Combination lamivudine and matrine,a Chinese herbal medicine,in the treatment of chronic hepatitis B patients with hyperbilirubinemia

Objective The main strategy dealing with chronic hepatitis B is the application of interferon-alpha and/or nucleoside analogues to inhibit the viral replication. But how to treat the hepatitis B patients with hyperbilirubinemia is often neglected by western scholars and they sometimes give the diagnosis ad libitum. We conducted a pilot clinical trial to observe the efficacy of combination matrine,a Chinese herbal medicine,and lamivudine in the treatment of chronic hepatitis B patients with hyperbilirubinemia. Methods A total of two hundreds and thirty-two patients with hyperbilirubinemia were divided into subgroup A1 (chronic hepatitis B of severe degree with good appetite,n=70),subgroup A2(with gastrointestinal symptoms,n=58),subgroup B1(chronic severe hepatitis B with underlying liver disease of chronic hepatitis B virus carrier,n=22),subgroup B2(with of chronic hepatitis B,n=34) and subgroup B3(with of liver cirrhosis, n=48). Lamivudine and matrine were given daily for all the patients except steroid for patients in subgroup A2,B1 and B2,and supporting therapy for all patients in group B. Results All patients in subgroup A1 and A2 recovered with three to four week treatment,while 4 (18.2%) in subgroup B1,9 (26.5%) in subgroup B 2 and 18 (37.5%) in subgroup B 3 died; At presentation,HBeAg positive dominated in subgroup B1 and anti-Hbe positive dominated in B3 and the highest HBV DNA level was in severe CHB patients with underlying HBV carriers (lg 7.2±1.4 copies/ml),and the relatively lowest in with liver cirrhosis(lg5.4±0.9 copies/ml,P0.01). 72.3% (8/11) and 27.8% (5/18) of patients in survived sub-group B2 and B1 had the serum HBeAg/anti-Hbe conversion,respectively. The serum HBV DNA got to negative in more than 90% of suvivals in every groups;The ascites subsided and the shrinked liver enlarged by CT scan in some patients and the liver pathohistological study showed the HAI scores and fibrosis improved. Conclusion It is feasible and efficient that combination matrine and lamivudine treatment for chronic hepatitis B patients with hyperbilirubinemia in addition to supporting measures based on different clinical diagnosis.