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《环球中医药》[ISSN:1006-6977/CN:61-1281/TN]

卷:

第10卷

期数:

2017年03期

页码:

288-292

栏目:

论著

出版日期:

2017-03-06

文章信息/Info

Title:

Research of Xingpi Yiqi and Shugan Tongluo therapy combined with artificial liver in treatment of hepatitis B liver failure

作者:

叶庆 曾义岚 李继科 王玥莲 高峰 刘大凤 段萌 毛创杰

610066 成都市公共卫生临床医疗中心中医研究室(叶庆、李继科、王玥莲),院长办公室(曾义岚),传染三病区(高峰),内科病区(刘大凤),传染二病区(段萌),传染一病区(毛创杰)

Author(s):

YE Qing; ZENG Yilan; LI Jike; et al.

Public Health Clinical Center of Chengdu,Traditional Chinese Medicine Research Office,Chengdu 610066,China

关键词:

醒脾益气;  疏肝通络;  肝脾疏络饮;  湿毒;  乙肝肝衰竭

Keywords:

Xingpi Yiqi;  Shugan Tongluo;  Ganpi Shuluo decoction;  Damp toxins;  Liver failure with hepatitis B

分类号:

R285.6

DOI:

10.3969/j.issn.1674-1749.2017.03.008

文献标志码:

A

摘要:

目的 探讨醒脾益气、疏肝通络法治疗乙肝肝衰竭的有效性和安全性。 方法 选取117例符合筛选标准的住院乙肝肝衰竭患者,按照入院的先后顺序将其分为试验组和对照组,其中试验组58例,对照组59例。对照组给予基础治疗、对症支持、并发症防治等西医综合方法并联合人工肝治疗; 试验组在上述西医治疗基础上加用中医药(醒脾益气、疏肝通络法-肝脾疏络饮)治疗。结果 两组患者在治疗4周后丙氨酸氨基转移酶(alanine amino transferase,ALT)、总胆红素(total bilirubin,TBIL)、总胆叶酸(total bile acid,TBA)、凝血酶原时间(prothroubin time,PT)均较前下降,其中试验组的PT和TBIL下降较对照组更为明显,差异有显著统计学意义(P＜0.01); 两组患者PTA、ALB水平较治疗前均升高,其中试验组PTA升高较对照组明显,差异有统计学意义(P＜0.05)。治疗8周后试验组和对照组的总有效率比较,差异无统计学意义(P＞0.05); 试验组HBV-DNA阴转率(36.2%)虽高于对照组HBV-DNA阴转率(30.5%),但差异无统计学意义(P＞0.05); 试验组症状总积分低于对照组,差异有显著性统计学意义(P＜0.01); 入组后人工肝次数以及较入组前增加的人工肝次数试验组明显少于对照组(P＜0.01)。所有入组患者中共死亡9例,在2周内、4周内及8周内死亡例数对照组均高于试验组,但两组总死亡率比较无统计学意义(P＞0.05)。两组均未见不良事件。结论 醒脾益气、疏肝通络法(肝脾疏络饮)治疗乙肝肝衰竭是有效安全的,在促进肝功能恢复、改善凝血功能、缓解临床症状和减少人工肝次数上较西医治疗有一定优势。

Abstract:

Objective To investigate the effectiveness and safety of Xingpi Yiqi and Shugan Tongluo therapy in the treatment of hepatitis B liver failure. Methods 117 hospitalized patients with hepatitis B liver failure were divided into the experimental group and the control group according to the order of admission to the hospital, there were 58 cases in the experimental group and 59 cases in the control group. The control group was treated with western medicine method, symptomatic support, prevention of complications and the treatment of artificial liver; the treatment of the experimental group was on the basis of conventional therapy combined with traditional Chinese medicine(Xingpi Yiqi, Shugan Tongluo method and Ganpi shuluo decoction)treatment. Results After 4 weeks of treatment, ALT, TBIL, TBA, PT of two groups were declined compared with before treatment, the result had statistical significance(P＜0.01), the PT and TBIL of experimental group was decreased more obvious than the control group(P＜0.01); The level of ALB and PTA in two groups were higher than before treatment, the difference was significant difference(P＜0.01), and the PTA of experimental group was higher than the control group, the difference was statistically significant(P＜0.05). After 8 weeks of treatment, the total effectiveness of treatment group was 87.9% which was slightly higher than that was 83.1% of control group, but there was no significance(P＞0.05)between two groups; The experimental group patients' HBV-DNA negative change rate(36.2%)was higher than the control group's rate(30.5%), but there was no significant difference(P＞0.05); The symptom scores of the two groups were decreased obvious compared with before treatment,the difference was significant difference(P＜0.01); The treatment group's symptoms scores after treatment was lower than the control group, the result had significant difference(P＜0.01); The times of artificial liver in the group and the increased times of artificial liver than before entering the group,the experimental group was obvious less than that of the control group(P＜0.01). In all patients, 9 cases were death, death cases of the control group in the 2 weeks, 4 weeks and 8 weeks were higher than the experimental group, but there was no significant statistical significance(P＞0.05). There was no adverse event in the process of treatment observation. Conclusion The study verified the Xingpi Yiqi and Shugan Tongluo method(Ganpi Shuluo decociton)in treatment of liver failure with hepatitis B is effective and safe, it has certain advantages in promoting liver function recovery, improving coagulation function, alleviating the clinical symptoms and reduce the times of artificial liver compared with western medicine treatment.

参考文献/References:

[1] 中华医学会肝病分会重型肝病与人工肝学组.肝衰竭诊疗指南[J].中华肝脏病杂志,2006,14(9):643-646.
[2] 郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:143-150.
[3] 孙传兴.临床疾病诊断依据治愈好转标准(第二版)[M].北京:人民军医出版社,2006:78-83.
[4] 张晶,段种平,何金秋,等.人工肝治疗对重型肝病患者生存期的影响[J].中华肝脏病杂志,2006,14(9):647.
[5] 王林,胡容,张鸿,等.不同类型非生物型人工肝治疗重型肝炎的总体疗效评估[J].四川医学,2010,31(8):1108-1110.
[6] 杨永峰,杨毅军.以循证医学评价人工肝支持系统的疗效[J].肝脏杂志,2008,13(6):501-502.
[7] 柳龙根,钱梅云,翟德芳,等.血浆置换术治疗各型重型肝炎l7l例疗效及影响因素分析[J].中国血液流变学杂志,2004,14(3):343-345.
[8] 张秋云,刘绍能,李秀惠,等.乙型慢重肝“毒损肝体”病因病机及治疗思路探讨[J].辽宁中医杂志,2005,32(5):1246-1248.
[9] 李军生,苏立稳.赤芍退黄汤联合人工肝支持系统治疗重型肝炎58例[J].中西医结合肝病杂志,2007,17(6):378-379.
[10] 黄学军,杨智海,黄小军,等.非生物型人工肝联合中医药治疗慢性乙型重型肝炎的思路与方法[J].中医研究,2007,20(10):2-5.
[11] 黄古叶,龙富立,石清兰,等.大黄煎剂配合人工肝支持系统治疗重型肝炎临床研究[J].辽宁中医杂志,2008,35(10):1537-1538.
[12] 杨智海,黄学军.凉血活血中药联合血浆置换治疗重型肝炎38例[J]. 实用中医内科杂志,2009,23(2):52.
[13] 冀爱英,马素平,赵文霞,等.中西药联合人工肝技术治疗重型肝炎63例[J]. 中国中西医结合急救杂志,2005,12(5):314-315.
[14] 吴树铎,段钟平,邝卫红,等.中药内服、灌肠联合人工肝治疗重型肝炎的临床研究[J].新中医,2008,40(2):30-31.
[15] 袁海宁,邓一鸣,吴健林.益气健脾方剂治疗慢性乙型肝炎重度患者的临床观察[J].广西医科大学学报,2006,23(2):303-304.
[16] 陈斌,黄裕红,龚磊,等.健脾温阳与清热化湿法治疗血浆置换术后慢性重型肝炎的临床比较[J].中西医结合肝病杂志,2008,18(6):368-370.
[17] 徐晓婧,杨大国,冉云,等.100例慢性重型乙型病毒性肝炎患者中医证型及临床特点分析[J].山西中医学院学报,2010,11(2):42-43.
[18] 叶庆,李继科,高峰,等.陈定潜辨治慢性重型乙型肝炎经验[J].环球中医药,2012,5(3):214-216.
[19] 叶庆,陈定潜.陈定潜从湿毒论治慢性重型乙肝[J].中国中医药现代远程教育,2015,13(3):28-30.
[20] 王丹妮,陈秀敏,蒋自强,等.湿邪与艾滋病免疫功能低下的相关性探讨[J].中华中医药杂志,2012,27(12):3038-3040.
[21] 李伟林.慢性乙型肝炎脾虚证临床病理学分析[J].中西医结合肝病杂志,1994,4(S1):63.
[22] 粱仲惠.乙型肝炎病毒胃粘膜感染与胃病[J].医学综述,2000,(4):177.
[23] 陈定潜,曾义岚,胡蓉,等.中西医结合治疗肝衰竭的疗效评价[J].四川中医,2013,31(7):61-64.
[24] 张诗军,陈泽雄,林佑武,等.化湿中药对慢性乙型肝炎湿证患者激活和功能T淋巴细胞亚群水平的影响[J].中国中西医结合杂志,2006,26(12):1078-1081.

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备注/Memo

备注/Memo:

基金项目: 四川省中医药管理局2012-2013年度科技专项(2012-A-092); 四川省卫生厅课题(120560)
作者简介: 叶庆(1970- ),女,博士,副主任中医师。研究方向:中西医结合防治传染病。E-mail:464671011@qq.com

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更新日期/Last Update: 2017-03-06