目的 探讨强肝胶囊联合富马酸丙酚替诺福韦片治疗恩替卡韦应答不佳的慢性乙型肝炎的临床疗效。方法 选取2020年3月—2021年2月柳州市人民医院收治的对恩替卡韦治疗应答不佳慢性乙型肝炎患者97例。根据随机数字表法将所有患者分为对照组（48例）和治疗组（49例）。对照组需随食物口服富马酸丙酚替诺福韦片，1次/d，1片/次。治疗组在对照组的基础上口服强肝胶囊，5粒/次，2次/d，每服6 d停1 d，8周为1个疗程，停1周，再进行第2个疗程。两组均连续治疗24周。评估两组的总有效率，比较两组的乙型肝炎病毒脱氧核糖核酸（HBV-DNA）转阴率、丙氨酸氨基转移酶（ALT）复常率、肝纤维化指标、肝功能指标和血清指标。结果 治疗后，治疗组患者的总有效率（91.84%）高于对照组（66.67%）（P＜0.05）。治疗后，治疗组的HBV-DNA转阴率、ALT复常率均高于对照组（P＜0.05）。治疗后，两组透明质酸酶（HA）、层黏连蛋白（LN）、Ⅲ型前胶原（PCⅢ）、Ⅳ型胶原（Ⅳ-C）、总胆红素（TBIL）、ALT、天冬氨酸氨基转移酶（AST）水平均下降（P＜0.05），且治疗组HA、LN、PCⅢ、Ⅳ-C、TBIL、ALT、AST均低于对照组（P＜0.05）。治疗后，两组血清血小板衍生生长因子-BB（PDGF-BB）、转化生长因子β1（TGF-β1）水平均下降（P＜0.05），且治疗组血清PDGF-BB、TGF-β1水平均低于对照组（P＜0.05）。结论 强肝胶囊联合富马酸丙酚替诺福韦片治疗恩替卡韦应答不佳的慢性乙型肝炎患者，可有效改善患者肝功能，抑制肝纤维化，调节血清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

柳州市科技计划项目（2020NBAB0821）