五苓散联合西药治疗乙型肝炎肝硬化腹水(气阴两虚)随机平行对照研究
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摘要
[目的]观察五苓散联合西药治疗乙型肝炎肝硬化腹水(气阴两虚)疗效。[方法]使用随机平行对照方法,将90例住院患者按随机数字表法分为两组。对照组45例恩替卡韦,0.5mg/次,1次/d;呋塞米,20～40mg/次,1次/d。治疗组45例五苓散(茯苓、泽泻、猪苓、白术、桂枝各15g),水煎400mL,1剂/d,早晚分服;肝郁气滞加香附、枳壳、木香、柴胡、陈皮各10g;脾虚湿蕴加白术、薏苡仁、姜干、党参、木香各10g;湿热蕴结加香附、黄芩、虎杖、黄连、蒲公英各10g;肝肾阴虚加丹皮、鳖甲、青蒿、山药、山茱萸各10g;脾肾阳虚加党参、姜干、附片、淫羊藿、白术各10g;西药治疗同对照组。连续治疗4周为1疗程。观测临床表现、腹水消失时间、肿大病灶缩小时间、肝功能指标改善50%时间、B超检查正常时间、肝功能、生活质量(文化、社会、生理和心理)评分、不良反应。治疗1疗程(4周),判定疗效。[结果]治疗组显效31例,有效11例,无效3例,总有效率93.33%;对照组显效17例,有效14例,无效14例,总有效率68.89%;治疗组疗效优于对照组(P<0.05)。腹水消失时间、肿大病灶缩小时间、肝功能指标改善50%时间、B超检查正常时间治疗组短于对照组(P<0.01);AST,ALT,HBV-DNA两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01);文化、社会分、心理、生理评分两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01)。[结论]五苓散联合西药治疗乙型肝炎肝硬化腹水(气阴两虚),疗效满意,无严重不良反应,值得推广。
[Objective] To observe the curative effect of Wulingsan combined with western medicine in treating hepatitis B cirrhosis ascites (Qi and Yin deficiency). [Methods] using random parallel control method, 90 hospitalized patients were divided into two groups according to random number table. In the control group, 45 cases were treated with entecavir, 0.5 mg/times, 1 times/d, furosemide, 20~40 mg/times, and 1 times/d. In the treatment group, 45 cases of Wulingsan (Fuling, Zexie, Zhuling, Baizhu, Guizhi each 15g), decocted 400 mL in water, one dose per day, taken in the morning and evening; stagnation of liver depression plus Xiangfu, Zhiqiao, Muxiang, Chaihu, Chenpi each 10g; deficiency of spleen and dampness plus Baizhu, Yiyiren, Ganjiang, Dangshen, Muxiang each 10g; liver and kidney yin deficiency plus Danpi, Biejia, Qinghao, Shayao, Shanzhuyu each 10g ; spleen and kidney Yang deficiency plus Dangshen, Ganjiang, Fupian, Yinyanghuo, Baizhu each 10g; western medicine treatment with the control group. Continuous treatment for 4 weeks was 1 courses. The clinical manifestations, disappearance time of ascites, reduction time of enlarged focus, 50% improvement time of liver function index, normal time of B-mode ultrasonography, liver function, quality of life (culture, society, physiology and psychology) score and adverse reactions were observed. The course of treatment was 1 weeks (4 weeks), and the curative effect was judged. [Result] 31 cases were markedly effective in the treatment group, 11 cases were effective, 3 cases were ineffective, the total effective rate was 93.33%. 17 cases were markedly effective in the control group, 14 cases were effective and 14 cases were ineffective, the total effective rate was 68.89%. The curative effect of the treatment group was better than that of the control group (P<0.05). Ascites disappearance time, enlarged lesion shrinkage time, 50% improvement of liver function index, normal time of B ultrasound examination in treatment group were shorter than those in control group (P<0.01); AST, ALT and HBV-DNA were improved in both groups (P<0.01), and the improvement in treatment group was better than that in control group (P<0.01); cultural, social, psychological and physiological scores were improved in both groups (P<0.01), the treatment group improved better than the control group (P<0.01). [Conclusion] Wulingsan combined with western medicine in the treatment of ascites due to hepatitis B cirrhosis (Qi and Yin deficiency) has satisfactory curative effect and no serious adverse reactions, which is worthy of promotion.
[Objective] To observe the curative effect of Wulingsan combined with western medicine in treating hepatitis B cirrhosis ascites (Qi and Yin deficiency). [Methods] using random parallel control method, 90 hospitalized patients were divided into two groups according to random number table. In the control group, 45 cases were treated with entecavir, 0.5 mg/times, 1 times/d, furosemide, 20~40 mg/times, and 1 times/d. In the treatment group, 45 cases of Wulingsan (Fuling, Zexie, Zhuling, Baizhu, Guizhi each 15g), decocted 400 mL in water, one dose per day, taken in the morning and evening; stagnation of liver depression plus Xiangfu, Zhiqiao, Muxiang, Chaihu, Chenpi each 10g; deficiency of spleen and dampness plus Baizhu, Yiyiren, Ganjiang, Dangshen, Muxiang each 10g; liver and kidney yin deficiency plus Danpi, Biejia, Qinghao, Shayao, Shanzhuyu each 10g ; spleen and kidney Yang deficiency plus Dangshen, Ganjiang, Fupian, Yinyanghuo, Baizhu each 10g; western medicine treatment with the control group. Continuous treatment for 4 weeks was 1 courses. The clinical manifestations, disappearance time of ascites, reduction time of enlarged focus, 50% improvement time of liver function index, normal time of B-mode ultrasonography, liver function, quality of life (culture, society, physiology and psychology) score and adverse reactions were observed. The course of treatment was 1 weeks (4 weeks), and the curative effect was judged. [Result] 31 cases were markedly effective in the treatment group, 11 cases were effective, 3 cases were ineffective, the total effective rate was 93.33%. 17 cases were markedly effective in the control group, 14 cases were effective and 14 cases were ineffective, the total effective rate was 68.89%. The curative effect of the treatment group was better than that of the control group (P<0.05). Ascites disappearance time, enlarged lesion shrinkage time, 50% improvement of liver function index, normal time of B ultrasound examination in treatment group were shorter than those in control group (P<0.01); AST, ALT and HBV-DNA were improved in both groups (P<0.01), and the improvement in treatment group was better than that in control group (P<0.01); cultural, social, psychological and physiological scores were improved in both groups (P<0.01), the treatment group improved better than the control group (P<0.01). [Conclusion] Wulingsan combined with western medicine in the treatment of ascites due to hepatitis B cirrhosis (Qi and Yin deficiency) has satisfactory curative effect and no serious adverse reactions, which is worthy of promotion.
引文
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[8]侯金林.恩替卡韦:慢性乙型肝炎治疗的新选择[J].肝脏,2005,10(2):164-166.
[9]林兴达.螺内酯联合呋塞米治疗肝硬化复发性腹水的疗效观察[J].医学信息,2012,25(9):390-391.
[10]席智文.肝硬化腹水临床治疗体会[J].中国社区医师(医学专业),2012,14(29):26.
[11]黄仙娥.AST/ALT比值在肝病中的变化及预后评估[J].中国实验诊断学,2009,13(1):117-118.
[12]车达平,徐龙,张志成.乙型肝炎患者血清中前S1蛋白、HBcAg及HBVDNA相关性临床研究[J].江西医药,2003,38(6):403-406.
[13]周仲瑛.中医内科学[M].北京:中国中医药出版社,2003:294.
[14]高学敏.中药学[M].北京:中国中医药出版社,2007.
[15]林雨果.五苓散联合六味地黄丸加减治疗乙肝肝硬化腹水的疗效分析[J].世界临床医学,2017,11(8):165,169.
[16]袁丕瑞.参苓白术散对免疫抑制小鼠免疫功能的影响研究[J].临床合理用药杂志,2011,4(29):67-68.
[17]刘新,马成,盛萍,等.茯苓与桂枝配伍对小鼠利尿的实验研究[J].新疆中医药,2009,27(5):45-48.
[2]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)[2016-01-01].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[3]范建高,蔡晓波.成人肝硬化腹水的诊断与治疗[J].肝脏,2004,9(3):193-195.
[4]闫秀川,刘成海.肝硬化腹水的中医证型分析[J].中国中医基础医学杂志,2008,14(1):49-50.
[5]张声生,王宪波,江宇泳.肝硬化腹水中医诊疗专家共识意见(2017)[J].临床肝胆病杂志,2017,33(9):1621-1626.
[6]王建江.浅谈肝硬化的临床诊治[J].中外医学研究,2012,10(10):104.
[7]刘昌军.乙型肝炎肝硬化抗病毒治疗研究进展分析[J].系统医学,2017,2(16):160-161.
[8]侯金林.恩替卡韦:慢性乙型肝炎治疗的新选择[J].肝脏,2005,10(2):164-166.
[9]林兴达.螺内酯联合呋塞米治疗肝硬化复发性腹水的疗效观察[J].医学信息,2012,25(9):390-391.
[10]席智文.肝硬化腹水临床治疗体会[J].中国社区医师(医学专业),2012,14(29):26.
[11]黄仙娥.AST/ALT比值在肝病中的变化及预后评估[J].中国实验诊断学,2009,13(1):117-118.
[12]车达平,徐龙,张志成.乙型肝炎患者血清中前S1蛋白、HBcAg及HBVDNA相关性临床研究[J].江西医药,2003,38(6):403-406.
[13]周仲瑛.中医内科学[M].北京:中国中医药出版社,2003:294.
[14]高学敏.中药学[M].北京:中国中医药出版社,2007.
[15]林雨果.五苓散联合六味地黄丸加减治疗乙肝肝硬化腹水的疗效分析[J].世界临床医学,2017,11(8):165,169.
[16]袁丕瑞.参苓白术散对免疫抑制小鼠免疫功能的影响研究[J].临床合理用药杂志,2011,4(29):67-68.
[17]刘新,马成,盛萍,等.茯苓与桂枝配伍对小鼠利尿的实验研究[J].新疆中医药,2009,27(5):45-48.