评估益气活血化浊法治疗Wilson病（也称肝豆状核变性，Wilson’s disease，WD）肝纤维化的临床效果。【方法】 采用回顾性研究方法，根据治疗方法的不同，将52例气虚血瘀型WD肝纤维化患者分为对照组24例和治疗组28例。对照组 采用西药常规驱铜治疗，治疗组在对照组的基础上联合益气活血化浊法中药汤剂治疗，共治疗4周。观察2组患者治疗前后 中医证候积分、统一肝豆状核变性评分量表（UWDRS）肝脏症状评分、血清肝纤维化指标[Ⅲ型前胶原（PCⅢ）、透明质酸 （HA）、Ⅳ型胶原（CⅣ）、层粘连蛋白（LN）]和CXC基序趋化因子配体10（CXCL10）水平以及基于声脉冲辐射力成像技术 （ARFI）的肝脏超声点剪波弹性成像（pSWE）值的变化情况，并评价2组患者的临床疗效。【结果】（1）疗效方面：治疗4周后， 治疗组的总有效率为85.71%（24/28），对照组为54.17%（13/24），组间比较（χ2检验），治疗组的疗效明显优于对照组（P＜ 0.05）。（2）中医证候积分方面：治疗后，2组患者的中医证候积分均较治疗前降低（P＜0.01），且治疗组对中医证候积分的降 低幅度明显优于对照组（P＜0.05）。（3）肝脏症状评分方面：治疗后，2组患者的UWDRS肝脏症状评分均较治疗前降低（P＜ 0.01），但治疗后组间比较，差异无统计学意义（P＞0.05）。（4）肝纤维化指标方面：治疗后，治疗组的血清HA、LN、CⅣ、 PCⅢ水平均较治疗前降低（P＜0.01），而对照组仅血清LN、PCⅢ水平较治疗前降低（P＜0.05）；组间比较，治疗组对血清 HA、LN、PCⅢ水平的降低幅度均明显优于对照组（P＜0.05或P＜0.01），而对血清CⅣ水平的降低幅度有优于对照组趋势， 但差异无统计学意义（P＞0.05）。（5）趋化因子方面：治疗后，治疗组的血清CXCL10水平较治疗前明显降低（P＜0.01），而对 照组较治疗前有降低趋势，但差异无统计意义（P＞0.05）；组间比较，治疗组对血清CXCL10水平的降低幅度明显优于对照 组（P＜0.05）。（6）影像学方面：治疗后，2组患者的肝脏超声pSWE值均较治疗前降低（P＜0.01），且治疗组对肝脏超声pSWE 值的降低幅度明显优于对照组（P＜0.01）。【结论】益气活血化浊法可以有效降低WD患者的中医证候积分，改善UWDRS肝脏 症状评分，下调肝纤维化指标和血清CXCL10表达水平，降低肝脏pSWE值，提高临床疗效。

To assess the clinical effect of the Yiqi Huoxue Huazhuo therapy （the therapy for replenishing qi，activating blood and resolving turbidity）for the treatment of hepatic fibrosis in Wilson’s disease （WD，also known as hepatolenticular degeneration）. Methods Using retrospective research method，52 patients with liver fibrosis in WD of qi deficiency and blood stasis type were divided into 24 cases in the control group and 28 cases in the treatment group according to the treatment method. The control group was treated with conventional decopper therapy with western medicines， and the treatment group was treated with Chinese herbal decoction based on Yiqi Huoxue Huazhuo therapy together with conventional decopper therapy. Both groups were treated for a total of 4 weeks. Before and after the treatment，the two groups were observed in the changes of traditional Chinese medicine（TCM）syndrome scores，Unified Wilson’s Disease Rating Scale（UWDRS）hepatic symptom scores， serum levels of liver fibrosis indicators of pre-collagen type Ⅲ（PCⅢ），hyaluronic acid（HA），collagen Ⅳ（CⅣ）， and laminin（LN），C-X-C motif chemokine ligand 10（CXCL10）level，and the point shear-wave elastography （pSWE）values of hepatic ultrasound based on acoustic radiation force impulse imaging（ARFI）. After treatment， the clinical efficacy of the two groups was evaluated. Results（1）After 4 weeks of treatment，the total effective rate of the treatment group was 85.71%（24/28）， while that of the control group was 54.17%（13/24），and the intergroup comparison（tested by chi-square test）showed that the therapeutic efficacy of the treatment group was significantly superior to that of the control group （P＜0.05）.（2）After treatment，the TCM syndrome scores in both groups were decreased compared with those before treatment（P＜0.01），and the decrease of TCM syndrome scores in the treatment group was significantly superior to that in the control group（P＜0.05）.（3）After treatment， the UWDRS liver symptom scores in the two groups were decreased compared with those before treatment（P＜ 0.01），but the difference was not statistically significant when comparing between the two groups after treatment （P＞0.05）.（4）After treatment， serum levels of liver fibrosis indicators of HA， LN， CⅣ and PCⅢ in the treatment group were all decreased compared with those before treatment（P＜0.01），while in the control group only serum LN and PCⅢ levels were decreased（P＜0.05）. The intergroup comparison showed that the decrease of serum HA，LN，and PCⅢ levels in the treatment group was superior to that in the control group（P＜0.05 or P＜ 0.01），while the decrease of serum CⅣ level tended to be superior to that in the control group，but the difference was not statistically significant（P＞0.05）.（5）After treatment， the serum chemokine CXCL10 level in the treatment group was significantly decreased compared with that before treatment（P＜0.01）， while the level tended to decrease in the control group， but the difference was not statistically significant（P＞0.05）. The intergroup comparison showed that the reduction of serum CXCL10 level in the treatment group was significantly superior to that in the control group（P＜0.05）.（6）After treatment，the pSWE values of hepatic ultrasound in the two groups were lower than those before treatment（P＜0.01），and the reduction of pSWE values in treatment group was significantly superior to that of the control group（P＜0.01）. Conclusion Yiqi Huoxue Huazhuo therapy can effectively reduce the TCM syndrome scores of WD patients，improve the UWDRS hepatic symptom scores， down-regulate the liver fibrosis indicator level and serum CXCL10 expression level，reduce the pSWE values of hepatic ultrasound，and enhance the clinical efficacy

R259.752

国家自然科学基金项目（编号：81603596）；大健康研究院新安医学与中医药现代化研究所专项基金资助项目（编号：2023CXMMTCM002）