目的 探讨五灵胶囊联合异甘草酸镁治疗慢性乙型肝炎的临床疗效。方法 选取2020年1月—2023年1月沧州市第三医院收治的260例慢性乙型肝炎患者，按随机数字表法将所有患者分为对照组和治疗组，每组各130例。对照组静脉滴注异甘草酸镁注射液，0.1 g/次，以0.9%氯化钠注射液（250 mL）稀释，1次/d。治疗组在对照组治疗基础上饭后30 min口服五灵胶囊，5粒/次，3次/d。两组疗程12周。观察两组临床疗效和症状好转时间；比较两组治疗前后乙型肝炎病毒脱氧核糖核酸（HBV DNA）水平，肝功能指标[天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）和总胆红素（TBIL）]，疲劳量表-14(FS-14)、肝病生存质量量表1.0(LDQOL 1.0)、症状自评量表（SCL-90）评分及血清白细胞介素-23(IL-23)、T淋巴细胞免疫球蛋白黏蛋白分子-3(TIM-3)、血管生成素-2(Ang-2)和基质金属蛋白酶-2(MMP-2)水平。结果 治疗后，治疗组总有效率是96.15%，显著高于对照组的85.38%(P<0.05)。治疗后，治疗组肝区不适、食欲减退、乏力、恶心好转时间短于对照组（P<0.05）。治疗后，两组血清HBV DNA和AST、ALT、TBIL水平都低于同组治疗前（P<0.05）；治疗后，治疗组血清HBV DNA水平和肝功能指标低于对照组（P<0.05）。治疗后，两组FS-14、SCL-90评分都显著减少（P<0.05），而LDQOL1.0评分均显著增加（P<0.05）；治疗后，治疗组FS-14、LDQOL 1.0、SCL-90评分改善优于对照组（P<0.05）。治疗后，两组血清IL-23、TIM-3、Ang-2、MMP-2水平都低于同组治疗前（P<0.05）；治疗后，治疗组血清IL-23、TIM-3、Ang-2、MMP-2水平低于对照组（P<0.05）。结论 五灵胶囊联合异甘草酸镁治疗慢性乙型肝炎能有效加速症状好转，抑制HBV感染和炎症反应程度，减轻肝损伤，利于患者身心状态及生活质量提升，值得临床推广应用。

Objective To explore the clinical efficacy of Wuling Capsules combined with magnesium isoglycyrrhizinate in treatment of chronic hepatitis B. Methods A total of 260 patients with chronic hepatitis B admitted to Cangzhou Third Hospital from January 2020 to January 2023 were selected and divided into control group and treatment group according to random number table method, with 130 patients in each group. Patients in control group were iv administered with Magnesium Isoglycyrrhizinate Injection, 0.1 g/time, diluted with 0.9% sodium chloride injection（250 mL）, once daily. Patients in treatment group were po administered with Wuling Capsules on basis of control group, 5 capsules/time, 3 times daily. Both groups were treated for 12 weeks. The clinical efficacy and symptom improvement time of two groups was evaluated, The levels of hepatitis B virus deoxyribonucleic acid（HBV DNA）, liver function indexes（AST, ALT, and TBIL）, FS-14 score, LDQOL 1.0 score, SCL-90 score, and serum IL-23, TIM-3, Ang-2, MMP-2 before and after treatment were compared between two groups. Results After treatment, the total effective rate of the treatment group was 96.15%, which was significantly higher than that of the control group 85.38%（P＜0.05）. After treatment, the improvement time of hepatic discomfort, anorexia, fatigue and nausea in treatment group was shorter than that in control group（P＜0.05）. After treatment, the levels of serum HBV DNA, AST, ALT and TBIL, in two groups were lower than those before treatment（P＜0.05）. After treatment, the serum HBV DNA level and liver function indexes in treatment group were lower than those in control group（P＜0.05）. After treatment, the scores of FS-14 and SCL-90 in both groups were significantly decreased（P＜0.05）, but the scores of LDQOL 1.0 were significantly increased（P＜0.05）. After treatment, the scores of FS-14, LDQOL 1.0, and SCL-90 in treatment group were better than those in control group（P＜0.05）. After treatment, serum levels of IL-23, TIM-3, Ang-2, and MMP-2 in two groups were lower than those before treatment（P＜0.05）. After treatment, the levels of IL-23, TIM-3, Ang-2, and MMP-2 in treatment group were lower than those in control group（P＜0.05）. Conclusion Wuling Capsules combined with magnesium isoglycyrrhizinate in treatment of chronic hepatitis B can effectively accelerate the improvement of symptoms, inhibit the degree of HBV infection and inflammation, reduce liver damage, and improve the physical and mental state and quality of life of patients, which is worthy of clinical promotion and application.

R975

沧州市重点研发计划指导项目(213106125)