目的 观察扶正化瘀片联合富马酸丙酚替诺福韦片治疗乙型肝炎肝硬化的临床疗效。方法 选取2022年3月—2024年5月天津市滨海新区大港医院收治的81例乙型肝炎肝硬化患者，根据治疗方案将患者分为对照组（40例）和治疗组（41例）。对照组口服富马酸丙酚替诺福韦片，25 mg/次，1次/d。治疗组在对照组基础上口服扶正化瘀片，4片/次，3次/d。两组的疗程均为24周。比较两组的临床疗效、肝功能指标、肝纤维化指标、肝硬度值、病毒学指标、炎症因子。结果 治疗组的总有效率（87.80%）高于对照组的总有效率（67.50%），组间比较差异显著（P＜0.05）。治疗后，两组白蛋白（ALB）水平升高，总胆红素（TBIL）、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）水平降低（P＜0.05）；且治疗组ALB水平高于对照组，TBIL、AST、ALT水平低于对照组（P＜0.05）。治疗后，两组Ⅲ型原胶原（PCIII）、Ⅳ型胶原（IVC）、透明质酸（HA）、层黏连蛋白（LN）水平均降低（P＜0.05），且治疗组PCIII、IVC、HA、LN水平均低于对照组（P＜0.05）。治疗后，两组肝硬度值（LSM）均下降（P＜0.05），且治疗组LSM显著低于对照组（P＜0.05）。治疗组的HBV-DNA下降值、转阴率、乙型肝炎E抗原（HBeAg）转阴率、乙型肝炎表面抗原（HBsAg）下降值均高于对照组（P＜0.05）。治疗后，两组血清白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平降低，血清白细胞介素-10（IL-10）水平升高（P＜0.05）；治疗组血清IL-6、TNF-α水平低于对照组，血清IL-10水平高于对照组（P＜0.05）。结论 扶正化瘀片联合富马酸丙酚替诺福韦片可显著改善乙型肝炎肝硬化患者的肝功能，促进纤维化逆转，降低肝硬度，增强病毒学应答，并调节血清炎症因子水平。

Objective To observe the clinical effect of Fuzheng Huayu Tablets combined with Tenofovir Alafenamide Fumarate Tablets in treatment of hepatitis B cirrhosis. Methods 81 Patients with hepatitis B cirrhosis admitted to Dagang Hospital, Tianjin Binhai New Area from March 2022 to May 2024 were selected and were divided into control group (40 cases) and treatment group (41 cases) according to the treatment plan. The control group was orally administered with Tenofovir Alafenamide Fumarate Tablets, 25 mg/time, once daily. The treatment group was orally administered with Fuzheng Huayu Tablets in addition to the control group, 4 tablets/time, 3 times daily. The treatment course for two groups was 24 weeks. The clinical efficacy, liver function indicators, liver fibrosis indicators, liver stiffness measurement (LSM), virological indicators, and inflammatory factors were compared between two groups. Results The total effective rate of the treatment group (87.80%) was higher than that of the control group (67.50%), and the difference between two groups was significant (P< 0.05). After treatment, the levels of albumin (ALB) increased in two groups, while the levels of total bilirubin (TBIL), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) decreased (P < 0.05). And the ALB level in the treatment group was higher than that in the control group, while the TBIL, AST, and ALT levels were lower than those in the control group (P < 0.05). After treatment, the levels of type III procollagen (PCIII), type IV collagen (IVC), hyaluronic acid (HA), and laminin (LN) in two groups decreased (P < 0.05), and the levels of PCIII, IVC, HA, and LN in the treatment group were lower than those in the control group (P< 0.05). After treatment, the LSM of two groups decreased (P < 0.05), and the LSM of the treatment group was significantly lower than that of the control group (P < 0.05). The decrease and conversion rate of HBV-DNA, hepatitis B E antigen (HBeAg) conversion rate, and hepatitis B surface antigen (HBsAg) decrease in the treatment group were higher than those in the control group (P < 0.05). After treatment, the serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) decreased in two groups, while the serum level of interleukin-10 (IL-10) increased (P< 0.05), and the serum levels of IL-6 and TNF-α in the treatment group were lower than those in the control group, while the level of serum IL-10 was higher than that in the control group (P < 0.05). Conclusion The combination of Fuzheng Huayu Tablets and Tenofovir Alafenamide Fumarate Tablets can significantly improve liver function in patients with hepatitis B cirrhosis, promote fibrosis reversal, reduce liver hardness, enhance virological response, and regulate serum inflammatory cytokine levels.

R975