目的 探討水飛薊賓膠囊聯(lián)合艾米替諾福韋治療慢性乙型肝炎的臨床療效。方法 選取2021年8月—2024年6月如皋市人民醫(yī)院收治的96例慢性乙型肝炎患者，按隨機(jī)數(shù)字表法將患者分為對(duì)照組和治療組，每組各48例。對(duì)照組隨食物服用艾米替諾福韋片，1片/次，1次/d。治療組在此基礎(chǔ)上口服水飛薊賓膠囊，3粒/次，3次/d。兩組療程12周。觀察兩組的臨床療效和癥狀緩解時(shí)間，比較治療前后肝功能指標(biāo)、乙型肝炎患者的生存質(zhì)量測(cè)定量表（QOL-HBV）評(píng)分、中性粒細(xì)胞與淋巴細(xì)胞比值（NLR）和血清乙肝病毒脫氧核糖核酸（HBV DNA）、白細(xì)胞介素-17（IL-17）、超氧化物歧化酶（SOD）、丙二醛（MDA）、高爾基體蛋白73（GP73）、基質(zhì)金屬蛋白酶-2（MMP-2）水平變化。結(jié)果 治療后，治療組總有效率是93.75%，顯著高于對(duì)照組的79.17%（P＜0.05）。治療組乏力、食欲減退、惡心、肝區(qū)不適緩解時(shí)間均明顯短于對(duì)照組（P＜0.05）。治療后，兩組血清丙氨酸轉(zhuǎn)氨酶（ALT）、總膽紅素（TBIL）、天冬氨酸轉(zhuǎn)氨酶（AST）水平均低于同組治療前（P＜0.05）；治療后，治療組ALT、TBIL、AST水平低于對(duì)照組（P＜0.05）。治療后，兩組QOL-HBV評(píng)分都顯著增加，血清HBV DNA水平都顯著下降（P＜0.05）；治療后，治療組QOL-HBV評(píng)分和血清HBV DNA水平改善均優(yōu)于對(duì)照組（P＜0.05）。治療后，兩組NLR和血清IL-17、MDA、GP73、MMP-2水平都低于治療前，血清SOD水平都顯著上升（P＜0.05）。治療后，治療組NLR和血清IL-17、SOD、MDA、GP73、MMP-2水平改善優(yōu)于對(duì)照組（P＜0.05）。結(jié)論 水飛薊賓膠囊聯(lián)合艾米替諾福韋治療慢性乙型肝炎患者耐受性較好，能有效加快患者病毒感染程度及癥狀緩解，促進(jìn)肝功能恢復(fù)和生存質(zhì)量改善，值得臨床推廣應(yīng)用。

Objective To investigate the clinical efficacy of Silibinin Capsules combined with tenofovir amibufenamide in treatment of chronic hepatitis B. Method A total of 96 patients with chronic hepatitis B treated in Rugao People's Hospital from August 2021 to June 2024 were selected and divided into control group and treatment group according to random number table method, with 48 patients in each group. Patients in control group received Tenofovir Amibufenamide Tablets with food, 1 tablet/time, once daily. Patients in treatment group were po administered with Silibinin Capsules on basis of the control group, 3 capsules/time, 3 times daily. Both groups were treated for 12 weeks. The clinical efficacy and symptom remission time of two groups were observed, and the changes of liver function index, QOL-HBV score, NLR, HBV DNA, IL-17, SOD, MDA, GP73, and MMP-2 were compared before and after treatment. Results After treatment, the total effective rate of treatment group was 93.75%, which was significantly higher than that of control group (79.17%, P < 0.05). The relief time of fatigue, anorexia, nausea and hepatic discomfort in treatment group was significantly shorter than that in control group (P < 0.05). After treatment, serum ALT, TBIL, and AST levels in two groups were lower than those before treatment (P < 0.05). After treatment, ALT, TBIL and AST levels in treatment group were lower than those in control group (P < 0.05). After treatment, QOL-HBV scores were significantly increased and serum HBV DNA levels were significantly decreased in both groups (P < 0.05). After treatment, QOL-HBV score and serum HBV DNA level in treatment group were better than those in control group (P < 0.05). After treatment, the levels of NLR, IL-17, MDA, GP73, and MMP-2 in both groups were lower than those before treatment, and the level of SOD in serum was significantly increased (P < 0.05). After treatment, the levels of NLR, IL-17, SOD, MDA, GP73, and MMP-2 in treatment group were better than those in control group (P < 0.05). Conclusion In treatment of chronic hepatitis B with Silibinin Capsules combined with tenofovir amibufenamide, patients have good tolerance, and it can effectively accelerate the degree of virus infection and symptoms of patients, promote the recovery of liver function and improve the life quality, which is worthy of clinical application.

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南通市衛(wèi)生健康委科研課題（指令性）立項(xiàng)課題項(xiàng)目（MSZ2023077）