Study On The Clinical Effect Of Ruangan Decoction On Liver Fibrosis Of Chronic Hepatitis B With Qi Deficiency And Blood Stasis Syndrome

Objective:1.To explore the risk factors associated with the progression of significant hepatic fibrosis in patients with CHB and to construct a risk factor model for hepatic fibrosis,and to guide the prediction of liver fibrosis.2.Observe the curative effect of the self-made Ruangan Decoction on patients with CHB liver fibrosis,Qi stagnation and blood stasis syndrome,and provide a scientific basis for clinical practice.Methods:The first part of the method was to collect patients with chronic hepatitis B liver fibers who met the inclusion criteria from the Department of Hepatobiliary Medicine of Fuzhou Second Hospital from October 2017 to December 2018,use Fibro Scan to detect LSM values,collect"serum HBVDNA","HBe Ag status","ALT""GGT"and other indicators,using single factor and multifactor Logistics regression analysis of age and the correlation between the above indicators and CHB progress to liver fibrosis,and further build a reasonable regression model.The second part selects the patients who meet the CHB liver fibrosis,qi stagnation and blood stasis syndrome by TCM syndrome differentiation and is divided into control group and experimental group.The control group was treated with entecavir alone,and the experimental group was given self-made Ruanganfang plus entecavir for 48 weeks.Both groups measured LSM value,liver function and HBV DNA load before treatment,24 weeks after treatment and48 weeks after treatment and calculated APRI according to the formula,and detected serum liver fibrosis at 48 weeks after treatment.Results:（1）To study the risk factors related to the progression of liver fibrosis in CHB patients and to construct a regression model:1.Serum ALT,GGT,HBV DNA load,and HBe Ag are relevant risk factors for CHB to progress to significant liver fibrosis.2.According to the statistical analysis results,select meaningful variables（ALT=X₂,GGT=X₃,HBV DNA=X₄,HBe Ag status=X₅）,and establish a logistic regression model of risk factors:P=e^s/1+e^s,S=-5.063+1.137X₂+2.757X₃+3.199X₄+0.905X₅.（2）Observate the clinical efficacy of self-made Ruangan Decoction on TCM with qi stagnation and blood stasis syndrome:1.The total effective rate of treatment of TCM was 96.97%in the experimental group and 62.5%in the control group.and the experimental group is superior to the control group（P<0.05）.2.Liver fibrosis test:In terms of LSM value and APRI,at the 24th week of treatment,both groups had a decrease and had statistical difference（P<0.05）,but there was no significant difference between the two groups.At the 48th week of treatment,the experimental group was significantly lower than that before treatment and the control group.In terms of the four items of liver fiber,the HA,LN and PⅢP experimental groups were superior to the control group（P<0.05）;although the experimental group had a significantly lower CⅣthan the control group,the difference was not statistically significant（P>0.05）.3.Serum liver function level:the levels of ALT,AST and GGT in the two groups were improved compared with the previous ones at The 24th and 48th of treatment（P<0.01）.The experimental group was better than the control group at the 48th week Group（P<0.05）,And the remaining indexes between the two groups were no significant difference（P>0.05）.4.Serum HBV DNA negative conversion rate:the experimental group and the control group had a total negative conversion rate of 90.91%and 84.38%at the 48th week of treatmen.At the 24th and 48th week of treatment,there was a difference in the conversion rate between the two groups（P<0.01）,but no statistical significance in the comparison between the two groups（P>0.05）.Conclusion:1."Serum HBVDNA load","HBe Ag status","ALT"and"GGT"in CHB patients may be related risk factors that affect the progression of CHB to liver fibrosis.The prediction model is P=e^s/1+e^s,S=-5.063+1.137X₂+2.757X₃+3.199X₄+0.905X₅.P is the probability of liver fibrosis in untreated and newly diagnosed chronic hepatitis B patients.The positive rate of prediction is still not good,considering the need to include more patients and influencing factors to improve accuracy.2.The self-made Ruangan prescription combined with entecavir can significantly improve the long-term liver fibrosis improvement effect and liver function in patients with chronic hepatitis B liver fiber qi stagnation and blood stasis syndrome,and improve the clinical efficacy of TCM symptoms.