世界中医药

目的：观察柴胡解毒汤在治慢性乙型肝炎方面的临床疗效，并借此探讨该方对细胞因子的影响。方法：选取2015年9月至2016年3月重庆三峡高等专科学校附属医院收治的慢性乙型肝炎患者90例，随机分成对照组和观察组，每组45例。对照组采用干扰素注射，1次/d，连续2周后，再改为隔日1次，连用3个月；观察组在使用干扰素基础上采用中药柴胡解毒汤治疗，2次/d，同样治疗14 d后观察2组治疗的临床疗效、肝功能比较、药物不良反应、血清IL-1β、IL-6、5-HT及TNF-α水平的变化、HBsAg、HBeA、HBV-DNA阴转率等情况。结果：1）治疗后观察组有效率86.67％，对照组有效率68.89％，2组有效率比较,差异有统计学意义（P<0.05）；2）2组与治疗前比较，肝功能指标均有明显改善,差异有统计学意义(P<0.05)；治疗后，观察组ALT、AST及TBIL值均明显低于对照组，差异有统计学意义(P<0.05)；3）不良反应中，对照组出现10例(33.00％)，观察组4例(8.80％)，观察组不良反应明显低于对照组,差异有统计学意义(P<0.05)；4）2组患者在治疗前，检测的血清IL-1β、IL-6、5-HT及TNF-α含量比较，差异无统计学意义(P>0.05)，而组间治疗后比较，观察组明显低于对照组，治疗后，上述指标均较治疗前下降，但观察组下降更明显，差异有统计学意义（P<0.05）；5）观察组HBsAg阴转率为24.4％、HBeAg阴转率为33.3％、HBV-DNA阴转率为48.8％均明显高于对照组，对照组HBsAg阴转率为15.5％、HBeAg阴转率为11.1％、HBV-DNA阴转率为28.9％，2组比较差异有统计学意义(P<0.05)。结论：柴胡解毒汤在治疗慢性乙肝方面有显著的临床效果，且不良反应较传统干扰素明显降低，值得推广，同时，该药对细胞因子等指标也有明显降低作用，考虑其可能是通过类似机制起作用。

English Summary:

To observe the effect of the Chaihu Jiedu Decoction in the treatment of chronic hepatitis B，and to discuss the influences on cytokines.Methods:A total of 90 patients with chronic hepatitis B who were admitted and treated in our hospital from September 2015 to March 2016 were selected.All patients were randomly divided into control group and observation group，with 45 patients in each group.The patients of control group were injected interferon each day，and after two weeks，changed to every other day for continuing three months; the patients of observation group were treated with Chaihu Jiedu Decoction based on conventional treatment，for twice a day.After 14 days of treatment，clinical efficacy，liver function comparison，adverse reactions，changes of serum IL-1β，IL-6，5-HT，negative conversion rate of TNF-r function，HBsAg，HBeA，HBV-DNA were observed.Results:1) After treatment，the effective rate in observation group was 86.67%，and in control group was 68.89% (P<0.05)；2) Compared with that before treatment，the liver functions of two groups were significantly improved after treatment (P<0.05); after treatment，ALT，AST and TBIL of observation group were significantly lower than that of the control group (P<0.05); 3) For the adverse reactions，the control group had 10 cases (33.00%) and observation group had 4 cases (8.80%).The adverse reaction of observation group was significantly lower than the control group (P<0.05); 4) Before treatment，the differences of serum IL-1β，IL-6，5-HT and TNF-α in two groups were not statistically significant，but after treatment，the observation group was significantly lower than the control group.The index above were decreased，but the observation group decreased more significantly (P<0.05); 5) The negative rates of HBsAg，HBeAg and HBV-DNA in observation group were 24.4%，33.3% and 48.8% respectively，which were significantly higher than the control group of 15.5%，11.1% and 28.9%.The differences between the two groups were statistically significant (P<0.05).Conclusion:The Chaihu Jiedu Decoction has significant clinical effect on curing chronic hepatitis B，and the adverse reactions were significantly reduced compared with traditional interferon，so it is worthy of clinical promotion.Meanwhile，the drug reduced the index of cytokines，like IL-1β，IL-6，5-HT and TNF-α，and it might have effects with a similar mechanism.

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