中药穴位贴敷联合干扰素治疗慢性乙型肝炎肝郁脾虚证
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摘要
目的观察中药穴位贴敷联合普通干扰素治疗慢性乙型肝炎(CHB)肝郁脾虚证的疗效。方法 306例经肝穿刺活检证实、辨证为肝郁脾虚证、拟接受干扰素α1b抗病毒治疗的HBeAg阳性CHB患者,按照患者意愿分组,对照组使用IFNα1b 5 MU/次,皮下注射,3次/周;联合治疗组在干扰素治疗基础上联合中药穴位贴敷治疗,选穴肝俞穴、章门、足三里,隔天1次,疗程24周。两组干扰素疗程均个体化。观察6个月时两组证候疗效、干扰素不良反应发生率的差异及干扰素结束时疗效差异。结果两组治疗前后中医证候积分改变的差异具有统计学意义(Z=-7.132,P=0.000),联合治疗组的临床痊愈率高于对照组,总有效率(临床痊愈率+显效率+有效率)高于对照组;联合治疗组治疗6个月时新发乏力(χ~2=21.114,P=0.000)、食欲下降(χ~2=37.260,P=0.000)、失眠(χ~2=20.158,P=0.000)及精神异常(χ~2=3.844,P=0.049)的发生率低于对照组;干扰素治疗结束时,联合治疗组HBeAg血清学转换率(χ~2=6.749,P=0.009)、HBV DNA阴转率(χ~2=5.417,P=0.020)、ALT复常率(χ~2=4.695,P=0.030)及完全应答率(χ~2=7.535,P=0.006)均显著高于对照组。结论中药穴位贴敷联合干扰素治疗CHB肝郁脾虚证,能有效改善减低中医证候积分,降低干扰素不良反应发生率,提高干扰素抗病毒疗效。
Objective To observe the curative effect of acupoint application with interferon in treating CHB with liver depression and spleen deficiency syndrome. Methods A total of 306 CHB patients with HBeAg-positive confirmed by liver biopsy and differentiated into liver depression and spleen deficiency syndrome and intended to receive interferon alpha 1 b antiviral therapy were enrolled in this study. Grouped according to patients' wishes, the control group was treated with 5 MU of IFNα1 b subcutaneously thrice weekly; The combined treatment group was treated with Acupoint Application on the basis of interferon therapy, and Choosed the point of GanShu, Zhangmen, St36, once every two days,with 24 weeks. The two groups of interferon treatments were tailored and prolonged. The difference of syndromes, the incidence of interferon adverse reactions at 6 months, and the efficacy 2 at the end of interferon between the two groups were observed. Results The difference of TCM syndrome scores between the two groups before and after treatment was statistically significant(Z=-7.132, P =0.000). The clinical cure rate of the combined treatment group was significantly higher than that of the control group, and the total effective rate(clinical cure rate + marked effective rate + effective rate) was also significantly higher than that of the control group. The incidence of new onset hypodynamia(χ~2=21.114, P =0.000), loss of appetite(χ~2=37.260, P = 0.000), insomnia(χ~2=20.158, P =0.000) and mental disorders(χ~2=3.844, P=0.049) in the combined treatment group was lower than that in the control group at 6 months. HBeAg seroconversion rate(χ~2=6.749, P =0.009), HBV DNA negative conversion rate(χ~2=5.417, P =0.020), ALT normalization rate(χ~2=4.695, P =0.030) and complete response rate(χ~2=7.535, P =0.006) in the combined treatment group were significantly higher than those in the control group at the end of interferon treatment. Conclusion Acupoint application of traditional Chinese medicine combined with interferon in the treatment of CHB with liver depression and spleen deficiency syndrome can effectively improve and reduce the integral of TCM syndrome, reduce the incidence of adverse reactions of interferon, and improve the antiviral effect of interferon.
Objective To observe the curative effect of acupoint application with interferon in treating CHB with liver depression and spleen deficiency syndrome. Methods A total of 306 CHB patients with HBeAg-positive confirmed by liver biopsy and differentiated into liver depression and spleen deficiency syndrome and intended to receive interferon alpha 1 b antiviral therapy were enrolled in this study. Grouped according to patients' wishes, the control group was treated with 5 MU of IFNα1 b subcutaneously thrice weekly; The combined treatment group was treated with Acupoint Application on the basis of interferon therapy, and Choosed the point of GanShu, Zhangmen, St36, once every two days,with 24 weeks. The two groups of interferon treatments were tailored and prolonged. The difference of syndromes, the incidence of interferon adverse reactions at 6 months, and the efficacy 2 at the end of interferon between the two groups were observed. Results The difference of TCM syndrome scores between the two groups before and after treatment was statistically significant(Z=-7.132, P =0.000). The clinical cure rate of the combined treatment group was significantly higher than that of the control group, and the total effective rate(clinical cure rate + marked effective rate + effective rate) was also significantly higher than that of the control group. The incidence of new onset hypodynamia(χ~2=21.114, P =0.000), loss of appetite(χ~2=37.260, P = 0.000), insomnia(χ~2=20.158, P =0.000) and mental disorders(χ~2=3.844, P=0.049) in the combined treatment group was lower than that in the control group at 6 months. HBeAg seroconversion rate(χ~2=6.749, P =0.009), HBV DNA negative conversion rate(χ~2=5.417, P =0.020), ALT normalization rate(χ~2=4.695, P =0.030) and complete response rate(χ~2=7.535, P =0.006) in the combined treatment group were significantly higher than those in the control group at the end of interferon treatment. Conclusion Acupoint application of traditional Chinese medicine combined with interferon in the treatment of CHB with liver depression and spleen deficiency syndrome can effectively improve and reduce the integral of TCM syndrome, reduce the incidence of adverse reactions of interferon, and improve the antiviral effect of interferon.
引文
[1]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年版)[J].中国肝脏病杂志(电子版),2015,7(3):1-13.
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[3]王安娜,李敏,代英,等.疏肝健脾膏穴位贴敷治疗慢性乙型肝炎(肝郁脾虚证)30例[J].中国中医药现代远程教育,2016,14(10):74-76.
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[5]龚文亮,吴荔,郑其进,等.消痛散穴位敷贴治疗慢性乙型肝炎胁痛的临床研究[J].现代医院,2016,16(1):51-55.
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[7]李夏元.用中药穴位贴敷法治疗肝病的临床疗效观察[J].当代医药论丛,2014,12(4):140-141.
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[9]张娟,杨帆,邵冬珊.中药穴位敷贴辅助治疗黄疸型慢性乙型肝炎的临床疗效观察[J].湖北中医杂志,2017,39(5):14-16.
[10]王燕,蔡满媛,唐芳,等.慢性乙型肝炎抗病毒治疗疗程与复发率的观察及护理对策[J].哈尔滨医药,2017,37(4):390-391.
[11]仵倚,章新友,周小玲,等.中药穴位贴敷法治疗慢性乙肝有效性的系统评价[J].江西中医药,2017,48(4):64-67.
[2]中华中医药学会肝胆病分会.病毒性肝炎中医辨证标准[J].临床肝胆病杂志,2017,33(10):1840-1841.
[3]王安娜,李敏,代英,等.疏肝健脾膏穴位贴敷治疗慢性乙型肝炎(肝郁脾虚证)30例[J].中国中医药现代远程教育,2016,14(10):74-76.
[4]郝毅,李玉春,王景琦.中药穴位贴敷治疗慢性乙型肝炎的适宜技术研究与推广[J].临床医药文献杂志,2018,5(41):162-163.
[5]龚文亮,吴荔,郑其进,等.消痛散穴位敷贴治疗慢性乙型肝炎胁痛的临床研究[J].现代医院,2016,16(1):51-55.
[6]田秀霞.健脾疏肝贴穴位贴敷治疗慢性乙型肝炎胁痛的疗效观察[J].继续医学教育,2018,32(5):157-159.
[7]李夏元.用中药穴位贴敷法治疗肝病的临床疗效观察[J].当代医药论丛,2014,12(4):140-141.
[8]刘春光,陈少颖,农桂东,等.中药穴位贴敷联合干扰素治疗慢性乙型肝炎的临床观察[J].内蒙古中医药,2015,34(4):92-93.
[9]张娟,杨帆,邵冬珊.中药穴位敷贴辅助治疗黄疸型慢性乙型肝炎的临床疗效观察[J].湖北中医杂志,2017,39(5):14-16.
[10]王燕,蔡满媛,唐芳,等.慢性乙型肝炎抗病毒治疗疗程与复发率的观察及护理对策[J].哈尔滨医药,2017,37(4):390-391.
[11]仵倚,章新友,周小玲,等.中药穴位贴敷法治疗慢性乙肝有效性的系统评价[J].江西中医药,2017,48(4):64-67.