温阳健脾汤治疗肝硬化顽固性腹水临床研究
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摘要
目的:观察温阳健脾汤治疗肝硬化顽固性腹水的临床疗效及对患者门静脉血流动力学指标的影响。方法:将顽固性腹水患者80例随机分为2组,对照组40例行西医常规治疗,观察组40例在对照组的基础上加服温阳健脾汤,疗程均为2周;于治疗前后测定患者24h尿量、腹围及体质量改变状况,ELISA法检测血清白蛋白(Alb)、丙氨酸氨基转移酶(ALT)、总胆红素(TBil)、门冬氨酸氨基转移酶(AST)、尿钠及血钠含量,彩色多普勒超声诊断仪检测门静脉及脾静脉血流量、流速和腹水暗区深度情况。结果:总有效率观察组为95.00%,对照组为70.00%,2组比较,差异有统计学意义(P <0.05)。治疗后2组患者脾静脉、门静脉血流量及腹水暗区深度均较治疗前明显降低(P <0.05),且观察组上述指标均低于对照组(P <0.05)。治疗后2组患者腹围较治疗前明显降低(P <0.05),24 h尿量明显升高(P <0.05);且观察组上述指标改善较对照组更显著(P <0.05)。治疗后观察组患者血清Alb含量较治疗前明显升高(P <0.05),ALT、TBil、AST含量明显降低(P <0.05);且观察组上述指标改善较对照组更显著(P <0.05)。2组治疗前后脾静脉血流速度、门静脉血流速度及体质量均变化不明显(P> 0.05)。结论:温阳健脾汤结合常规西药治疗可显著改善肝硬化顽固性腹水患者肝功能、门静脉血流动力学指标,临床疗效显著。
Objective: To observe the clinical effect of Wenyang Jianpi tang for refractory ascites induced by cirrhosis and its influence on portal hemodynamic parameters. Methods:Divided 80 cases of patients with refractory ascites randomly into two groups.40 cases in the control group were treated with western medicine,while other 40 cases in the observation group were additionally given Wenyang Jianpi tang. The course of treatment was both 2 weeks. Measured the changes of urine volume in 24 hours of patients before and after treatment, abdominal circumference and body mass, detected serum albumin(Alb), alanine aminotransferase(ALT), total bilirubin(TBil),aspartate aminotransferase(AST),urine sodium and blood sodium content by ELISA,and detected blood flow of portal vein and splenic vein, velocity and depth of ascites dark area by color Doppler ultrasound diagnostic instrument. Results: The total effective rate was 95.00% in the observation group and 70.00% in the control group, compared the two groups, difference being significant(P < 0.05). After treatment,the blood flow of the splenic vein and portal vein and the depth of the ascites dark area of patients in the two groups were significantly lower than those before treatment(P < 0.05);these indexes in the observation group were lower than those in the control group(P < 0.05). After treatment,the abdominal circumference of patients in the two groups was significantly lower than that before treatment(P < 0.05);the urine volume in 24 h was significantly increased(P < 0.05);the improvement of these indexes in the observation group was more significant than that of the control group(P < 0.05). After treatment,the serum Alb levels of patients in the observation group were evidently higher than those before treatment(P < 0.05); the contents of ALT, TBil and AST were obviously decreased(P < 0.05);the improvement of the these indexes in the observation group was more significant than that in the control group(P < 0.05). There were no significant changes being found in the comparison of splenic venous flow velocity,portal venous flow velocity and body mass in the two groups before and after treatment(P > 0.05). Conclusion:The application of Wenyang Jianpi tang combined with routine western medicine treatment can significantly improve liver function,portal hemodynamic parameters in patients with refractory ascites induced by cirrhosis. It has obvious clinical effect.
Objective: To observe the clinical effect of Wenyang Jianpi tang for refractory ascites induced by cirrhosis and its influence on portal hemodynamic parameters. Methods:Divided 80 cases of patients with refractory ascites randomly into two groups.40 cases in the control group were treated with western medicine,while other 40 cases in the observation group were additionally given Wenyang Jianpi tang. The course of treatment was both 2 weeks. Measured the changes of urine volume in 24 hours of patients before and after treatment, abdominal circumference and body mass, detected serum albumin(Alb), alanine aminotransferase(ALT), total bilirubin(TBil),aspartate aminotransferase(AST),urine sodium and blood sodium content by ELISA,and detected blood flow of portal vein and splenic vein, velocity and depth of ascites dark area by color Doppler ultrasound diagnostic instrument. Results: The total effective rate was 95.00% in the observation group and 70.00% in the control group, compared the two groups, difference being significant(P < 0.05). After treatment,the blood flow of the splenic vein and portal vein and the depth of the ascites dark area of patients in the two groups were significantly lower than those before treatment(P < 0.05);these indexes in the observation group were lower than those in the control group(P < 0.05). After treatment,the abdominal circumference of patients in the two groups was significantly lower than that before treatment(P < 0.05);the urine volume in 24 h was significantly increased(P < 0.05);the improvement of these indexes in the observation group was more significant than that of the control group(P < 0.05). After treatment,the serum Alb levels of patients in the observation group were evidently higher than those before treatment(P < 0.05); the contents of ALT, TBil and AST were obviously decreased(P < 0.05);the improvement of the these indexes in the observation group was more significant than that in the control group(P < 0.05). There were no significant changes being found in the comparison of splenic venous flow velocity,portal venous flow velocity and body mass in the two groups before and after treatment(P > 0.05). Conclusion:The application of Wenyang Jianpi tang combined with routine western medicine treatment can significantly improve liver function,portal hemodynamic parameters in patients with refractory ascites induced by cirrhosis. It has obvious clinical effect.
引文
[1]贾运乔,王静,冯小涛,等.综合疗法治疗顽固性肝硬化腹水疗效研究[J].河北中医药学报,2016,31(1):23-25.
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[3]龚江波,吴利达,金学林,等.再改良Sugiura术对肝硬化门静脉高压症患者门静脉血流动力学及肝功能的影响[J].中华肝胆外科杂志,2017,23(2):90-94.
[4]王吉耀.现代肝病治疗:理论与进展[M].上海:上海医科大学出版社,1999:172-176.
[5]RUNYON B A.Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis2012[J].Hepatology,2013,29(9):1651-1653.
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[7]滕英.中医临床病证诊断疗效标准[J].医药卫生(文摘版),1996,10(8):200.
[8]徐大洲,梁旭阳,张志梅.阿罗洛尔治疗肝硬化患者门静脉高压的疗效观察[J].中国中西医结合消化杂志,2017,11(8):579-582.
[9]常帅,曹新山,姜兴岳,等.相位对比法磁共振成像技术在乙型肝炎硬化肝功能状况评价中的应用及意义[J].中国临床研究,2018,31(1):13-17.
[10]祝峻峰,钱平安,范兴良,等.消水方联合托伐普坦治疗肝炎肝硬化顽固性腹水临床研究[J].实用肝脏病杂志,2016,19(2):192-195.
[11]何盟国,沈乃营,谭栋,等.脾切除贲门周围血管离断术对肝硬化门静脉高压症患者肝脏血流动力学及肝功能的影响[J].中国普外基础与临床杂志,2016,13(8):978-981.
[12]SINHA R,LOCKMAN K A,MALLAWAARACHCHI N,et al.Carvedilol use is associated with improved survival in patients with liver cirrhosis and ascites[J].Journal of Hepatology,2017,67(1):40-46.
[13]刘翔.柔肝补血中药治疗酒精性肝硬化伴门脉高压性腹水疗效及对内皮素-1、血管内皮生长因子的影响[J].现代中西医结合杂志,2018,7(3):260-263.
[14]GRONBEK H,RODGAARDHANSEN S,AAGAARD N K,et al.The soluble macrophage activation markers s CD163 and Mannose Receptor(s MR)predict mortality in patients with liver cirrhosis without or with acute-on-chronic liver failure(ACLF)[J].Journal of Hepatology,2016,64(4):813-822.
[2]MOHAMED S Y,EMARA M H,HUSSIEN H I,et al.Changes in portal blood flow and liver functions in cirrhotics during Ramadan fasting in the summer;a pilot study[J].Gastroenterology and Hepatology From Bed to Bench,2016,9(3):180-188.
[3]龚江波,吴利达,金学林,等.再改良Sugiura术对肝硬化门静脉高压症患者门静脉血流动力学及肝功能的影响[J].中华肝胆外科杂志,2017,23(2):90-94.
[4]王吉耀.现代肝病治疗:理论与进展[M].上海:上海医科大学出版社,1999:172-176.
[5]RUNYON B A.Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis2012[J].Hepatology,2013,29(9):1651-1653.
[6]朱文锋.中医内科疾病诊疗常规[M].长沙:湖南科学技术出版社,1999:210-215.
[7]滕英.中医临床病证诊断疗效标准[J].医药卫生(文摘版),1996,10(8):200.
[8]徐大洲,梁旭阳,张志梅.阿罗洛尔治疗肝硬化患者门静脉高压的疗效观察[J].中国中西医结合消化杂志,2017,11(8):579-582.
[9]常帅,曹新山,姜兴岳,等.相位对比法磁共振成像技术在乙型肝炎硬化肝功能状况评价中的应用及意义[J].中国临床研究,2018,31(1):13-17.
[10]祝峻峰,钱平安,范兴良,等.消水方联合托伐普坦治疗肝炎肝硬化顽固性腹水临床研究[J].实用肝脏病杂志,2016,19(2):192-195.
[11]何盟国,沈乃营,谭栋,等.脾切除贲门周围血管离断术对肝硬化门静脉高压症患者肝脏血流动力学及肝功能的影响[J].中国普外基础与临床杂志,2016,13(8):978-981.
[12]SINHA R,LOCKMAN K A,MALLAWAARACHCHI N,et al.Carvedilol use is associated with improved survival in patients with liver cirrhosis and ascites[J].Journal of Hepatology,2017,67(1):40-46.
[13]刘翔.柔肝补血中药治疗酒精性肝硬化伴门脉高压性腹水疗效及对内皮素-1、血管内皮生长因子的影响[J].现代中西医结合杂志,2018,7(3):260-263.
[14]GRONBEK H,RODGAARDHANSEN S,AAGAARD N K,et al.The soluble macrophage activation markers s CD163 and Mannose Receptor(s MR)predict mortality in patients with liver cirrhosis without or with acute-on-chronic liver failure(ACLF)[J].Journal of Hepatology,2016,64(4):813-822.