目的 探讨促肝细胞生长素联合丙酚替诺福韦治疗慢性乙型肝炎的临床疗效。方法 选取2024年1月—2025年1月漯河市中心医院收治的81例慢性乙型肝炎资料，依据治疗方法差异分为对照组（41例）和治疗组（40例）。对照组口服富马酸丙酚替诺福韦片，1次/d，1片/次，需随食物送服。治疗组在对照组基础上静脉滴注注射用促肝细胞生长素，80～100 mg/次，1次/d。两组均连续治疗4周。观察两组的临床疗效，比较治疗前后两组肝功能指标、肝纤维化指标、T淋巴细胞亚群、血清细胞因子水平的变化情况。结果 治疗后，治疗组总有效率是97.50%，显著高于对照组的总有效率75.61%（P＜0.05）。治疗后，两组血清天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、总胆红素（TBIL）较治疗前下降较明显（P＜0.05），且治疗组血清AST、ALT、TBIL低于对照组（P＜0.05）。治疗后，两组血清透明质酸（HA）、层黏连蛋白（LN）、Ⅳ型胶原（Ⅳ-C）、Ⅲ型前胶原（PC-Ⅲ）均较治疗前下降明显（P＜0.05），且治疗组血清HA、LN、IV-C、PC-Ⅲ低于对照组（P＜0.05）。治疗后，两组血清CD3⁺、CD4⁺、CD4⁺/CD8⁺较治疗前提高显著（P＜0.05），且治疗组血清CD3⁺、CD4⁺、CD4⁺/CD8⁺高于对照组（P＜0.05）。治疗后，两组血清可溶性生长刺激表达基因2蛋白（sST2）和白细胞介素-33（IL-33）较治疗前显著下降（P＜0.05），且治疗组血清sST2、IL-33低于对照组（P＜0.05）。结论 促肝细胞生长素联合丙酚替诺福韦治疗慢性乙型肝炎具有协同作用，可通过多靶点改善慢性乙型肝炎患者的肝纤维化、肝功能、免疫状态及炎症反应，建议作为临床优化策略加以应用。

Objective To explore the effect of hepatocyte growth-promoting factor combined with alafenamide tenofovir in treatment of chronic hepatitis B. Methods Selecting the data of 81 cases of chronic hepatitis B patients admitted to Luohe Central Hospital from January 2024 to January 2025, they were divided into the control group (41 cases) and the treatment group (40 cases) based on the differences in treatment methods. Patients in control group were given oral administration of Tenofovir Alafenamide Fumarate Tablets, once daily, 1 tablet per time, to be taken with food. Patients in treatment group were received intravenous infusion of Hepatocyte Growth-promoting Factor for injection, 80 — 100 mg per time, once daily. Both groups were treated continuously for 4 weeks. The clinical efficacy of two groups was observed, and the changes in liver function indicators, liver fibrosis indicators, T lymphocyte subsets, and serum cytokine levels before and after treatment were compared. Results After treatment, the total effective rate of treatment group was 97.50%, significantly higher than that of control group (75.61%) (P < 0.05). After treatment, the levels of serum AST, ALT, and TBIL in both groups decreased significantly compared to before treatment (P < 0.05), and the serum AST, ALT, and TBIL in treatment group were lower than those in control group (P < 0.05). After treatment, serum HA, LN, IV-C, and PC-III in both groups decreased significantly compared to before treatment (P < 0.05), and serum HA, LN, IV-C, and PC-III in treatment group were lower than those in control group (P < 0.05). After treatment, the serum CD3⁺, CD4⁺, CD4⁺/CD8⁺ levels in both groups increased significantly compared to before treatment (P < 0.05), and the serum CD3⁺, CD4⁺, and CD4⁺/CD8⁺ levels in treatment group were higher than those in control group (P < 0.05). After treatment, serum sST2 and IL-33 in both groups decreased significantly compared to before treatment (P < 0.05), and serum sST2 and IL-33 in treatment group were lower than those in control group (P < 0.05). Conclusion The combination of hepatocyte growth factor and alafenamide tenofovir in treatment of chronic hepatitis B has a synergistic effect. It can improve liver fibrosis, liver function, immune status and inflammatory response in patients with chronic hepatitis B through multiple targets, which is recommended to be applied as a clinical optimization strategy.

R978.7

河南省医学科技攻关计划项目（LHGJ20230936）