消胀贴膏治疗肝硬化腹水的效果及其对肾素-血管紧张素-醛固酮系统的影响
|
摘要
目的观察消胀贴膏对肝硬化腹水患者的疗效及其对肾素-血管紧张素-醛固酮系统的影响。方法选取2015年3月-2016年3月间上海市宝山区中西医结合医院消化内科住院的肝硬化腹水患者220例,分为常规治疗组60例、消胀贴膏组60例和特利加压素组100例。常规治疗组采用肝硬化腹水常规治疗方案并限制利尿剂用量,消胀贴膏组患者在常规治疗基础上加用消胀贴膏,特利加压素组在常规治疗基础上加用特利加压素。观察疗效指标(腹水最深处深度、24 h尿量、腹围、体质量、Child-Pugh评分)、症状体征(腹胀、饮食、肛门排气、大便等),以及血清肝肾功能、电解质、血常规、凝血功能、门静脉直径、肾小球滤过率、血管活性物质[血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)]。计量资料多组间比较采用方差分析,进一步两两比较采用LSD-t检验。结果 3组间治疗14 d和28 d时的腹水深度、尿量、腹围、Child评分、AngⅡ水平、ALD水平比较差异均有统计学意义(14 d:F值分别为6. 566、16. 236、10. 856、5. 727、41. 860、20. 845; 28 d:169. 311、67. 686、13. 521、39. 721、159. 256、80. 400,P值均<0. 05); 3组间治疗28 d时体质量、PRA水平比较差异均有统计学意义(F值分别为5. 068、0. 012,P值均<0. 05); 3组间腹胀评分、肛门排气评分、肛门排便评分治疗7 d、14 d、28 d时比较差异均有统计学意义(7 d:F值分别为38. 311、33. 405、33. 996; 14 d:64. 414、39. 481、52.455; 28 d:57. 596、23. 041、47. 576,P值均<0. 05)。结论消胀贴膏和特利加压素均可减少肝硬化腹水患者腹水量,而作用特点可能不同。消胀贴膏对肝硬化腹水的疗效优于常规治疗,且能显著改善患者临床症状,其作用机制可能与降低PRA、AngⅡ、ALD水平有关。
Objective To investigate the effect of Xiaozhang plaster in the treatment of cirrhotic ascites and its influence on the renin-angiotensin-aldosterone system. Methods A total of 220 patients with cirrhotic ascites who were hospitalized in Department of Gastroenterology in Shanghai Baoshan Integrated Traditional Chinese and Western Medical Hospital from March 2015 to March 2016 were enrolled and divided into routine treatment group with 60 patients,Xiaozhang plaster group with 60 patients,and terlipressin group with 100 patients. The patients in the routine treatment group received the routine treatment of cirrhotic ascites with a limitation of the dose of diuretics,those in the Xiaozhang plaster group were treated with Xiaozhang plaster in addition to the routine treatment,and those in the terlipressin group were treated with terlipressin in addition to the routine treatment. The three groups were observed in terms of related outcome measures( depth of ascites,24-hour urine volume,abdominal circumference,body weight,and Child-Pugh score),symptoms and signs( abdominal distension,diet,passage of gas by anus,and defecation),hepatic and renal function,electrolytes,routine blood test results,coagulation function,portal vein diameter,glomerular filtration rate,and vasoactive substances [plasma renin activity( PRA),angiotensin Ⅱ( AngⅡ),and aldosterone( ALD) ]. An analysis of variance was used for comparison of continuous data between multiple groups,and the least significant difference t-test was used for comparison within each group. Results There were significant differences between the three groups in depth of ascites,urine volume,abdominal circumference,Child-Pugh score,AngⅡ level,and ALD level on days 14 and 28 of treatment( day14: F = 6. 566,16. 236,10. 856,5. 727,41. 860,and 20. 845,all P < 0. 05; day 28: F = 169. 311,67. 686,13. 521,39. 721,159. 256,and 80. 400,all P < 0. 05). There were significant differences between the three groups in body weight and PRA level on day 28 of treatment( F = 5. 068 and 0. 012,both P < 0. 05). There were also significant differences between the three groups in the scores of abdominal distension,passage of gas by anus,and defecation on days 7,14,and 28 of treatment( day 7: F = 38. 311,33. 405,and 33. 996,all P < 0. 05; day 14: F = 64. 414,39. 481,and 52. 455,all P < 0. 05; day 28: F = 57. 596,23. 041,and 47. 576,all P < 0. 05). Conclusion Both Xiaozhang plaster and terlipressin can reduce ascites volume in patients with cirrhotic ascites,but they may have different action characteristics. Xiaozhang plaster is superior to terlipressin in the treatment of cirrhotic ascites and can significantly improve clinical symptoms,possibly by reducing the levels of PRA,AngⅡ,and ALD.
Objective To investigate the effect of Xiaozhang plaster in the treatment of cirrhotic ascites and its influence on the renin-angiotensin-aldosterone system. Methods A total of 220 patients with cirrhotic ascites who were hospitalized in Department of Gastroenterology in Shanghai Baoshan Integrated Traditional Chinese and Western Medical Hospital from March 2015 to March 2016 were enrolled and divided into routine treatment group with 60 patients,Xiaozhang plaster group with 60 patients,and terlipressin group with 100 patients. The patients in the routine treatment group received the routine treatment of cirrhotic ascites with a limitation of the dose of diuretics,those in the Xiaozhang plaster group were treated with Xiaozhang plaster in addition to the routine treatment,and those in the terlipressin group were treated with terlipressin in addition to the routine treatment. The three groups were observed in terms of related outcome measures( depth of ascites,24-hour urine volume,abdominal circumference,body weight,and Child-Pugh score),symptoms and signs( abdominal distension,diet,passage of gas by anus,and defecation),hepatic and renal function,electrolytes,routine blood test results,coagulation function,portal vein diameter,glomerular filtration rate,and vasoactive substances [plasma renin activity( PRA),angiotensin Ⅱ( AngⅡ),and aldosterone( ALD) ]. An analysis of variance was used for comparison of continuous data between multiple groups,and the least significant difference t-test was used for comparison within each group. Results There were significant differences between the three groups in depth of ascites,urine volume,abdominal circumference,Child-Pugh score,AngⅡ level,and ALD level on days 14 and 28 of treatment( day14: F = 6. 566,16. 236,10. 856,5. 727,41. 860,and 20. 845,all P < 0. 05; day 28: F = 169. 311,67. 686,13. 521,39. 721,159. 256,and 80. 400,all P < 0. 05). There were significant differences between the three groups in body weight and PRA level on day 28 of treatment( F = 5. 068 and 0. 012,both P < 0. 05). There were also significant differences between the three groups in the scores of abdominal distension,passage of gas by anus,and defecation on days 7,14,and 28 of treatment( day 7: F = 38. 311,33. 405,and 33. 996,all P < 0. 05; day 14: F = 64. 414,39. 481,and 52. 455,all P < 0. 05; day 28: F = 57. 596,23. 041,and 47. 576,all P < 0. 05). Conclusion Both Xiaozhang plaster and terlipressin can reduce ascites volume in patients with cirrhotic ascites,but they may have different action characteristics. Xiaozhang plaster is superior to terlipressin in the treatment of cirrhotic ascites and can significantly improve clinical symptoms,possibly by reducing the levels of PRA,AngⅡ,and ALD.
引文
[1]DONG CL,YU MD,TAO R,et al.Clinical value of moxibustion combined with sticking therapy at Shenque point in improving cirrhotic ascites[J].J Changchun Univ Chin Med,2018,34(3):525-527.(in Chinese)董春玲,俞美定,陶茹,等.艾灸联合神阙穴贴敷改善肝硬化腹水[J].长春中医药大学学报,2018,34(3):525-527.
[2]Chinese Society of Infectious Diseases and Parasitology and Chinese Society of Hepatology,Chinese Medical Association.Regimens for the prevention and treatment of viral hepatitis[J].Chin JIntern Med,2001,40(1):62-68.(in Chinese)中华医学会传染病与寄生虫病学分会、肝病学分会.病毒性肝炎防治方案[J].中华内科杂志,2001,40(1):62-68.
[3]Chinese Society of Hepatology,Chinese Medical Association.Guidelines on the management of ascites and complications in cirrhosis[J].J Clin Hepatol,2017,33(10):1847-1863.(in Chinese)中华医学会肝病学分会.肝硬化腹水及相关并发症的诊疗指南[J].临床肝胆病杂志,2017,33(10):1847-1863.
[4]China Association of Chinese Medicine.Guidelines for the diagnosis and treatment of common diseases in Chinese internal medicine:Diseases of traditional Chinese medicine[M].Beijing:China Press of Traditional Chinese Medicine,2008:95-97.(in Chinese)中华中医药学会.中医内科常见病诊疗指南·中医病证部分[M].北京:中国中医药出版社,2008:95-97.
[5]LIU CH,ZHANG YL,FENG NP,et al.Effects of syndrome dependent umbilical sticking with shizhang cataplasm and xuzhang cataplasm in treating liver cirrhosis caused ascites[J].Chin J Integr Trad West Med,2006,26(5):411-414.(in Chinese)刘成海,张雅丽,冯年平,等.实胀方与虚胀方辨证敷脐对肝硬化腹水的作用[J].中国中西医结合杂志,2006,26(5):411-414.
[6]Interventional Group,Chinese Society of Radiology,Chinese Medical Association.Expert consensus on transjugular intrahepatic portosystemic shunt[J].J Clin Hepatol,2017,33(7):1218-1228.(in Chinese)中华医学会放射学分会介入学组.经颈静脉肝内门体分流术专家共识[J].临床肝胆病杂志,2017,33(7):1218-1228.
[7]ZHANG HT,LI QY,LYU WH,et al.Clinical efficacy of terlipressin combined with human albumin for refractory ascites due to cirrhosis[J].Guangxi Med J,2018,40(7):759-762.(in Chinese)张会涛,李秋雅,吕文浩,等.特利加压素联合人血白蛋白治疗肝硬化顽固性腹水的临床疗效[J].广西医学,2018,40(7):759-762.
[8]PAN CF,ZHANG YL,CAI JP,et al.Umbilical compress therapy for cirrhotic ascites[J].Chin J Integr Tradit West Med Liver Dis,2004,14(2):126-128.(in Chinese)潘传芳,张雅丽,蔡俊萍,等.肝硬化腹水的敷脐疗法[J].中西医结合肝病杂志,2004,14(2):126-128.
[9]LEI L.Clinical effect of traditional Chinese medicine umbilical compress therapy in treatment of cirrhotic ascites:An analysis of 41 cases[J].Chin J Integr Tradit West Med Liver Dis,1994,4(2):41.(in Chinese)雷陵.中药敷脐为主治疗肝硬化腹水41例[J].中西医结合肝病杂志,1994,4(2):41.
[10]SECCHI MF,CRESCENZI M,RUSSO FP,et al.A novel role for heparanase in the onset of liver fibrosis[J].Dig Liver Dis,2017,49(1):e20-e21.
[11]STOLL D,YOKOTA R,ARAGAO DS,et al.Modulation of the intracrine renin angiotensin system in mesangial cells submitted to aldosterone stimulus[J].FASEB J,2017,31(1 Supplement):1031.6.
[2]Chinese Society of Infectious Diseases and Parasitology and Chinese Society of Hepatology,Chinese Medical Association.Regimens for the prevention and treatment of viral hepatitis[J].Chin JIntern Med,2001,40(1):62-68.(in Chinese)中华医学会传染病与寄生虫病学分会、肝病学分会.病毒性肝炎防治方案[J].中华内科杂志,2001,40(1):62-68.
[3]Chinese Society of Hepatology,Chinese Medical Association.Guidelines on the management of ascites and complications in cirrhosis[J].J Clin Hepatol,2017,33(10):1847-1863.(in Chinese)中华医学会肝病学分会.肝硬化腹水及相关并发症的诊疗指南[J].临床肝胆病杂志,2017,33(10):1847-1863.
[4]China Association of Chinese Medicine.Guidelines for the diagnosis and treatment of common diseases in Chinese internal medicine:Diseases of traditional Chinese medicine[M].Beijing:China Press of Traditional Chinese Medicine,2008:95-97.(in Chinese)中华中医药学会.中医内科常见病诊疗指南·中医病证部分[M].北京:中国中医药出版社,2008:95-97.
[5]LIU CH,ZHANG YL,FENG NP,et al.Effects of syndrome dependent umbilical sticking with shizhang cataplasm and xuzhang cataplasm in treating liver cirrhosis caused ascites[J].Chin J Integr Trad West Med,2006,26(5):411-414.(in Chinese)刘成海,张雅丽,冯年平,等.实胀方与虚胀方辨证敷脐对肝硬化腹水的作用[J].中国中西医结合杂志,2006,26(5):411-414.
[6]Interventional Group,Chinese Society of Radiology,Chinese Medical Association.Expert consensus on transjugular intrahepatic portosystemic shunt[J].J Clin Hepatol,2017,33(7):1218-1228.(in Chinese)中华医学会放射学分会介入学组.经颈静脉肝内门体分流术专家共识[J].临床肝胆病杂志,2017,33(7):1218-1228.
[7]ZHANG HT,LI QY,LYU WH,et al.Clinical efficacy of terlipressin combined with human albumin for refractory ascites due to cirrhosis[J].Guangxi Med J,2018,40(7):759-762.(in Chinese)张会涛,李秋雅,吕文浩,等.特利加压素联合人血白蛋白治疗肝硬化顽固性腹水的临床疗效[J].广西医学,2018,40(7):759-762.
[8]PAN CF,ZHANG YL,CAI JP,et al.Umbilical compress therapy for cirrhotic ascites[J].Chin J Integr Tradit West Med Liver Dis,2004,14(2):126-128.(in Chinese)潘传芳,张雅丽,蔡俊萍,等.肝硬化腹水的敷脐疗法[J].中西医结合肝病杂志,2004,14(2):126-128.
[9]LEI L.Clinical effect of traditional Chinese medicine umbilical compress therapy in treatment of cirrhotic ascites:An analysis of 41 cases[J].Chin J Integr Tradit West Med Liver Dis,1994,4(2):41.(in Chinese)雷陵.中药敷脐为主治疗肝硬化腹水41例[J].中西医结合肝病杂志,1994,4(2):41.
[10]SECCHI MF,CRESCENZI M,RUSSO FP,et al.A novel role for heparanase in the onset of liver fibrosis[J].Dig Liver Dis,2017,49(1):e20-e21.
[11]STOLL D,YOKOTA R,ARAGAO DS,et al.Modulation of the intracrine renin angiotensin system in mesangial cells submitted to aldosterone stimulus[J].FASEB J,2017,31(1 Supplement):1031.6.