目的:观察双环醇片联合中药对乙型肝炎E抗原(HBeAg)阳性初治慢性乙肝患者的临床疗效.方法:72例HBeAg阳性初治慢性乙肝患者,依据治疗方法不同随机分为治疗组与对照组,各36例.治疗组采用口服双环醇片50mg,对照组采用注射短效干扰素500 MU,两组均联合中药辨证论治.比较两组临床疗效.结果:治疗48周后,治疗组的丙氨酸氨基转移酶(ALT)复常率高于对照组(P＜0.05);经治疗后,两组的乙肝病毒载量(HBV-DNA载量)载量与HBeAg血清转换率相比差异无统计学意义(P＞0.05);治疗组患者的白细胞计数(WBC)和血小板(PLT)计数与治疗前相比,差异无统计学意义(P＞0.05),而对照组治疗前后差异有统计学意义(P＜0.05).结论:双环醇片联合中药辨证治疗在降低ALT方面效果明显,且副作用小.

在乙型肝炎病毒(HBV)感染的自然史中,既往认为HBeAg阳性提示HBV复制活跃,传染性强,HBV DNA水平高.当HBeAg阴转且伴有抗-HBe阳转时,则代表HBV DNA水平下降或消失,传染性小,同时伴肝脏炎症减轻或消失,表现为转氨酶复常,是病情趋于稳定的状态.因此,临床上常将HBeAg转阴并出现抗-HBe阳性(e抗原血清学转换)作为CHB(慢性乙型肝炎)抗病毒治疗的目标之一.

There will be some different outcomes after HBV infection:(1) acute self-limited hepatitis B;(2) chronic hepatitis;(3) chronic HBV carriers or HBsAg carriers;(4) occult chronic hepatitis B;(5) cirrhosis caused by chronic hepatitis B;(6) severe hepatitis.And(2)(3)(4)(5) could be called chronic HBV infection.Chronic hepatitis B is a long process which is positively correlated with cirrhosis and hepatocellular carcinoma.It is very important to cure chronic hepatitis B and prevent the occurrence of cirrhosis and hepatocellular carcinoma.Recently,lots of research achievements on the pathogenetic mechanism of chronic hepatitis B were reported,which mainly were related to viral load,genotype and state of the host immune.This article summarizes recent developments on pathogenetic mechanism of chronic hepatitis B.

慢性乙型病毒性肝炎治疗的关键是抗病毒,该文通过近3年来的临床观察和文献研究发现,抗HBV药物干扰素、核苷类药物和中药及其提取物联合治疗慢乙肝取得较满意的疗效,不管是抑制乙肝病毒复制、降低变异率,还是改善肝功能、纤维化和临床症状,联合治疗均优于单一治疗,提示中西医结合治疗有确切的疗效和优势,可能是治疗慢乙肝的首选疗法。