健脾补肾利水方治疗肝硬变腹水临床研究
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摘要
目的:观察健脾补肾利水方对肝硬变腹水患者下腹部腹水量、血清白蛋白(serum albumin,ALB)、胆碱酯酶(cholinesterase,CHE)水平、症状总积分的影响,并以此评价临床疗效。方法:将138例肝硬变腹水患者随机分为观察组和对照组,各69例。对照组给予西医基础治疗,观察组在此基础上服用健脾补肾利水方,疗程为1个月,随访1个月。结果:与治疗前相比,观察组治疗15 d、1个月及随访1个月后ALB、CHE水平显著升高(P<0.05),且显著高于同期对照组(P<0.05)。观察组患者治疗15 d、1个月、随访1个月腹水量与治疗前相比均显著下降(P<0.05),且显著低于同期对照组(P<0.05)。观察组患者治疗15 d、1个月及随访1个月后症状总积分下降程度优于同期对照组(P<0.05)。观察组患者治疗结束随访1年腹水发生及住院次数显著低于治疗前(P<0.05),且显著低于同期对照组(P<0.05)。结论:健脾补肾利水方可提高肝硬变腹水患者血清ALB、CHE水平,降低腹水量,改善肝硬变腹水患者腹胀、气短乏力、面色萎黄等临床症状,提高生存质量,减少肝硬变腹水患者腹水发生次数、住院次数。
Objective:To observe the effect of Jianpi Bushen Lishui Prescription on ascites,serum albumin( ALB),cholinesterase(CHE) levels and total symptom scores in patients with cirrhosis and ascites and to evaluate clinical efficacy based on that. Methods:138 patients with cirrhosis ascites were randomly divided into observation group and control group,69 cases each. The control group was given basic Western medicine treatment. The observation group was treated with Jianpi Bushen Lishui Prescription in addition to that of the control group for one month and followed up for one month. Results:Compared with before treatment,the ALB and CHE levels in the observation group were significantly higher( P < 0. 05) after 15 days,1 month,and 1 month follow-up,and that was significantly higher than those in the control group at the same time( P < 0. 05). In the observation group,the amount of ascites in the 15 days,1 month,and 1 month follow-up was significantly lower than that before the treatment( P < 0. 05),and it was significantly lower than that in the control group at the same time( P < 0. 05). In the observation group,the decrease in total scores after 15 days,1 month,and 1 month follow-up was significantly better than that in the control group at the same time( P <0. 05). The number of occurrences of ascites and the number of hospitalizations in the observation group at the end of treatment were significantly lower than that before treatment in the observation group( P < 0. 05),and it was significantly lower than those in the control group at the same time( P < 0. 05). Conclusion:Jianpi Bushen Lishui Prescription can increase the levels of serum ALB and CHE in patients with cirrhosis and ascites,reduce the amount of ascites,improve the clinical symptoms such as bloating,shortness of breath,fatigue,pale complexion and other symptoms in cirrhotic ascites,improve the quality of life,and reduce the incidence of ascites in patients with cirrhosis and ascites as well as the number of hospitalizations.
Objective:To observe the effect of Jianpi Bushen Lishui Prescription on ascites,serum albumin( ALB),cholinesterase(CHE) levels and total symptom scores in patients with cirrhosis and ascites and to evaluate clinical efficacy based on that. Methods:138 patients with cirrhosis ascites were randomly divided into observation group and control group,69 cases each. The control group was given basic Western medicine treatment. The observation group was treated with Jianpi Bushen Lishui Prescription in addition to that of the control group for one month and followed up for one month. Results:Compared with before treatment,the ALB and CHE levels in the observation group were significantly higher( P < 0. 05) after 15 days,1 month,and 1 month follow-up,and that was significantly higher than those in the control group at the same time( P < 0. 05). In the observation group,the amount of ascites in the 15 days,1 month,and 1 month follow-up was significantly lower than that before the treatment( P < 0. 05),and it was significantly lower than that in the control group at the same time( P < 0. 05). In the observation group,the decrease in total scores after 15 days,1 month,and 1 month follow-up was significantly better than that in the control group at the same time( P <0. 05). The number of occurrences of ascites and the number of hospitalizations in the observation group at the end of treatment were significantly lower than that before treatment in the observation group( P < 0. 05),and it was significantly lower than those in the control group at the same time( P < 0. 05). Conclusion:Jianpi Bushen Lishui Prescription can increase the levels of serum ALB and CHE in patients with cirrhosis and ascites,reduce the amount of ascites,improve the clinical symptoms such as bloating,shortness of breath,fatigue,pale complexion and other symptoms in cirrhotic ascites,improve the quality of life,and reduce the incidence of ascites in patients with cirrhosis and ascites as well as the number of hospitalizations.
引文
[1]刘成海,危北海,姚树坤.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.
[2]European Association for the Study of the Liver.EASL clinical practice guidelines on the management of ascites,spontaneous bacterial petitonitis,and hepatorenal syndrome in cirrhosis[J].Journal of Hepatology,2010,53(1):397-417.
[3]田秋菊,贾继东.肝硬化腹水及其相关并发症治疗新进展[J].实用肝脏病杂志,2015,18(1):1-3.
[4]CHEN R P,ZHUGE X J,HUANGZ M,et al.Prophylactic use of transjugularintrahepa-tic portosystemic shunt aids in the treatment of refractory ascites:Metaregression and trial sequential metaanalysis[J].J Clin Gastroenterol,2014,48(3):290-299.
[5]熊焰,董婷,余东慧,等.明清鼓胀病症候规律研究[J].中华中医药杂志,2015,30(7):2590-2593.
[6]姚乃礼,陈兰羽,郑宝平.肝纤维化毒损肝络机制研究[C].北京:中华中医药学会内科分会全国中医内科临床科学研究专题研讨会论文汇编,2009.
[7]华忠,李光,薛博瑜.金实教授应用龙柴方辨治肝炎肝纤维化经验[J].现代中西医结合杂志,2011,20(30):3850-3908.
[8]张春光,朱媛雯.益气健脾化浊汤治疗肝硬化低蛋白血症30例临床观察[J].浙江中医杂志,2015,50(1):25.
[9]冯宏汉,舒治娥.自拟健脾补肾方治疗肝硬化低蛋白血症临床研究[J].光明中医,2014,29(2):272-274.
[10]张英凯,张冰,张敏.加用健软汤治疗慢性乙肝肝硬化失代偿期低蛋白血症的临床观察[J].广西中医药大学学报,2014,17(1):23-25.
[11]周东红.升白汤治疗肝硬化低蛋白血症的临床观察[J].长春中医药大学学报,2009,25(4):527.
[12]孔庆辉,刘春芳,孙秉海,等.芪甲柴术饮治疗肝硬化低蛋白血症的临床研究[J].中西医结合肝病杂志,2009,19(4):200-202.
[13]马素平,赵文霞.益气活血利水方联合逐水膏腧穴贴敷治疗气虚血瘀型肝硬化腹水临床研究[J].中西医结合肝病杂志,2017,27(1):31-33.
[2]European Association for the Study of the Liver.EASL clinical practice guidelines on the management of ascites,spontaneous bacterial petitonitis,and hepatorenal syndrome in cirrhosis[J].Journal of Hepatology,2010,53(1):397-417.
[3]田秋菊,贾继东.肝硬化腹水及其相关并发症治疗新进展[J].实用肝脏病杂志,2015,18(1):1-3.
[4]CHEN R P,ZHUGE X J,HUANGZ M,et al.Prophylactic use of transjugularintrahepa-tic portosystemic shunt aids in the treatment of refractory ascites:Metaregression and trial sequential metaanalysis[J].J Clin Gastroenterol,2014,48(3):290-299.
[5]熊焰,董婷,余东慧,等.明清鼓胀病症候规律研究[J].中华中医药杂志,2015,30(7):2590-2593.
[6]姚乃礼,陈兰羽,郑宝平.肝纤维化毒损肝络机制研究[C].北京:中华中医药学会内科分会全国中医内科临床科学研究专题研讨会论文汇编,2009.
[7]华忠,李光,薛博瑜.金实教授应用龙柴方辨治肝炎肝纤维化经验[J].现代中西医结合杂志,2011,20(30):3850-3908.
[8]张春光,朱媛雯.益气健脾化浊汤治疗肝硬化低蛋白血症30例临床观察[J].浙江中医杂志,2015,50(1):25.
[9]冯宏汉,舒治娥.自拟健脾补肾方治疗肝硬化低蛋白血症临床研究[J].光明中医,2014,29(2):272-274.
[10]张英凯,张冰,张敏.加用健软汤治疗慢性乙肝肝硬化失代偿期低蛋白血症的临床观察[J].广西中医药大学学报,2014,17(1):23-25.
[11]周东红.升白汤治疗肝硬化低蛋白血症的临床观察[J].长春中医药大学学报,2009,25(4):527.
[12]孔庆辉,刘春芳,孙秉海,等.芪甲柴术饮治疗肝硬化低蛋白血症的临床研究[J].中西医结合肝病杂志,2009,19(4):200-202.
[13]马素平,赵文霞.益气活血利水方联合逐水膏腧穴贴敷治疗气虚血瘀型肝硬化腹水临床研究[J].中西医结合肝病杂志,2017,27(1):31-33.