目的 探討強(qiáng)肝膠囊聯(lián)合富馬酸丙酚替諾福韋片治療恩替卡韋應(yīng)答不佳的慢性乙型肝炎的臨床療效。方法 選取2020年3月—2021年2月柳州市人民醫(yī)院收治的對恩替卡韋治療應(yīng)答不佳慢性乙型肝炎患者97例。根據(jù)隨機(jī)數(shù)字表法將所有患者分為對照組（48例）和治療組（49例）。對照組需隨食物口服富馬酸丙酚替諾福韋片，1次/d，1片/次。治療組在對照組的基礎(chǔ)上口服強(qiáng)肝膠囊，5粒/次，2次/d，每服6 d停1 d，8周為1個(gè)療程，停1周，再進(jìn)行第2個(gè)療程。兩組均連續(xù)治療24周。評估兩組的總有效率，比較兩組的乙型肝炎病毒脫氧核糖核酸（HBV-DNA）轉(zhuǎn)陰率、丙氨酸氨基轉(zhuǎn)移酶（ALT）復(fù)常率、肝纖維化指標(biāo)、肝功能指標(biāo)和血清指標(biāo)。結(jié)果 治療后，治療組患者的總有效率（91.84%）高于對照組（66.67%）（P＜0.05）。治療后，治療組的HBV-DNA轉(zhuǎn)陰率、ALT復(fù)常率均高于對照組（P＜0.05）。治療后，兩組透明質(zhì)酸酶（HA）、層黏連蛋白（LN）、Ⅲ型前膠原（PCⅢ）、Ⅳ型膠原（Ⅳ-C）、總膽紅素（TBIL）、ALT、天冬氨酸氨基轉(zhuǎn)移酶（AST）水平均下降（P＜0.05），且治療組HA、LN、PCⅢ、Ⅳ-C、TBIL、ALT、AST均低于對照組（P＜0.05）。治療后，兩組血清血小板衍生生長因子-BB（PDGF-BB）、轉(zhuǎn)化生長因子β1（TGF-β1）水平均下降（P＜0.05），且治療組血清PDGF-BB、TGF-β1水平均低于對照組（P＜0.05）。結(jié)論 強(qiáng)肝膠囊聯(lián)合富馬酸丙酚替諾福韋片治療恩替卡韋應(yīng)答不佳的慢性乙型肝炎患者，可有效改善患者肝功能，抑制肝纖維化，調(diào)節(jié)血清PDGF-BB、TGF-β1水平。

Objective To investigate the clinical efficacy of Qianggan Capsules combined with Tenofovir alafenamide Fumarate Tablets in treatment of chronic hepatitis B with poor response to entecavir. Methods Patients (97 cases) with chronic hepatitis B with poor response to entecavir in Liuzhou People’s Hospital from March 2020 to February 2021 were divided into the control group (48 cases) and the treatment group (49 cases) according to random number tablet method. Patients in the control group were po administered with Tenofovir alafenamide Fumarate Tablets, 1 tablet/time, once daily. Patients in the treatment group were po administered with Qianggan Capsules on the basis of the control group, 5 grains/time, twice daily, stop for 1 day every 6 days, with 8 weeks as one course of treatment, stopping for 1 week before proceeding to the second course of treatment. Patients in two groups were treated for 24 weeks. After treatment, the clinical efficacies were evaluated, and HBV-DNA negative conversion rate and ALT normalizing rate, liver fibrosis indexes, liver function indexes, serum indicators in two groups were compared. Results After treatment, the total effective rate of the treatment group (91.84%) was higher than that of the control group (66.67%) (P＜0.05). After treatment, HBV-DNA conversion rate and ALT normalization rate in the treatment group were higher than those in the control group (P＜0.05). After treatment, the levels of HA, LN, PC III, IV-C, TBIL, ALT, and AST in two groups were decreased (P＜0.05), and the levels of HA, LN, PC III, IV-C, TBIL, ALT, and AST in the treatment group were lower than those in the control group (P＜0.05). After treatment, the serum levels of PDGF-BB and TGF-β1 in two groups decreased (P＜0.05), and the serum levels of PDGF-BB and TGF-β1 in the treatment group were lower than those in the control group (P＜0.05). Conclusion Qianggan Capsules combined with Tenofovir alafenamide Fumarate Tablets of chronic hepatitis B with poor response to entecavir can effectively improve liver function in patients, inhibit liver fibrosis, and regulate serum levels of PDGF-BB and TGF-β1.

R976

柳州市科技計(jì)劃項(xiàng)目（2020NBAB0821）