目的 探討安絡(luò)化纖丸聯(lián)合硫普羅寧治療慢性乙型肝炎肝硬化的臨床療效。方法 選取2021年8月—2023年2月西安市第八醫(yī)院收治的166例慢性乙型肝炎肝硬化患者，按隨機數(shù)字表法將所有患者分為對照組和治療組，每組各83例。對照組靜脈滴注注射用硫普羅寧，每次將0.2 g加入0.9%氯化鈉注射液250 mL中充分稀釋后給藥，1次/d。治療組在對照組治療基礎(chǔ)上口服安絡(luò)化纖丸，6 g/次，2次/d。兩組患者的療程均為3個月。觀察兩組臨床療效，比較治療前后兩組肝功能指標(biāo)[谷丙轉(zhuǎn)氨酶（ALT）、總膽紅素（TBiL）、白蛋白與球蛋白比值（A/G）]、谷草轉(zhuǎn)氨酶（AST）與血小板（PLT）比值指數(shù)（APRI）評分、肝臟硬度測量（LSM）值、肝/脾CT值比值及血清肝纖維化指標(biāo)[Ⅲ型前膠原N端肽（PC-Ⅲ）、透明質(zhì)酸（HA）、Ⅳ型膠原（Ⅳ-C）、層黏連蛋白（LN）]和高遷移率族蛋白B1（HMGB1）、白細胞介素-17（IL-17）、可溶性P選擇素（sP-selectin）水平。結(jié)果 治療后，治療組總有效率為90.36%，顯著高于對照組的78.31%（P＜0.05）。治療后，兩組血清ALT、TBiL水平均顯著降低，而A/G均顯著增高（P＜0.05）；治療后，治療組肝功能指標(biāo)改善優(yōu)于對照組（P＜0.05）。治療后，兩組APRI評分、LSM值均顯著降低，肝/脾CT值比值均顯著升高（P＜0.05）；且均以治療組改善更顯著（P＜0.05）。治療后，兩組血清PC-Ⅲ、HA、Ⅳ-C、LN水平均顯著下降（P＜0.05）；均以治療組改善更顯著（P＜0.05）。治療后，兩組血清HMGB1、IL-17、sP-selectin水平均顯著下降（P＜0.05）；治療后，治療組HMGB1、IL-17、sP-selectin水平均低于對照組（P＜0.05）。結(jié)論 安絡(luò)化纖丸聯(lián)合硫普羅寧治療慢性乙型肝炎肝硬化能有效提高療效，改善肝功能和肝纖維化，抑制機體慢性炎癥及肝硬化進程，且安全性較佳，值得臨床推廣。

Objective To explore the clinical efficacy of Anluo Huaxian Pills combined with tiopronin in treatment of liver cirrhosis caused by chronic hepatitis B. Methods A total of 166 patients with chronic hepatitis B cirrhosis admitted to Xi'an Eighth Hospital from August 2021 to February 2023 were selected and divided into control group and treatment group according to random number table method, with 83 cases in each group. Patients in the control group were iv administered with Tiopronin for injection, 0.2 g was added into 0.9% sodium chloride injection 250 mL for full dilution and administration, once daily. Patients in the treatment group were po administered with Anluo Huaxian Pills on the basis of the control group, 6 g/time, twice daily. The treatment course of both groups was 3 months. After treatment, the clinical efficacy was evaluated, and the liver function indexes [alanine transaminase (ALT), total bilirubin (TBiL), albumin to globulin ratio (A/G)], aspartate Transaminase to platelet (PLT) ratio index (APRI) score, liver hardness measurement (LSM) value, and liver/spleen CT value ratio were compared between the two groups before and after treatment. The levels of serum hepatic fibrosis markers [type Ⅲ procollagen N-terminal peptide (PC - Ⅲ), hyaluronic acid (HA), type Ⅳ collagen (Ⅳ-C), Laminin (LN)], High-mobility group protein B1 (HMGB1), interleukin-17 (IL-17), soluble P Selectin (sP selectin)] were also measured. Results After treatment, the total effective rate of the treatment group was 90.36%, which was significantly higher than that of control group (78.31%, P < 0.05). After treatment, serum ALT and TBiL levels were significantly decreased, but A/G were significantly increased in both groups (P < 0.05). After treatment, the improvement of liver function indexes in treatment group was better than that in control group (P < 0.05). After treatment, APRI score and LSM value were significantly decreased, and the ratio of liver/spleen CT value was significantly increased in both groups (P < 0.05). The improvement was more significant in treatment group (P < 0.05). After treatment, the serum levels of PC-Ⅲ, HA, Ⅳ-C and LN in 2 groups were significantly decreased (P < 0.05). The improvement was more significant in treatment group (P < 0.05). After treatment, serum HMGB1, IL-17 and sP-selectin levels in 2 groups were significantly decreased (P< 0.05). After treatment, the levels of HMGB1, IL-17 and sP-selectin in treatment group were lower than those in control group (P < 0.05). Conclusion Anluo Huaxian Pills combined with tiopronin can effectively improve the curative effect in treatment of liver cirrhosis caused by chronic hepatitis B, and can improve liver function and liver fibrosis, inhibit the process of chronic inflammation and cirrhosis of the body with good safety, which is worthy of clinical promotion.

R975

西安市科技計劃項目（21YXYJ0063）