目的 探讨水飞蓟宾胶囊联合艾米替诺福韦治疗慢性乙型肝炎的临床疗效。方法 选取2021年8月—2024年6月如皋市人民医院收治的96例慢性乙型肝炎患者，按随机数字表法将患者分为对照组和治疗组，每组各48例。对照组随食物服用艾米替诺福韦片，1片/次，1次/d。治疗组在此基础上口服水飞蓟宾胶囊，3粒/次，3次/d。两组疗程12周。观察两组的临床疗效和症状缓解时间，比较治疗前后肝功能指标、乙型肝炎患者的生存质量测定量表（QOL-HBV）评分、中性粒细胞与淋巴细胞比值（NLR）和血清乙肝病毒脱氧核糖核酸（HBV DNA）、白细胞介素-17（IL-17）、超氧化物歧化酶（SOD）、丙二醛（MDA）、高尔基体蛋白73（GP73）、基质金属蛋白酶-2（MMP-2）水平变化。结果 治疗后，治疗组总有效率是93.75%，显著高于对照组的79.17%（P＜0.05）。治疗组乏力、食欲减退、恶心、肝区不适缓解时间均明显短于对照组（P＜0.05）。治疗后，两组血清丙氨酸转氨酶（ALT）、总胆红素（TBIL）、天冬氨酸转氨酶（AST）水平均低于同组治疗前（P＜0.05）；治疗后，治疗组ALT、TBIL、AST水平低于对照组（P＜0.05）。治疗后，两组QOL-HBV评分都显著增加，血清HBV DNA水平都显著下降（P＜0.05）；治疗后，治疗组QOL-HBV评分和血清HBV DNA水平改善均优于对照组（P＜0.05）。治疗后，两组NLR和血清IL-17、MDA、GP73、MMP-2水平都低于治疗前，血清SOD水平都显著上升（P＜0.05）。治疗后，治疗组NLR和血清IL-17、SOD、MDA、GP73、MMP-2水平改善优于对照组（P＜0.05）。结论 水飞蓟宾胶囊联合艾米替诺福韦治疗慢性乙型肝炎患者耐受性较好，能有效加快患者病毒感染程度及症状缓解，促进肝功能恢复和生存质量改善，值得临床推广应用。

Objective To investigate the clinical efficacy of Silibinin Capsules combined with tenofovir amibufenamide in treatment of chronic hepatitis B. Method A total of 96 patients with chronic hepatitis B treated in Rugao People's Hospital from August 2021 to June 2024 were selected and divided into control group and treatment group according to random number table method, with 48 patients in each group. Patients in control group received Tenofovir Amibufenamide Tablets with food, 1 tablet/time, once daily. Patients in treatment group were po administered with Silibinin Capsules on basis of the control group, 3 capsules/time, 3 times daily. Both groups were treated for 12 weeks. The clinical efficacy and symptom remission time of two groups were observed, and the changes of liver function index, QOL-HBV score, NLR, HBV DNA, IL-17, SOD, MDA, GP73, and MMP-2 were compared before and after treatment. Results After treatment, the total effective rate of treatment group was 93.75%, which was significantly higher than that of control group (79.17%, P < 0.05). The relief time of fatigue, anorexia, nausea and hepatic discomfort in treatment group was significantly shorter than that in control group (P < 0.05). After treatment, serum ALT, TBIL, and AST levels in two groups were lower than those before treatment (P < 0.05). After treatment, ALT, TBIL and AST levels in treatment group were lower than those in control group (P < 0.05). After treatment, QOL-HBV scores were significantly increased and serum HBV DNA levels were significantly decreased in both groups (P < 0.05). After treatment, QOL-HBV score and serum HBV DNA level in treatment group were better than those in control group (P < 0.05). After treatment, the levels of NLR, IL-17, MDA, GP73, and MMP-2 in both groups were lower than those before treatment, and the level of SOD in serum was significantly increased (P < 0.05). After treatment, the levels of NLR, IL-17, SOD, MDA, GP73, and MMP-2 in treatment group were better than those in control group (P < 0.05). Conclusion In treatment of chronic hepatitis B with Silibinin Capsules combined with tenofovir amibufenamide, patients have good tolerance, and it can effectively accelerate the degree of virus infection and symptoms of patients, promote the recovery of liver function and improve the life quality, which is worthy of clinical application.

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南通市卫生健康委科研课题（指令性）立项课题项目（MSZ2023077）