化瘀软肝汤联合西药治疗代偿期肝硬化(湿热蕴结)随机平行对照研究
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摘要
[目的]观察化瘀软肝汤联合西药治疗代偿期肝硬化(湿热蕴结)疗效。[方法]使用随机平行对照方法,将115例门诊患者按随机数字表随机分为两组。对照组58例恩替卡韦,0.5mg/次,1次/d;泮托拉唑,40mg/次,1次/d;熊去氧胆酸,250mg/次,1次/d。治疗组57例化瘀软肝汤(生大黄6g,炮山甲、鳖甲、桃仁、土鳖虫各9g,白术10g,丹参、党参、黄芪20g,鸡骨草、溪黄草、赤芍、蛇舌草各30g,茵陈60g),水煎400mL,早晚温服;腹腔积水加猪苓、茯苓、泽泻各15g;黄疸加栀子30g,茵陈60g;西药治疗同对照组。连续治疗2个月为1疗程。观测临床表现、谷丙转氨酶、血清白蛋白、谷草转氨酶、总胆红素、不良反应。治疗1疗程(2个月),判定疗效。[结果]治疗组显效33例,有效21例,无效3例,总有效率94.74%;对照组显效23例,有效22例,无效11例,总有效率81.03%;治疗组疗效优于对照组(P<0.05)。ALT、ALB、AST、TBIL两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01)。[结论]化瘀软肝汤联合西药治疗代偿期肝硬化(湿热蕴结),疗效满意,无严重不良反应,值得推广。
[Objective] To observe the curative effect of Huayu Ruangan decoction combined with western medicine on compensatory cirrhosis(Shire Yunjie). [Method] 115 outpatients were randomly divided into two groups by random number table method. The control group consisted of 58 cases of entecavir, 0.5 mg/time,once a day; pantoprazole, 40 mg/time, once a day; ursodeoxycholic acid, 250 mg/time, once a day. Treatment group: 57 cases of Huayu Ruangan decoction(Shengdahuang 6 g, Paoshanjia, Taoren, Tubeichong each 9 g,Baizhu 10 g, Danshen, Dangshen, Huangqi each 20 g, Jigucao, Xihuangcao, Chishao, Sheshecao each 30 g,Yinchen 60 g), water fried 400 mL, morning and evening warm clothing; peritoneal hydrops plus Zhuling,Fuling, Zexie 15 g; jaundice plus Zhizi 30 g, Yinchen 60 g; western medicine treatment with the control group.Continuous treatment for 2 months is a course of treatment. Clinical manifestations, alanine aminotransferase,serum albumin, glutamic oxaloacetic aminotransferase, total bilirubin and adverse reactions were observed.One course of treatment(2 months) was used to determine the curative effect. [Result] 33 cases were markedly effective in the treatment group, 21 cases were effective, 3 cases were ineffective and the total effective rate was 94.74%. 23 cases were markedly effective in the control group, 22 cases were effective and 11 cases were ineffective, the total effective rate was 81.03%. The curative effect of the treatment group was better than that of the control group(P<0.05). ALT, ALB, AST and TBIL were improved in both groups(P<0.01),and the improvement in treatment group was better than that in control group(P<0.01). [Conclusion] Huayu Ruangan decoction combined with western medicine in the treatment of compensatory cirrhosis(Shire Yunjie)has satisfactory curative effect and no serious adverse reactions, which is worthy of promotion.
[Objective] To observe the curative effect of Huayu Ruangan decoction combined with western medicine on compensatory cirrhosis(Shire Yunjie). [Method] 115 outpatients were randomly divided into two groups by random number table method. The control group consisted of 58 cases of entecavir, 0.5 mg/time,once a day; pantoprazole, 40 mg/time, once a day; ursodeoxycholic acid, 250 mg/time, once a day. Treatment group: 57 cases of Huayu Ruangan decoction(Shengdahuang 6 g, Paoshanjia, Taoren, Tubeichong each 9 g,Baizhu 10 g, Danshen, Dangshen, Huangqi each 20 g, Jigucao, Xihuangcao, Chishao, Sheshecao each 30 g,Yinchen 60 g), water fried 400 mL, morning and evening warm clothing; peritoneal hydrops plus Zhuling,Fuling, Zexie 15 g; jaundice plus Zhizi 30 g, Yinchen 60 g; western medicine treatment with the control group.Continuous treatment for 2 months is a course of treatment. Clinical manifestations, alanine aminotransferase,serum albumin, glutamic oxaloacetic aminotransferase, total bilirubin and adverse reactions were observed.One course of treatment(2 months) was used to determine the curative effect. [Result] 33 cases were markedly effective in the treatment group, 21 cases were effective, 3 cases were ineffective and the total effective rate was 94.74%. 23 cases were markedly effective in the control group, 22 cases were effective and 11 cases were ineffective, the total effective rate was 81.03%. The curative effect of the treatment group was better than that of the control group(P<0.05). ALT, ALB, AST and TBIL were improved in both groups(P<0.01),and the improvement in treatment group was better than that in control group(P<0.01). [Conclusion] Huayu Ruangan decoction combined with western medicine in the treatment of compensatory cirrhosis(Shire Yunjie)has satisfactory curative effect and no serious adverse reactions, which is worthy of promotion.
引文
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[6]中国中西医结合学会消化系统疾病专业委员会.肝硬化中西医结合诊疗共识[J].中国中西医结合消化杂志,2011,19(4):277-279.
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[10]陈玉兰.血清谷丙转氨酶增高与病毒性肝炎临床意义的探讨[J]中国现代医药,2005,4(3):73.
[11]赵聪亚,乔京贵,陈继龙.探讨血清白蛋白和球蛋白对乙型肝炎相关肝硬化的诊断价值[J].中国实验诊断学,2015,19(11):1877-1879.
[12]罗育春,陈大兰.肝硬化患者血清谷丙转氨酶、谷草转氨酶和总胆红素与肝纤维化标志物的相关性研究[J].实用预防医学,201118(8):1542-1544.
[13]陈卓鹏.血清总胆红素与肝硬化病情预后及肝纤维化的关系[J]中国冶金工业医学杂志,2005,22(5):506-507.
[14]曾婷,谢逸欣,马丽.恩替卡韦的药理毒理学研究[J].河北医学,2012,18(10):1421-1423.
[15]许长青,卢爱君,杨东风,等.泮托拉唑的药理作用与临床应用[J]武警医学,2002,13(5):304-305.
[16]李光明,谢青,周霞秋.熊去氧胆酸在慢性肝病中的应用及机制[J]肝脏,2002,7(1):59-61.
[17]余小萍,方祝元.中医内科学[M].3版.上海:上海科学技术出版社2018:225.
[18]张仲景.金匮要略[M].北京:人民卫生出版社,2018:80.
[19]高学敏.中药学[M].北京:中国中医药出版社,2007.
[20]熊宗斌,吴萍,黄云峰,等.丹参改善小鼠慢性酒精性肝损伤机制的研究[J].中国中西医结合杂志,2005,25(5):425-428.
[21]张云华,陈群.化瘀软肝汤治疗代偿期乙型肝炎肝硬化的疗效观察[J].中西医结合研究,2014,6(6):290-292.
[22]余晓珂,任平,胡清伟.化瘀软肝汤对代偿期乙型肝炎肝硬变患者肝脏功能及凝血功能的影响[J].中医学报,2018,33(11):177-180.
[23]李红德.化瘀软肝汤对乙肝肝硬化代偿期患者凝血功能及肝纤维化指标的影响[J].广西中医药,2017,40(2):41-43.
[2]方香顺,鲁景奎.浅谈治疗代偿期肝硬化的思路、方法与用药[J].中国民族民间医药,2010,19(23):123.
[3]中华中医药学会.中医内科常见病诊疗指南.西医疾病部分[M]北京:中国中医药出版社,2008:25.
[4]中华人民共和国卫生部.涉及人的生物医学研究伦理审查办法(试行)[S].(2007-03-26)[2017-01-01].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[5]周永兴.现代肝硬化诊断治疗学[M].北京:人民军医出版社,200236.
[6]中国中西医结合学会消化系统疾病专业委员会.肝硬化中西医结合诊疗共识[J].中国中西医结合消化杂志,2011,19(4):277-279.
[7]施光峰.肝纤维化的常见病因与发病机制[J].实用临床医药杂志2005,9(7):1-3.
[8]齐海宇,孙芳芳,阴赪宏.肝纤维化的病因及其发病机制[J].中国医刊,2011,46(7):12-14.
[9]伊方善,石玉青,甘天福,等.代偿期乙肝性肝硬化肝活检病理定性(附31例分析)[J].滨州医学院学报,2002,25(1):77-78.
[10]陈玉兰.血清谷丙转氨酶增高与病毒性肝炎临床意义的探讨[J]中国现代医药,2005,4(3):73.
[11]赵聪亚,乔京贵,陈继龙.探讨血清白蛋白和球蛋白对乙型肝炎相关肝硬化的诊断价值[J].中国实验诊断学,2015,19(11):1877-1879.
[12]罗育春,陈大兰.肝硬化患者血清谷丙转氨酶、谷草转氨酶和总胆红素与肝纤维化标志物的相关性研究[J].实用预防医学,201118(8):1542-1544.
[13]陈卓鹏.血清总胆红素与肝硬化病情预后及肝纤维化的关系[J]中国冶金工业医学杂志,2005,22(5):506-507.
[14]曾婷,谢逸欣,马丽.恩替卡韦的药理毒理学研究[J].河北医学,2012,18(10):1421-1423.
[15]许长青,卢爱君,杨东风,等.泮托拉唑的药理作用与临床应用[J]武警医学,2002,13(5):304-305.
[16]李光明,谢青,周霞秋.熊去氧胆酸在慢性肝病中的应用及机制[J]肝脏,2002,7(1):59-61.
[17]余小萍,方祝元.中医内科学[M].3版.上海:上海科学技术出版社2018:225.
[18]张仲景.金匮要略[M].北京:人民卫生出版社,2018:80.
[19]高学敏.中药学[M].北京:中国中医药出版社,2007.
[20]熊宗斌,吴萍,黄云峰,等.丹参改善小鼠慢性酒精性肝损伤机制的研究[J].中国中西医结合杂志,2005,25(5):425-428.
[21]张云华,陈群.化瘀软肝汤治疗代偿期乙型肝炎肝硬化的疗效观察[J].中西医结合研究,2014,6(6):290-292.
[22]余晓珂,任平,胡清伟.化瘀软肝汤对代偿期乙型肝炎肝硬变患者肝脏功能及凝血功能的影响[J].中医学报,2018,33(11):177-180.
[23]李红德.化瘀软肝汤对乙肝肝硬化代偿期患者凝血功能及肝纤维化指标的影响[J].广西中医药,2017,40(2):41-43.