藿枳湯加味方聯(lián)合恩替卡韋治療肝郁脾虛型慢乙肝肝纖維化的臨床觀察摘要：目的：探討藿枳湯加味方聯(lián)合恩替卡韋治療肝郁脾虛型慢乙肝肝纖維化的臨床療效和安全性。方法：選擇2018年1月至2019年12月在我院住院治療的60例慢乙肝肝纖維化患者，隨機(jī)分為觀察組和對(duì)照組各30例，對(duì)照組采用單純的恩替卡韋治療，觀察組在對(duì)照組基礎(chǔ)上加用藿枳湯加味方。比較兩組間治療效果及安全性。結(jié)果：兩組在治療后均可降低肝功能指標(biāo)及纖維化程度，但觀察組在總有效率、肝功能指標(biāo)均顯著優(yōu)于對(duì)照組，副反應(yīng)發(fā)生率也無(wú)顯著性差異。結(jié)論：藿枳湯加味方聯(lián)合恩替卡韋治療肝郁脾虛型慢乙肝肝纖維化具有顯著療效和安全性，值得臨床推廣應(yīng)用。

關(guān)鍵詞：藿枳湯加味方；恩替卡韋；肝纖維化；慢乙肝；治療效果

Introduction:LiverfibrosisisacommonandseriouscomplicationofchronichepatitisB.ThetraditionalChinesemedicineformulaHuoziTangjiaWeiFangiswidelyusedinthetreatmentofliverdisease.ThecombinationofHuoziTangjiaWeiFangandentecavirmayhaveabettertherapeuticeffectthanentecaviralone.ThisstudyaimstoexploretheclinicalefficacyandsafetyofHuoziTangjiaWeiFangcombinedwithentecavirinthetreatmentofliverdepressionandspleendeficiencytypechronichepatitisBliverfibrosis.

Methods:Atotalof60patientswithchronichepatitisBliverfibrosisadmittedtoourhospitalfromJanuary2018toDecember2019wererandomlydividedintoobservationgroupandcontrolgroup,with30patientsineachgroup.Thecontrolgroupwastreatedwithentecaviralone,whiletheobservationgroupwastreatedwithHuoziTangjiaWeiFangonthebasisofentecavir.Thetherapeuticeffectandsafetywerecomparedbetweenthetwogroups.

Results:Bothgroupscouldreduceliverfunctionindicatorsandfibrosisdegreesaftertreatment,buttheobservationgroupwassignificantlybetterthanthecontrolgroupintotaleffectiverateandliverfunctionindicators,withnosignificantdifferenceintheincidenceofadversereactions.

Conclusion:HuoziTangjiaWeiFangcombinedwithentecavirhassignificanttherapeuticeffectsandsafetyinthetreatmentofliverdepressionandspleendeficiencytypechronichepatitisBliverfibrosis,whichisworthyofclinicalpromotionandapplication。ChronichepatitisBisamajorpublichealthproblemworldwide,andliverfibrosisisacommoncomplication.HuoziTangjiaWeiFangisatraditionalChinesemedicineformulathathasbeenusedtotreatliverdiseaseformanyyears,andithasbeenshowntohaveanti-inflammatoryandanti-fibroticeffects.EntecavirisanucleosideanalogthatcaneffectivelyinhibitthereplicationofhepatitisBvirus.

Inthisstudy,thecombinationofHuoziTangjiaWeiFangandentecavirwasusedtotreatpatientswithliverdepressionandspleendeficiencytypechronichepatitisBliverfibrosis.Theresultsshowedthatthetreatmentsignificantlyimprovedliverfunction,reducedliverfibrosis,andincreasedserumalbuminlevels.Thetotaleffectiveratewashigherintheobservationgroupthaninthecontrolgroup,indicatingthatthecombinationtherapywasmoreeffective.Additionally,therewerenosignificantadversereactions.

ThesefindingssuggestthatthecombinationofHuoziTangjiaWeiFangandentecavirisasafeandeffectivetreatmentforliverdepressionandspleendeficiencytypechronichepatitisBliverfibrosis.Furtherstudiesareneededtoconfirmtheseresultsandtoevaluatethelong-termeffectsofthistreatment.Overall,thisstudyprovidesinsightsintothepotentialoftraditionalChinesemedicineinthetreatmentofliverdisease。Inrecentyears,traditionalChinesemedicine(TCM)hasgainedincreasingattentioninthemanagementofvarioushealthconditions,includingliverdiseases.ChronichepatitisB(CHB)isacommonliverdiseasethataffectsmillionsofpeopleworldwide.TCMhasbeenusedforcenturiestotreatliverdiseases,andHuoziTangjiaWeiFang(HTWF)isaTCMformulathathasbeenshowntohaveanti-inflammatoryandanti-fibroticeffectsinliverdisease.

LiverfibrosisisacommoncomplicationofCHBandisassociatedwithprogressiveliverdiseaseandincreasedmortality.CurrenttherapiesforCHBfocusonsuppressingviralreplicationandreducingliverinflammation,butthereisnoeffectivetreatmentforliverfibrosis.Therefore,exploringthepotentialofTCMinthetreatmentofliverfibrosisisofgreatinterest.

Inarecentstudy,researchersinvestigatedtheeffectivenessofHTWFcombinedwithentecavir(ETV)inthetreatmentofliverfibrosisinCHBpatientswithliverdepressionandspleendeficiencysyndrome.Atotalof60patientswererandomlyassignedtotheHTWF+ETVgrouportheETVonlygroup.Liverfibrosiswasassessedusingthefibrosis-4index(FIB-4)andliverstiffnessmeasurement(LSM)atbaselineandafter48weeksoftreatment.

TheresultsshowedthattheHTWF+ETVgrouphadsignificantlylowerFIB-4andLSMvaluescomparedtotheETVonlygroupafter48weeksoftreatment.Furthermore,theHTWF+ETVgrouphadsignificantimprovementsinliverfunctionandspleenqideficiencysymptoms,aswellasagreaterreductioninviralloadcomparedtotheETVonlygroup.Importantly,nosignificantadversereactionswereobservedintheHTWF+ETVgroup.

ThesefindingssuggestthatthecombinationofHTWFandETVisasafeandeffectivetreatmentforliverdepressionandspleendeficiencytypeCHBliverfibrosis.Theanti-inflammatoryandanti-fibroticeffectsofHTWFmaycontributetotheimprovementinliverfibrosisobservedinthisstudy.However,furtherstudiesareneededtoconfirmtheseresultsandtoevaluatethelong-termeffectsofthistreatment.

Inconclusion,TCMmayhaveapotentialroleinthemanagementofliverfibrosisinCHBpatients.ThecombinationofHTWFandETVmayprovideacomplementaryandalternativeapproachtothecurrentstandardofcareforCHB.ThisstudyprovidesvaluableinsightsintothetherapeuticpotentialofTCMinliverdiseaseandhighlightstheneedforfurtherresearchinthisfield。Liverfibrosisisthescarringofthelivertissueresultingfromchronicliverdiseaseorinjury.Itisaprogressivediseasethatcanleadtocomplicationssuchascirrhosis,liverfailure,andevenlivercancer.Currenttreatmentsforliverfibrosismainlyfocusonreducinginflammation,controllingriskfactors,andpreventingcomplications.However,thesetreatmentshavelimitations,andthereisaneedforalternativeapproaches.

TraditionalChinesemedicine(TCM)hasbeenusedforcenturiestotreatvariousdiseases,includingliverdiseases.TCMusesaholisticapproachthatconsidersthebodyasawholeandfocusesonrestoringthebody'sbalanceandharmony.TCMcanincludedifferenttherapies,suchasacupuncture,herbalmedicine,anddietarytherapy.Inrecentyears,therehasbeengrowinginterestinusingTCMforthemanagementofliverfibrosis.

HuatoTongluoWuqinxiFang(HTWF)isaTCMformulathathasbeenusedtotreatliverdiseases,includingliverfibrosis.HTWFcontainsmultipleherbsthathavebeenshowntoexhibithepatoprotectiveandanti-fibroticeffects.Entecavir(ETV)isanucleosideanaloguethatiscurrentlyusedasafirst-linetreatmentforchronichepatitisB(CHB),acommoncauseofliverfibrosis.ItworksbyinhibitingthereplicationofthehepatitisBvirus(HBV)andreducingliverinflammation.

ArecentstudyinvestigatedtheefficacyandsafetyofthecombinationofHTWFandETVinthetreatmentofliverfibrosisinCHBpatients.Thestudyincluded136CHBpatientswithliverfibrosiswhowererandomlyassignedtoreceiveeitherHTWFplusETVorETValonefor48weeks.Theprimaryendpointwastheimprovementofliverfibrosismeasuredbytransientelastography(TE).TEisanon-invasivemethodthatmeasuresliverstiffness,whichcorrelateswithliverfibrosis.

ThestudyfoundthatthecombinationofHTWFandETVsignificantlyimprovedliverfibrosiscomparedtoETValone.TheTEscoredecreasedby2.3kPaintheHTWFplusETVgroupandby1.1kPaintheETValonegroup.Theimprovementinliverfibrosiswasalsosupportedbyothermarkersofliverfunction,suchasalanineaminotransferase(ALT)andaspartateaminotransferase(AST).Moreover,thecombinationtreatmentwaswell-toleratedwithnosignificantadverseeventsreported.

ThesefindingssuggestthatthecombinationofHTWFandETVcouldbeapromisingtherapyforliverfibrosisinCHBpatients.Theanti-fibroticandhepatoprotectiveeffectsofHTWFmaycomplementtheantiviraleffectsofETV,resultinginbetteroutcomes.However,furtherstudiesarenecessarytoconfirmtheseresultsandevaluatethelong-termsafetyandefficacyofthistreatment.Additionally,themechanismsunderlyingtheanti-fibroticeffectsofHTWFneedtobefurtherinvestigated.

Inconclusion,TCMhasthepotentialtoplayaroleinthemanagementofliverfibrosisinCHBpatients.ThecombinationofHTWFandETVcouldprovideacomplementaryandalternativeapproachtothecurrentstandardofcareforCHB.ThisstudyhighlightsthetherapeuticpotentialofTCMinliverdiseasesandcallsforfurtherresearchinthisarea.TCMhasarichhistoryandoffersabroadrangeoftherapiesthatmaybenefitliverfibrosispatients.WithabetterunderstandingofTCManditsmechanisms,wemaybeabletodevelopmoreeffectiveandsafertherapiesforliverfibrosisinthefuture。InadditiontoTCM,thereareotheralternativetherapiesthathaveshownpromisingresultsinthetreatmentofliverfibrosis.Theseincludenaturalproducts,dietaryinterventions,andexercise.

Naturalproducts,suchasmilkthistleandcurcumin,havebeenextensivelystudiedfortheirpotentialtherapeuticeffectsonliverdiseases.Milkthistleisaherbthathasbeentraditionallyusedforliverdisorders,anditsactivecomponent,silymarin,hasbeenshowntohaveanti-inflammatoryandantioxidanteffects,aswellastheabilitytoinhibitfibrosis.Similarly,curcumin,acompoundfoundinthespiceturmeric,hasbeenshowntohaveanti-inflammatoryandanti-fibroticeffectsinliverdiseases.

Dietaryinterventions,suchasreducingalcoholintakeandincreasingconsumptionoffruitsandvegetables,havealsobeenfoundtobebeneficialforliverhealth.Alcoholisamajorcauseofliverdiseasesandcanleadtofibrosis,solimitingalcoholintakeorabstainingaltogethercanhelppreventorreverseliverfibrosis.Fruitsandvegetablesarerichinantioxidants,whichcanhelpreduceinflammationandoxidativestressintheliver.

Exercisehasalsobeenshowntohavepositiveeffectsonliverhealth.Regularexercisecanhelpreduceinflammationandimproveliverfunctioninpatientswithliverdiseases,includingfibrosis.Exercisehasalsobeenfoundtodecreaseinsulinresistance,whichcancontributetothedevelopmentofliverfibrosis.

Inconclusion,liverfibrosisisaseriousconditionthatcanleadtocirrhosisandliverfailure.Thecurrentstandardofcareforliverfibrosisislimited,andthereisaneedfornewandeffectivetherapies.Alternativetherapies,suchasTCM,naturalproducts,dietaryinterventions,andexercise,offerpromisingoptionsforthetreatmentofliverfibrosis.Furtherresearchisneededtofullyevaluatetheefficacyandsafetyofthesetherapies,andtodevelopmoreeffectivetreatmentsforthisdebilitatingcondition。Inrecentyears,therehasbeenagrowinginterestinalternativetherapiesforliverfibrosis.TraditionalChineseMedicine(TCM)hasbeenusedforthousandsofyearstotreatliverdiseases,andmanynaturalproductshaveshownpromiseinreducingliverfibrosisinpreclinicalstudies.

TCMusesaholisticapproachtodiagnoseandtreatliverfibrosis,whichinvolvesrestoringthebalanceofenergyandpromotingbloodflow.TCMtherapiesincludeacupuncture,herbalmedicine,anddietaryinterventions.Forexample,theherbSophoraflavescenshasbeenshowntoreduceliverfibrosisinpreclinicalstudies.Acupuncturehasalsobeenshowntoreduceliverfibrosisbypromotingthereleaseofanti-inflammatoryandanti-fibroticfactors.

Naturalproducts,suchascurcumin,resveratrol,andsilymarin,havealsobeeninvestigatedfortheirpotentialintreatingliverfibrosis.Curcumin,foundinturmeric,hasbeenshowntoreduceliverfibrosisbyinhibitingtheactivationofhepaticstellatecells,whichareresponsiblefortheexcessiveproductionofextracellularmatrixinliverfibrosis.Resveratrol,foundingrapesandredwine,hasalsobeenshowntoreduceliverfibrosisbyinhibitingtheactivationofhepaticstellatecellsandpromotingliverregeneration.Silymarin,foundinmilkthistle,hasbeenusedforcenturiestotreatliverdiseasesandhasbeenshowntoreduceliverfibrosisbyreducinginflammationandoxidativestress.

Dietaryinterventions,suchastheMediterraneandietandintermittentfasting,havealsobeeninvestigatedfortheirpotentialinreducingliverfibrosis.TheMediterraneandiet,whichisrichinfruits,vegetables,wholegrains,fish,andhealthyfats,hasbeenshowntoreduceliverfibrosisbyreducinginflammationandoxidativestress.Intermittentfasting,whichinvolvesalternatingbetweenperiodsoffastingandeating,hasalsobeenshowntoreduceliverfibrosisbypromotingautophagy,aprocessthathelpstoremovedamagedcellsandpromoteliverregeneration.

Exercisehasalsobeenshowntoreduceliverfibrosisbyreducinginflammationandoxidativestress,andpromotingliverregeneration.Exercisehasbeenshowntoimproveliverfunction,reduceliverfataccumulation,andimproveinsulinsensitivity,allofwhichcanhelptoreduceliverfibrosis.

Inconclusion,alternativetherapiessuchasTCM,naturalproducts,dietaryinterventions,andexerciseofferpromisingoptionsforthetreatmentofliverfibrosis.Furtherresearchisneededtofullyevaluatetheefficacyandsafetyofthesetherapies,andtodevelopmoreeffectivetreatmentsforthisdebilitatingcondition。Additionalstrategiesbeinginvestigatedforthetreatmentofliverfibrosisincludeantioxidanttherapies,immunomodulatoryagents,andgenetherapy.

Antioxidanttherapieshavebeenshowntotargetoxidativestress,whichisakeydriverofliverfibrosis.ExamplesofantioxidantsthathavebeenstudiedinthecontextofliverdiseaseincludevitaminE,N-acetylcysteine,andsilymarin.Whilesomestudieshaveshownbenefitsofthesetherapiesinreducingmarkersoffibrosis,furtherresearchisneededtoconfirmtheirefficacy.

Immunomodulatoryagentsarebeingexploredasawaytotargettheunderlyingimmunesystemdysregulationthatcontributestoliverfibrosis.Examplesoftheseagentsincludeinterferon,whichhasbeenusedtotreathepatitisCvirus(HCV)infectionandhasshownsomeefficacyinreducingfibrosisinpatientswithHCV-relatedliverdisease.Otheragen