目的 探讨舒肝宁注射液联合富马酸丙酚替诺福韦治疗慢性乙型病毒性肝炎的临床研究。方法 选取2019年1月—2020年1月在南阳市中心医院治疗的112例慢性乙型病毒性肝炎患者，随机分成对照组（56例）和治疗组（56例）。对照组患者口服富马酸丙酚替诺福韦片，1片/次，1次/d。治疗组患者在对照组的基础上iv舒肝宁注射液，20 mL加入5%葡萄糖注射液300 mL，1次/d。两组均治疗21 d。观察两组患者临床疗效，比较治疗前后两组患者肝功能指标总胆红素（TBIL）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）和总蛋白（TP），淋巴细胞亚群指标CD4⁺、CD4⁺/CD8⁺和不良反应。结果 治疗组临床总有效率为96.43%，明显高于对照组的83.93%（P<0.05）。治疗后，两组TBIL、ALT、AST均显著降低，而TP升高（P<0.05）；治疗后，治疗组患者TBIL、ALT、AST均低于对照组，而TP指标高于对照组（P<0.05）。治疗后，两组CD83、CD86、MHC-DR、CD1a均显著升高（P<0.05）；治疗后治疗组外周血树突状细胞水平高于对照组（P<0.05）。治疗后，两组患者CD4⁺、CD4⁺/CD8⁺升高，而CD8⁺指标降低（P<0.05）；治疗后，治疗组淋巴细胞亚群优于对照组（P<0.05）。治疗组不良反应总发生率为7.14%，低于对照组17.86%的不良反应发生率（P<0.05）。结论 舒肝宁注射液联合富马酸丙酚替诺福韦片治疗慢性乙型病毒性肝炎疗效显著，肝功能改善明显，并能够改善外周血树突状细胞和淋巴细胞亚群功能，增强机体免疫能力。

Objective To explore the clinical study of Shuganning Injection combined with tenofovir alafenamide fumarate in treatment of chronic hepatitis B. Methods Patients (112 cases) with chronic hepatitis B in Nanyang Central Hospital from January 2019 to January 2020 were randomly divided into control (56 cases) and treatment (56 cases) groups. Patients in the control group were po administered with Tenofovir alafenamide Fumarate Tablets, 1 tablet/time, once daily. Patients in the treatment group were iv administered with Shuganning Injection on the basis of the control group, 20 mL added into 5% glucose injection 500 mL, once daily. Patients in two groups were treated for 21 d. After treatment, the clinical efficacy was evaluated, and the liver function indexes of TBIL, ALT, AST and TP, the lymphocyte subgroup indexes of CD4⁺ and CD4⁺/CD8⁺, the dendritic cell content in peripheral blood and adverse reactions in two groups before and after treatment were compared. Results After treatment, the total clinical effective rate of the treatment group was 96.43%, which was significantly higher than 83.93% of the control group (P<0.05). After treatment, TBIL, ALT and AST in both groups were significantly decreased, while TP was increased (P<0.05). After treatment, TBIL, ALT and AST in the treatment group were lower than those in the control group, while TP in the treatment group was higher than those in the control group (P<0.05). After treatment, CD83, CD86, MHC-DR and CD1A in two groups were significantly increased (P<0.05); After treatment, the level of peripheral blood dendritic cells in treatment group was higher than that in control group (P<0.05). After treatment, CD4⁺ and CD4⁺/CD8⁺ in two groups were increased, while CD8⁺ indexes were decreased (P<0.05); After treatment, lymphocyte subsets in treatment group were superior to those in control group (P<0.05). The total incidence of adverse reactions in the treatment group was 7.14%, which was lower than 17.86% in the control group (P<0.05). Conclusion Shuganning Injection combined with tenofovir alafenamide fumarate is effective in treatment of chronic hepatitis B. The liver function is improved obviously, and the function of dendritic cells and lymphocyte subsets in peripheral blood can be improved, and the immune ability of the body can be enhanced.

R978

河南省医学科技攻关计划项目（2018020415）