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目的:观察健脾清化方联合拉米夫定在减少乙肝病毒P区基因YMDD变异方面的作用。方法:选取乙肝病毒主要复制指标HBV DNA(PCR法)阳性且中医辨证为肝郁脾虚兼湿热证的慢性乙型肝炎患者63例,随机分为健脾清化方联合拉米夫定治疗组32例、拉米夫定对照组31例,疗程2年,疗程结束时,采用caliper1000微流芯片仪对HBVDNA阳性患者进行YMDD变异检测。结果:2年疗程结束时,健脾清化方联合拉米夫定治疗组YMDD变异率为15.6%(5/32),拉米夫定对照组变异率为38.7%(12/31),治疗组低于对照组(P<0.05),较长的疗程、治疗前较高的DNA含量与变异的发生具有相关性(R=0.888,P=0.018)。结论:健脾清化方联合拉米夫定治疗中医辨证为肝郁脾虚兼湿热型慢性乙型肝炎患者比单独应用能有效减少病毒YMDD变异,提高临床疗效。
Objective: To observe the role of Jianpi Qinghua Decoction combined with lamivudine in reducing the mutation of YMDD gene in hepatitis B virus P region. Methods: Sixty-three patients with chronic hepatitis B who were positive for HBV DNA (PCR method) and were diagnosed as TCM syndrome differentiation of liver-qi and deficiency of spleen by damp-heat syndrome were randomly divided into three groups: treatment group with Jianpi Qinghua Decoction combined with lamivudine Cases, 31 cases of lamivudine control group, treatment of 2 years, the end of treatment, the use of caliper1000 microfluidic chip HBVDNA positive patients YMDD mutation detection. Results: At the end of 2 years of treatment, YMDD mutation rate was 15.6% (5/32) in the patients treated with Jianpi Qinghua Decoction plus lamivudine, and 38.7% (12/31) in the lamivudine control group. Treatment (P <0.05). The longer course of treatment and the higher DNA content before treatment were correlated with the occurrence of mutation (R = 0.888, P = 0.018). Conclusion: Jianpi Qinghua Decoction combined with lamivudine can reduce the mutation of virus YMDD effectively and improve the clinical curative effect than the single application of traditional Chinese medicine for differentiation of liver and spleen deficiency syndrome and damp-heat type chronic hepatitis B patients.