摘要目的：研究益肝清毒颗粒联合阿德福韦酯（ ADV）对ADV停药后鸭乙肝病毒（ DHBV）感染模型体内乙肝病毒反弹的抑制作用。方法用鸭乙肝病毒阳性血清感染雏鸭7d后，实时荧光定量PCR筛选出DHBV阳性鸭，并随机分成5组，分别设为模型对照组、ADV组、中药替换组、联合给药高剂量组以及联合给药低剂量组。 ADV组持续给予ADV（0．25 mg／ml）21 d，然后停药继续饲养14 d；中药替换组持续给予ADV（0．25 mg／ml）21 d后换用益肝清毒颗粒（1．2 g／ml）再持续给药14 d；联合给药高剂量组同时给予益肝清毒颗粒（1．2 g／ml）和ADV（0．25 mg／ml）21 d后再单独使用益肝清毒颗粒（1．2 g／ml）持续治疗14 d；联合给药低剂量组同时给予益肝清毒颗粒（0．6 g／ml）和ADV （0．125 mg／ml）持续治疗21 d后单独使用益肝清毒颗粒（0．6 g／ml）持续治疗14 d。各组分别于给药后0 d、7 d、14 d、21 d及停用ADV后7 d、14 d，自腿静脉取血，检测血清中DHBV-DNA滴度以及谷丙转氨酶（ ALT）和谷草转氨酶（ AST）含量。结果停用ADV前，中药替换组、联合给药高剂量组和联合给药低剂量组与模型组比较，血清中DHBV-DNA、ALT和AST均显著降低（P＜0．01或P＜0．05），而且联合给药高剂量组较ADV组血清中DHBV-DNA含量更低。 ADV停药后， ADV组血清中DHBV-DNA、ALT和AST均出现严重反弹。与ADV组比较，中药替换组和联合给药高剂量组仍能维持在较低水平（P＜0．01或P＜0．05），而联合给药低剂量组虽然DHBV-DNA和ALT出现一定反弹，但仍处于较低水平（P＜0．01或P＜0．05）。结论益肝清毒颗粒联合ADV能有效抑制体内乙肝病毒，同时能显著抑制ADV停药后病毒的反弹。

abstractsAbstract] Objective To investigate the in vivo therapeutic effects of an extract of herb medi-cines, YiGanQingDuKeLi, in combination with adefovir dipivoxil (ADV) on the rebound of duck hepatitis B virus ( DHBV) multiplication after withdrawal of ADV treatment.Methods Peking ducks were infected with DHBV positive serum samples for 7 days and then screened by SYBR Green real-time PCR.The ducks positive for DHBV were randomly divided into five groups including the model control group, the ADV treat-ment group, the herb treatment group, the high-dose combination therapy group and the low-dose combina-tion therapy group.The ducks in the ADV treatment and the herb treatment groups were respectively treated with distilled water and YiGanQingDuKeLi (1.2 g/ml) for 14 days after the treatment of ADV (0.25 mg/ml) for 21 days.The ducks in the high-dose group were treated with YiGanQingDuKeLi (1.2 g/ml) for 14 days after the combined treatment with high-dose YiGanQingDuKeLi (1.2 g/ml) and ADV (0.25 mg/ml) for 21 days.The ducks in the low-dose group were treated with YiGanQingDuKeLi (0.6 g/ml) for 14 days after the combined treatment with YiGanQingDuKeLi (0.6 g/ml) and ADV (0.125 mg/ml) for 21 days.Blood samples were collected from each duck via leg vein after 0, 7, 14 and 21 days of drug adminis-tration and after 7 and 14 days of drug withdrawal.The levels of DHBV-DNA, alanine aminotransferase ( ALT) and aspartate aminotransferase ( AST) in blood serum samples were detected.Results Compared with the model group, the levels of DHBV-DNA, ALT and AST in ducks from the herb treatment group and combined treatment groups were decreased before the discontinuation of ADV treatment ( P<0.05 or P<0.01).Moreover, the titers of DHBV-DNA in ducks treated with high doses of drugs were much lower than those from ADV treatment group.The levels of DHBV-DNA, ALT and AST in ducks treated with herb medi-cine and high doses of drugs remained at relatively low levels after the cessation of ADV treatment, but re-bounded significantly in ducks with ADV treatment.The levels of DHBV-DNA and ALT rebounded slightly in ducks treated with low doses of drugs as compared with those of ADV treatment group ( P<0.01 or P<0.05).Conclusion The treatment of YiGanQingDuKeLi in combination with ADV could inhibit not only the in vivo replication of DHBV, but also the rebound of DHBV multiplication after ADV withdrawal.