計學意義（P < 0.05）；且治療組這些觀察指標明顯高于同期對照組，兩組比較差異具有統(tǒng)計學意義（P < 0.05）。治療24、48周后，兩組血清丙氨酸氨基轉移酶（ALT）、天冬氨酸氨基轉氨酶（AST）、總膽紅素（TBIL）水平均明顯下降，同組治療前后比較差異有統(tǒng)計學意義（P < 0.05）；且治療組這些觀察指標明顯低于同期對照組，兩組比較差異具有統(tǒng)計學意義（P < 0.05）。治療24、48周后，兩組血清透明質酸（HA）、層黏連蛋白（LN）、Ⅲ型前膠原（PCⅢ）、Ⅳ型膠原（Ⅳ-C）水平均明顯下降，同組治療前后比較差異有統(tǒng)計學意義（P < 0.05）；且治療組這些觀察指標明顯低于同期對照組，兩組比較差異具有統(tǒng)計學意義（P < 0.05）。結論 苦參堿注射液聯(lián)合富馬酸替諾福韋二吡呋酯片治療拉米夫定耐藥慢性乙型肝炎具有較好的臨床療效，能提高HBV-DNA陰轉率、HBeAg陰轉率和HBeAg血清轉換率，改善肝功能和肝纖維化，具有一定臨床推廣應用價值。

Objective To investigate the clinical efficacy of Matrine Injection combined with Tenofovir Disoproxil Fumarate Tablets in treatment of lamivudine-resistant chronic hepatitis B. Methods Patients (92 cases) with lamivudine-resistant chronic hepatitis B in Chifeng Infectious Disease Prevention and Control Hospital from February 2014 to October 2016 were randomly divided into control and treatment groups, and each group had 46 cases. Patients in the control group were po administered with Tenofovir Disoproxil Fumarate Tablets, 300 mg/time, once daily. Patients in the treatment group were iv administered with Matrine Injection on the basis of the control group, 150 mg added into 5% glucose solution 250 mL, once daily. After 2 weeks of continuous administration, they rested for 2 weeks. Patients in two groups were treated for 48 weeks. After treatment, the clinical efficacies were evaluated, and serological and virological index, liver function index, liver fibrosis index in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 76.09% and 91.30%, respectively, and there was difference between two groups (P < 0.05). After treatment for 24 and 48 weeks, HBV-DNA negative conversion rate, HBeAg negative conversion rate, and HBeAg seroconversion rate in two groups were significantly increased, and the difference was statistically significant in the same group (P < 0.05). And the observational indexes in the treatment group were significantly higher than those at the same period in the control group, with significant difference between two groups (P < 0.05). After treatment for 24 and 48 weeks, the levels of ALT, AST and TBIL in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And the observational indexes in the treatment group were significantly lower than those at the same period in the control group, with significant difference between two groups (P < 0.05). After treatment for 24 and 48 weeks, the levels of HA, LN, PCⅢ, and Ⅳ-C in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And the observational indexes in the treatment group were significantly lower than those at the same time in the control group, with significant difference between two groups (P < 0.05). Conclusion Matrine Injection combined with Tenofovir Disoproxil Fumarate Tablets has clinical curative effect in treatment of lamivudine-resistant chronic hepatitis B, can increase HBV-DNA negative conversion rate, HBeAg negative conversion rate, and HBeAg seroconversion rate, improve liver function and liver fibrosis, which has a certain clinical application value.