目的 探討鱉甲煎丸聯(lián)合替比夫定治療乙型肝炎肝硬化的臨床效果。方法 選取2018年3月—2021年3月渭南市中心醫(yī)院收治的116例乙型肝炎肝硬化患者，隨機(jī)分成對照組和治療組，每組各58例。對照組口服替比夫定片，600 mg/次，1次/d。在對照組基礎(chǔ)上，治療組餐后口服鱉甲煎丸，3 g/次，3次/d。兩組均連續(xù)治療6個月。觀察兩組患者臨床療效，比較治療前后兩組患者乙型肝炎病毒脫氧核糖核酸（HBV DNA）水平，肝臟硬度值（LSM）和36項健康調(diào)查簡表（SF-36）總分，血清丙氨酸氨基轉(zhuǎn)移酶（ALT）、總膽紅素（TBil）、白蛋白（Alb）、透明質(zhì)酸（HA）、層黏連蛋白（LN）、Ⅲ型前膠原（PC-III）、Ⅳ型膠原（IV-C）、腫瘤壞死因子-α（TNF-α）、轉(zhuǎn)化生長因子-β1（TGF-β1）和丙二醛（MDA）水平。結(jié)果 治療后，治療組臨床有效率為82.76%，顯著高于對照組（65.52%，P＜0.05）。治療后，兩組血清ALT、TBil及HBV DNA水平均較治療前顯著降低（P＜0.05），血清Alb水平均較治療前顯著升高（P＜0.05），且均以治療組的改善更顯著（P＜0.05）。與治療前對比，兩組治療后LSM顯著減小，SF-36總分顯著增加（P＜0.05），且均以治療組的改善更顯著（P＜0.05）。兩組治療后血清肝纖維化四項（HA、LN、PC-III、IV-C）水平均較治療前顯著下降（P＜0.05），且治療組對血清肝纖維化四項水平的降低作用顯著優(yōu)于對照組（P＜0.05）。與治療前比較，兩組治療后血清TNF-α、TGF-β1和MDA水平均顯著降低（P＜0.05），且治療組顯著低于對照組（P＜0.05）。結(jié)論 鱉甲煎丸聯(lián)合替比夫定治療乙型肝炎肝硬化的整體療效確切，能有效抑制患者體內(nèi)HBV的復(fù)制，改善肝功能與肝纖維化，并可一定程度上逆轉(zhuǎn)肝硬化，提高患者生活質(zhì)量，且安全性較好。

Objective To investigate the clinical effect of Biejiajian Pills combined with telbivudine in treatment of hepatitis B cirrhosis. Methods Patients (116 cases) with hepatitis B cirrhosis in Weinan Central Hospital from March 2018 to March 2021 were randomly divided into control and treatment group, and each had 58 cases. Patients in the control group were po administered with Telbivudine Tablets, 600 mg/time, once daily. Patients in the treatment group were po administered with Biejiajian Pills on the basis of the control group, 3 g/time, three times daily. Patients in two groups were treated for 6 months. After treatment, the clinical evaluation was evaluated, the HBV DNA levels, the scores of LSM and SF-36, the levels of serum ALT, TBil, Alb, HA, LN, PC-Ⅲ, Ⅳ-C, TNF-α, TGF-β1 and MDA in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group was 82.76% (48/58), which was significantly higher than that of the control group[65.52% (38/58), P < 0.05]. After treatment, the levels of serum ALT, TBil and HBV DNA in two groups were significantly lower than those before treatment, while the levels of serum Alb in two groups were significantly higher than those before treatment (P < 0.05), and the improvement in the treatment group was more significant (P < 0.05). Compared with those before treatment, the LSM of the two groups were significantly decreased and the total score of SF-36 were significantly increased after treatment (P < 0.05), and the improvement in the treatment group was more significant (P < 0.05). The serum levels of four hepatic fibrosis items (HA, LN, PC- Ⅲ, Ⅳ-C) in two groups after treatment were significantly lower than those before treatment (P < 0.05), and the effect of the treatment group was significantly better than that of the control group (P < 0.05). Compared with those before treatment, the levels of serum TNF-α, TGF-β1 and MDA in two groups were significantly decreased (P < 0.05), which in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion The overall curative effect of Biejiajian Pills combined with telbivudine in treatment of hepatitis B cirrhosis is definite, which can effectively inhibit the replication of HBV in patients, improve liver function and liver fibrosis, reverse liver cirrhosis to a certain extent, improve the quality of life of patients, and is safe.

R975