The Long-term Cohort Study Of Chinese Medicine Teating Chronic Hepatitis B

ObjectiveAmong 20 to 30 million chronic hepatitis B(CHB)patients in China, the number of whom with standardized antiviral therapy is less than 5 million. Anti-inflammatory and hepatoprotecetion is an important treatment of CHB. Chinese medicine, with an exact clinical efficacy and good effects in repairing liver and improve inflammation, plays an important role in anti-inflammatory and hepatoprotecetion treatment. But there is not much clinical long-term cohort study currently. This study consists of treatment combing Chinese medicine with anti-inflammatory and hepatoprotecetion drugs(Treatment group) and treatment using anti-inflammatory and hepatoprotecetion drugs alone (Control group). Based on the long-term follow-up medical information at different stages of chronic hepatitis B(CHB or cirrhosis), the clinical efficacy and outcomes between different treatment programs were contrasted. We followed up the patients for 2 to 21 years, observed the efficacy and benefits of the treatment group in improving liver function, reducing HBV DNA and cirrhosis and HCC incidence in the long term, so as to provide a reference for the time and factors of antiviral therapy. It plays an important role in guiding the clinical treatment of CHB.MethodsA retrospective cohort study was conducted in this research. Different anti-inflammatory and hepatoprotecetion treatment programs were used on 410 CHB patients and 138 patients with cirrhosis who had failed to take antiviral therapy due to various reasons. The level of ALT, AST, AFP, TB, HBV-DNA, the HBeAg status and other indicators were observed, and the cumulative incidence and risk factors of cirrhosis and HCC were analyzed. In the treatment group, there were 230 CHB patients and 89 patients with cirrhosis. In the control group, there were 180 CHB patients and 49 patients with cirrhosis. Chinese medicine was combined with anti-inflammatory and hepatoprotecetion drugs in the treatment group, and anti-inflammatory and hepatoprotecetion drugs were used alone in the control group.Results1. Among 410 CHB patients, there were 113 cases of cirrhosis, with 54 in the treatment group and 59 in the control group, the incidence of two groups were significantly different (P=0.036). And 18 cases of patients developed into HCC with 8 and 10 cases in treatment group and control group,9 patients died during the research with 4 and 5 cases respectively.Among 138 patients with cirrhosis,50 developed into HCC and 23 died. But there were no significant difference.2. The indicators of CHB treatment group improved significantly(p<0.05),while the cirrhosis group was not so.3. Among 410 CHB patients,55 cases in treatment group and 27 cases in control group had e antigen seroconversion after treatment (P=0.025),74 cases in treatment group and 33 cases in control group with HBV-DNA＜103 after treatment (P=0.002). In 138 patients with cirrhosis,e antigen seroconversion and HBV-DNA level after treatment had no significant difference.4. The cumulative incidence of cirrhosis of CHB patients in control group was much higher than treatment group (P=0.030). The cumulative incidence of HCC in hepatitis B liver cirrhosis patients in two groups had no significant difference.5. Multivariate analysis of risk in 410 CHB patients, cox regression showed that age、LogDNA、ALT、AST were the risk factors of cirrhosis.Multivariate analysis of risk in 138 patients with cirrhosis, cox regression showed that sex was the independent risk of HCC、age、DNA、TB、ALT、AS、PT were the risk factors of HCC.ConclusionsChinese medicine has a positive effect in improving liver inflammation and indicators in patients with CHB,when combined with anti-inflammatory and hepatoprotecetion drugs, the function of anti-inflammatory and hepatoprotecetion is much better than using anti-inflammatory and hepatoprotecetion drugs alone. It can significantly reduce the incidence of liver cirrhosis and has a higher HbeAg and HBV-DNA clearance. But for patients with cirrhosis,that advantage is not obvious. Therefore, the main goal of CHB patients is to prevent cirrhosis,while in patients with cirrhosis,antiviral treatment should be as soon as possible.