目的 探讨六味五灵片联合富马酸丙酚替诺福韦片治疗慢性乙型肝炎的临床疗效。方法 选取2021年11月—2024年5月山西医科大学第一医院感染病科诊治的120例慢性乙型肝炎患者，按照随机数字法将患者分为对照组60例和治疗组60例。对照组口服富马酸丙酚替诺福韦片，25 mg/次，每日1次。治疗组在对照组的基础上口服六味五灵片，1.0 g/次，每日3次。两组连续治疗24周。观察对比两组疗效情况，比较两组治疗前后中医证候积分、血清总胆红素（TBIL）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、γ-谷氨酰转肽酶（GGT）、层黏连蛋白（LN）、Ⅲ型前抗原（PC-Ⅲ）、透明质酸（HA）、IV型胶原（IV-C）、肝脏硬度数值（LSM）、简明健康状况调查量表（SF-36）、白细胞介素17（IL-17）、转化生长因子-β1（TGF-β1）、血清可溶性Ⅰ型补体受体（sCR1）、血清高尔基体跨膜糖蛋白73（GP73）水平的变化情况。结果 治疗后，治疗组总有效率是97.06%，显著高于对照组的85.29%（P＜0.05）。治疗后，两组TBIL、ALT、AST、GGT水平均显著降低（P＜0.05）；与对照组对比，治疗组TBIL、ALT、AST、GGT水平均较低（P＜0.05）。治疗后，两组LN、PC-Ⅲ、HA、IV-C指标均显著降低（P＜0.05）；治疗后，与对照组对比，治疗组LN、PC-Ⅲ、HA、IV-C指标均较低（P＜0.05）。治疗后，两组LSM显著降低，而SF-36评分显著升高（P＜0.05）；治疗后，治疗组LSM低于对照组，而SF-36评分高于对照组（P＜0.05）。结论 六味五灵片联合富马酸丙酚替诺福韦片治疗慢性乙型肝炎效果较佳，可明显改善患者肝功能，提高患者生活质量，值得借鉴与推广。

Objective To explore the effects of Liuwei Wuling Tablets combined with tenofovir alafenamide in treatment of chronic hepatitis B. Methods A total of 120 patients with chronic hepatitis B diagnosed and treated in the Infectious Disease Department of the First Hospital of Shanxi Medical University from November 2021 to May 2024 were selected and divided into control group (60 cases) and treatment group (60 cases) according to random number method. Patients in control group were po administered with Tenofovir alafenamide Fumarate Tablets, 25 mg/time, once daily. Patients in treatment group were po administered with Liuwei Wuling Tablets on the basis of control group, 1.0 g/time, three times daily. Both groups were treated continuously for 24 weeks. The efficacy of t two groups was observed and compared. The changes of TCM syndrome scores, serum TBIL, ALT, AST, GGT, LN, PC-Ⅲ, HA, IV-C, Liver hardness value (LSM), SF-36 score, IL-17, TGF-β1, sCR1, and GP73 were compared before and after treatment. Results After treatment, the total effective rate of treatment group was 97.06%, significantly higher than that of control group (85.29%) (P < 0.05). After treatment, the levels of TBIL, ALT, AST, and GGT in both groups were significantly decreased (P < 0.05). Compared with control group, the levels of TBIL, ALT, AST, and GGT in treatment group were lower (P < 0.05). After treatment, LN, PC-Ⅲ, HA, and IV-C were significantly decreased in both groups (P < 0.05). After treatment, LN, PC-Ⅲ, HA and IV-C indexes in treatment group were lower than those in control group (P < 0.05). After treatment, LSM was significantly decreased in both groups, but SF-36 score was significantly increased (P < 0.05). After treatment, LSM in treatment group was lower than that in control group, but SF-36 score was higher than that in control group (P < 0.05). Conclusion Liuwei Wuling Tablets combined with tenofovir alafenamide has a good effect in treatment of chronic hepatitis B, and can obviously improve the liver function and improve the life quality of patients, which is worth learning and promoting.

R975

吴阶平医学基金会临床科研专项资助基金项目（320.6750.2023-06-37）