健脾散结化痰活血法联合大黄解毒汤结肠给药治疗肝硬化临床研究
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摘要
目的:观察健脾散结化痰活血法口服给药联合大黄解毒汤结肠给药治疗肝硬化的临床疗效。方法:将60例肝硬化患者随机分为治疗组(30例)与对照组(30例)。两组均采用健脾散结化痰活血法的中医治疗,给予水红花子汤加减口服。治疗组在此基础上加用大黄解毒汤结肠给药,每日1次。疗程为12周。观察两组治疗前后主要症状、体征、相关检验指标。结果:两组均能改善肝功能、凝血、血内毒素、炎症指标、肝脏超声测量指标及肝纤维化程度。治疗组在改善肝功能、降低血内毒素、改善肝纤维化程度、改善小便色黄、便溏、腹胀等方面疗效优于对照组,差异有显著性(P<0.05)。治疗组总有效率为76.67%,对照组为56.67%,治疗组的疗效优于对照组(P<0.05)。结论:健脾散结化痰活血法治疗肝硬化的疗效确切,结肠给药可以有效治疗肝硬化患者的肠源性内毒素血症,加用大黄解毒汤结肠给药可以提高治疗肝硬化的临床疗效。
Objective: Observe the Jianpisanjiehuathuoxue method oral administration. methods joint rhubarb jiedu decoction for drug treatment of liver cirrhosis colon clinical effect. Methods: 60 patients with cirrhosis were randomly divided into treatment group (30 cases) and control group (30cases),the two groups were both treated with Chinese medicine of the method of jianpisanjiehuatanhuoxue, give ShuiGong hanako decoction orally. The treatment group were treated with retention-enema of Rhubarb Jiedu Decoction additionally, once-daily for 12 weeks. Observe two groups before and after the treatment main symptoms, signs, relevant inspection index. Results: Both groups can improve liver function, blood coagulation, blood endotoxin, inflammation index, liver ultrasound measurement indexes and the liver fibrosis degree. The treatment group in improve liver function, reduce blood endotoxin, improve liver fibrosis degree, improve pee color yellow, loose stools, abdominal distension, etc curative effect than control group(P<0.05).The total effective rate of the treatment group( 76.67%) is superior to that of control group (56.67%) (P<0.05). Conclusion: The curative effect of the method of jianpisanjiehuatan with Chinese medicine on cirrhosis is remarkable. Colonic drug could be an effective treatment for the patients with cirrhosis enterogenous endotoxin hematic disease,and add a rhubarb jiedu decoction can improve treatment for medicine colon clinical curative effect of cirrhosis
Objective: Observe the Jianpisanjiehuathuoxue method oral administration. methods joint rhubarb jiedu decoction for drug treatment of liver cirrhosis colon clinical effect. Methods: 60 patients with cirrhosis were randomly divided into treatment group (30 cases) and control group (30cases),the two groups were both treated with Chinese medicine of the method of jianpisanjiehuatanhuoxue, give ShuiGong hanako decoction orally. The treatment group were treated with retention-enema of Rhubarb Jiedu Decoction additionally, once-daily for 12 weeks. Observe two groups before and after the treatment main symptoms, signs, relevant inspection index. Results: Both groups can improve liver function, blood coagulation, blood endotoxin, inflammation index, liver ultrasound measurement indexes and the liver fibrosis degree. The treatment group in improve liver function, reduce blood endotoxin, improve liver fibrosis degree, improve pee color yellow, loose stools, abdominal distension, etc curative effect than control group(P<0.05).The total effective rate of the treatment group( 76.67%) is superior to that of control group (56.67%) (P<0.05). Conclusion: The curative effect of the method of jianpisanjiehuatan with Chinese medicine on cirrhosis is remarkable. Colonic drug could be an effective treatment for the patients with cirrhosis enterogenous endotoxin hematic disease,and add a rhubarb jiedu decoction can improve treatment for medicine colon clinical curative effect of cirrhosis
引文
[1]姚祯,姚宗歌,汪耘,等.肝硬化的临床流行病学分析[J]临床肝胆病杂志,2001,17(1):3
[2]国泽延,侯金林.乙肝相关性肝硬化的治疗进展[J].医学信息,2002,15(6):386
[3] Samue1D,FerayC,BISmuthH[J].JGastroentero1Hepatol,1997,12(Suppl):5335
[5]中华医学会传染病与寄生虫病学分会,肝病学分会.病毒性肝炎的诊断标准[J].中西医结合肝病杂志,2001;11(1):56-60.
[5]中华医学会肝病学分会、感染病学分会.慢性乙型肝炎防治指南[J].中华肝脏病杂志,2005,13(12):881-891.
[6]张育轩,危北海整理.肝硬变临床诊断、中医辨证和疗效评定标准(试行方案)[J].新消化病学杂志,1994;2(2):126
[7]王功遂,王曼曼,姜湘宁,等.两种不同方式经皮肝穿刺活组织检查的优缺点分析[J]实用肝脏病杂志2010; 13:170-172.
[8] Tu CT,Guo JS,Wang M,Wang JY.Antifibrotic activity of rofecoxib in vivo is associated with redueed portal hyPertension in rats with carbon tetrachloride-induced liver injury[J].J Gastroen Hepatol, 2007:22:877-884.
[9] Hiroko Matsui,Norifumi Kawada.Effeet of S-adenosyl-l-methionine on the activation , Proliferation and contraction of hepatic stellate cells[J].EurJPharmacol,2005;509:31-36.
[10] Iseri , S0;Sener , G:Saglam , B , et al.Ghrelin alleviates biliary obstruetion-induced chronic hepatic injury in rats[J].Regul Peptides,2008;146:73-79.
[11] Okuyama H,Nakamura H,Shimahara Y,et al.Overexpression of thioredoxin prevents thioacetamide-induced hepatic fibrosis in mice[J].J Hepatol,2005:42:117-123.
[12] WaiCT,Greenson JK, Fontana RJ,et al.A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronichepatitisC[J].Hepatology, 2003, 38(2): 518-526.
[13] ZhangYX,Wu WJ, ZhangYZ,etal.Noninvasive assessmentof liver fibrosiswith combined serum aminotransferase/platelet ratio index and hyaluronic acid in patientswith chronic hepatitis B[J].World JGastroentero,l 2008, 14(46): 7117-7121.
[14] Poynard T, AubertA, Bedossa P, et a.l A simple biological index fordetection ofalcoholic liverdisease in drinkers[J].Gastroenterology, 1991, 100(5 Pt1)∶1397-402.
[15]白宇宁,刘绍能,姚乃礼.中医药抗肝纤维化的研究概况[J].中国中医基础医学杂志, 2001,7(8)∶74-77
[16]晏军.王绵之教授治疗早期肝硬化的经验[J].北京中医药大学学报,2001,7(24):56-58
[17]李建华,蔡北源.罗日永治疗肝硬化腹水经验[J].山东中医杂志,2005,24(12):750
[18]慕永平.王磊.刘平教授治疗肝硬化经验浅析[J].上海中医药大学学报,2004,18(3):29-32
[19]齐洪军,胡曼菁.从“痰瘀”角度浅析肝纤维化的病因病机及治疗[J]四川中医,2004,22(6):26-28.
[20]李佃贵,李刚,刘金里,等.李佃贵以“浊毒”立论治疗肝硬化经验[J].陕西中医, 2006, 27(11): 1394-1395.
[21]宋立人.中华本草[M].上海:上海科学技术出版社,1999.
[22]刘平.现代中医肝脏病学[M].北京:人民卫生出版社,2002,61-105.
[23]郭兰忠.现代实用中药学[M].北京:人民卫生出版社,1999.
[1]白宇宁,刘绍能,姚乃礼.中医药抗肝纤维化的研究概况[J].中国中医基础医学杂志, 2001, 7(8)∶74-77
[2]晏军.王绵之教授治疗早期肝硬化的经验[J].北京中医药大学学报,2001,7(24):56-58
[3]李建华,蔡北源.罗日永治疗肝硬化腹水经验[J].山东中医杂志,2005,24(12):750
[4]慕永平.王磊.刘平教授治疗肝硬化经验浅析[J].上海中医药大学学报,2004,18(3):29-32
[5]齐洪军,胡曼菁.从“痰瘀”角度浅析肝纤维化的病因病机及治疗[J].四川中医,2004,22(6):26-28.
[6]薛盟举.周信有治疗慢性病毒性肝炎的经验[J].中医药临床杂志,2006,8(18):351
[7]盛国光.肝纤维化的临床辩证论治[J].江苏中医药,2007,39(5):3
[8]李佃贵,李刚,刘金里,等.李佃贵以“浊毒”立论治疗肝硬化经验[J].陕西中医, 2006, 27(11): 1394-1395.
[9]高宪虹.肝硬化辨证分型论治体会[J].中医药临床杂志,2007,19(1): 54-55.
[10]骆欢欢,王新华.从肝瘀正虚论肝纤维化治疗思路[J].中医杂志,2010,51(5):463-465
[11]曾浩,郑翔.郑翔治疗肝硬化经验[J].辽宁中医药大学学报,2011,13(1):148
[12]贲长恩,中医药抗肝纤维化研究的现状和展望[J].北京中医药大学学报1996,9;19(5):2-8
[13]刘绍能,吕文良.慢性乙型肝炎肝纤维化的辩证分型研究[J].中医药信息杂志,2002,19(5):1
[14]李亚珠,单戈.中西医治疗肝硬化腹水的研究与展望[J].中医药信息,2002,19(3):9
[15]张杰,吕明安.浅谈慢性病毒性肝炎的诊治[J].中国中医基础医学杂志,2006,12(3):223
[16]高宪虹.肝硬化的辩证分型论治体会[J].中医药临床杂志,2007,19(1):54-55
[17]张育轩,危北海.肝硬化临床诊断中医辨证和疗效评定标准(试行方案)[J].中国中西医结合杂志,1994;14(4):237
[18]刘路明,邓淑玲,辛俊平等.肝硬化中医证型研究及其临床意义[J].中国热带医学杂志,2007,7(4):659
[19]危北海,张万岱,陈治水等.肝硬化中西医结合诊治方案(草案)[J].中国中西医结合杂志,2004,24(10):869-871
[20]施卫兵.杨素霞.乙型病毒性肝炎肝硬化中医证型与客观检测指标相关性[J].安徽中医学院学报,2009,28(4):28-29
[21]陈云,杜建,王玉海.慢性乙型肝炎血清肝纤维化指标与中医虚实证及肝脏病理的关系[J].福建中医药,2004,35(3):1-3
[22]梁淑慧.肝硬化患者红细胞体积分布宽度改变及临床意义[J].上海医学检验杂志,2003,18(6):352-353
[23]何冠华,朱兰平.肝硬化辨证分型与child-Pugh分级及并发症关系初探[J].辽宁中医杂志,2002,29(l):126-128.
[24]冀爱英,赵英红,杜明瑞.肝炎肝硬化中医证型与免疫学指标的相关性研究[J].中医药学报,2006,12(3):23-25·
[25]曹家麟,黄腊平,祝梅君,等.肝炎肝硬化中医证型与肝纤维化指标及病理改变相关性分析[J].中西医结合肝病杂志,2002;12(4):234-235.
[26]张慧芳.辨证治疗失代偿期肝硬化100例总结[J].甘肃中医,2003,16(7):18-19.
[27]李纲.肝硬化临床证治探讨[J].光明中医,2003(6):61-62
[28]沈龙柱,高虹,吴兆洪.辨病辨证治疗肝硬化腹水47例[J].辽宁中医药杂志,2004,31(6):473-474.
[29]王万卿,王岩.肝硬化腹水的辨证施治[J].河北中医,2005, 27(12): 916-917.
[30]郭利平.浅谈肝硬化的中医辨证论治[J].内蒙古中医药,2007, 26(1): 45.
[31]韩小平,王守智.辨证分型治疗肝硬化36例临床观察[J].新疆中医药, 2008, 26(3): 55-56.
[32]韩其芳.肝病规范用药研究的几点设想[J].中医药临床杂志,2009,21(3): 255-257.
[33]王尚金.自拟清化软肝汤辨证治疗肝硬化[J].中医研究,2002, 5(1): 50-51
[34]段占全,段立峰.三七白术散为主治疗肝硬化腹水36例疗效观察[J].河北中医,2004,26(l):30.
[35]陈立新.强复丸治疗肝炎后肝硬化176例[J].河南中医,2004,24(4):31-32.
[36]王迎新,梁国英,刘朝霞.柔肝合剂为主治疗肝硬化的临床观察[J].中医药学报,2004,32(2):36-37.
[37]史志宏.臌胀灵加减治疗肝硬化腹水50例[J].陕西中医,2005,26(1):11-12.
[38]肩晓宇,陈云凤,王灵台.灵甲柔肝方治疗慢性乙型肝炎肝炎后肝硬化43例[J].中医研究,2005,18(6):28-30.
[39]王红永.参苓白术散加减治疗肝硬化60例疗效观察[J].四川中医, 2008, 26(2): 56.
[40]鲁庆林.穴位贴敷为主治疗肝炎后肝硬化[J].中医外治杂志,1996(4):41.
[41]王利东.经络全息刮痧法在肝硬化腹水中的应用[J].中国民间疗法,2000,8(7):15
[42]吕蔓生.按摩、中药相结合治疗门静脉性肝硬化腹水[J].按摩与导引,2003,20(2):29
[43]陈帅.辨证分型敷脐治疗肝硬化腹水临床体会[J].江苏中医药,2003,24(11):19-20.
[44]林日武.中药灌肠治疗肝硬化难治性腹水[J].浙江中西医结合杂志,2002,12(2):97
[45]吴云忠,王融冰.中药灌肠治疗肝性脑病27例临床疗效分析[J].中华现代中西易杂志,2005,13(3):1220
[46]程井军,吴其恺,孙国杰.灸法治疗乙型肝炎肝硬化高胆红素血症的临床观察[J].湖北中医杂志,2008,30(6):53-54.
[2]国泽延,侯金林.乙肝相关性肝硬化的治疗进展[J].医学信息,2002,15(6):386
[3] Samue1D,FerayC,BISmuthH[J].JGastroentero1Hepatol,1997,12(Suppl):5335
[5]中华医学会传染病与寄生虫病学分会,肝病学分会.病毒性肝炎的诊断标准[J].中西医结合肝病杂志,2001;11(1):56-60.
[5]中华医学会肝病学分会、感染病学分会.慢性乙型肝炎防治指南[J].中华肝脏病杂志,2005,13(12):881-891.
[6]张育轩,危北海整理.肝硬变临床诊断、中医辨证和疗效评定标准(试行方案)[J].新消化病学杂志,1994;2(2):126
[7]王功遂,王曼曼,姜湘宁,等.两种不同方式经皮肝穿刺活组织检查的优缺点分析[J]实用肝脏病杂志2010; 13:170-172.
[8] Tu CT,Guo JS,Wang M,Wang JY.Antifibrotic activity of rofecoxib in vivo is associated with redueed portal hyPertension in rats with carbon tetrachloride-induced liver injury[J].J Gastroen Hepatol, 2007:22:877-884.
[9] Hiroko Matsui,Norifumi Kawada.Effeet of S-adenosyl-l-methionine on the activation , Proliferation and contraction of hepatic stellate cells[J].EurJPharmacol,2005;509:31-36.
[10] Iseri , S0;Sener , G:Saglam , B , et al.Ghrelin alleviates biliary obstruetion-induced chronic hepatic injury in rats[J].Regul Peptides,2008;146:73-79.
[11] Okuyama H,Nakamura H,Shimahara Y,et al.Overexpression of thioredoxin prevents thioacetamide-induced hepatic fibrosis in mice[J].J Hepatol,2005:42:117-123.
[12] WaiCT,Greenson JK, Fontana RJ,et al.A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronichepatitisC[J].Hepatology, 2003, 38(2): 518-526.
[13] ZhangYX,Wu WJ, ZhangYZ,etal.Noninvasive assessmentof liver fibrosiswith combined serum aminotransferase/platelet ratio index and hyaluronic acid in patientswith chronic hepatitis B[J].World JGastroentero,l 2008, 14(46): 7117-7121.
[14] Poynard T, AubertA, Bedossa P, et a.l A simple biological index fordetection ofalcoholic liverdisease in drinkers[J].Gastroenterology, 1991, 100(5 Pt1)∶1397-402.
[15]白宇宁,刘绍能,姚乃礼.中医药抗肝纤维化的研究概况[J].中国中医基础医学杂志, 2001,7(8)∶74-77
[16]晏军.王绵之教授治疗早期肝硬化的经验[J].北京中医药大学学报,2001,7(24):56-58
[17]李建华,蔡北源.罗日永治疗肝硬化腹水经验[J].山东中医杂志,2005,24(12):750
[18]慕永平.王磊.刘平教授治疗肝硬化经验浅析[J].上海中医药大学学报,2004,18(3):29-32
[19]齐洪军,胡曼菁.从“痰瘀”角度浅析肝纤维化的病因病机及治疗[J]四川中医,2004,22(6):26-28.
[20]李佃贵,李刚,刘金里,等.李佃贵以“浊毒”立论治疗肝硬化经验[J].陕西中医, 2006, 27(11): 1394-1395.
[21]宋立人.中华本草[M].上海:上海科学技术出版社,1999.
[22]刘平.现代中医肝脏病学[M].北京:人民卫生出版社,2002,61-105.
[23]郭兰忠.现代实用中药学[M].北京:人民卫生出版社,1999.
[1]白宇宁,刘绍能,姚乃礼.中医药抗肝纤维化的研究概况[J].中国中医基础医学杂志, 2001, 7(8)∶74-77
[2]晏军.王绵之教授治疗早期肝硬化的经验[J].北京中医药大学学报,2001,7(24):56-58
[3]李建华,蔡北源.罗日永治疗肝硬化腹水经验[J].山东中医杂志,2005,24(12):750
[4]慕永平.王磊.刘平教授治疗肝硬化经验浅析[J].上海中医药大学学报,2004,18(3):29-32
[5]齐洪军,胡曼菁.从“痰瘀”角度浅析肝纤维化的病因病机及治疗[J].四川中医,2004,22(6):26-28.
[6]薛盟举.周信有治疗慢性病毒性肝炎的经验[J].中医药临床杂志,2006,8(18):351
[7]盛国光.肝纤维化的临床辩证论治[J].江苏中医药,2007,39(5):3
[8]李佃贵,李刚,刘金里,等.李佃贵以“浊毒”立论治疗肝硬化经验[J].陕西中医, 2006, 27(11): 1394-1395.
[9]高宪虹.肝硬化辨证分型论治体会[J].中医药临床杂志,2007,19(1): 54-55.
[10]骆欢欢,王新华.从肝瘀正虚论肝纤维化治疗思路[J].中医杂志,2010,51(5):463-465
[11]曾浩,郑翔.郑翔治疗肝硬化经验[J].辽宁中医药大学学报,2011,13(1):148
[12]贲长恩,中医药抗肝纤维化研究的现状和展望[J].北京中医药大学学报1996,9;19(5):2-8
[13]刘绍能,吕文良.慢性乙型肝炎肝纤维化的辩证分型研究[J].中医药信息杂志,2002,19(5):1
[14]李亚珠,单戈.中西医治疗肝硬化腹水的研究与展望[J].中医药信息,2002,19(3):9
[15]张杰,吕明安.浅谈慢性病毒性肝炎的诊治[J].中国中医基础医学杂志,2006,12(3):223
[16]高宪虹.肝硬化的辩证分型论治体会[J].中医药临床杂志,2007,19(1):54-55
[17]张育轩,危北海.肝硬化临床诊断中医辨证和疗效评定标准(试行方案)[J].中国中西医结合杂志,1994;14(4):237
[18]刘路明,邓淑玲,辛俊平等.肝硬化中医证型研究及其临床意义[J].中国热带医学杂志,2007,7(4):659
[19]危北海,张万岱,陈治水等.肝硬化中西医结合诊治方案(草案)[J].中国中西医结合杂志,2004,24(10):869-871
[20]施卫兵.杨素霞.乙型病毒性肝炎肝硬化中医证型与客观检测指标相关性[J].安徽中医学院学报,2009,28(4):28-29
[21]陈云,杜建,王玉海.慢性乙型肝炎血清肝纤维化指标与中医虚实证及肝脏病理的关系[J].福建中医药,2004,35(3):1-3
[22]梁淑慧.肝硬化患者红细胞体积分布宽度改变及临床意义[J].上海医学检验杂志,2003,18(6):352-353
[23]何冠华,朱兰平.肝硬化辨证分型与child-Pugh分级及并发症关系初探[J].辽宁中医杂志,2002,29(l):126-128.
[24]冀爱英,赵英红,杜明瑞.肝炎肝硬化中医证型与免疫学指标的相关性研究[J].中医药学报,2006,12(3):23-25·
[25]曹家麟,黄腊平,祝梅君,等.肝炎肝硬化中医证型与肝纤维化指标及病理改变相关性分析[J].中西医结合肝病杂志,2002;12(4):234-235.
[26]张慧芳.辨证治疗失代偿期肝硬化100例总结[J].甘肃中医,2003,16(7):18-19.
[27]李纲.肝硬化临床证治探讨[J].光明中医,2003(6):61-62
[28]沈龙柱,高虹,吴兆洪.辨病辨证治疗肝硬化腹水47例[J].辽宁中医药杂志,2004,31(6):473-474.
[29]王万卿,王岩.肝硬化腹水的辨证施治[J].河北中医,2005, 27(12): 916-917.
[30]郭利平.浅谈肝硬化的中医辨证论治[J].内蒙古中医药,2007, 26(1): 45.
[31]韩小平,王守智.辨证分型治疗肝硬化36例临床观察[J].新疆中医药, 2008, 26(3): 55-56.
[32]韩其芳.肝病规范用药研究的几点设想[J].中医药临床杂志,2009,21(3): 255-257.
[33]王尚金.自拟清化软肝汤辨证治疗肝硬化[J].中医研究,2002, 5(1): 50-51
[34]段占全,段立峰.三七白术散为主治疗肝硬化腹水36例疗效观察[J].河北中医,2004,26(l):30.
[35]陈立新.强复丸治疗肝炎后肝硬化176例[J].河南中医,2004,24(4):31-32.
[36]王迎新,梁国英,刘朝霞.柔肝合剂为主治疗肝硬化的临床观察[J].中医药学报,2004,32(2):36-37.
[37]史志宏.臌胀灵加减治疗肝硬化腹水50例[J].陕西中医,2005,26(1):11-12.
[38]肩晓宇,陈云凤,王灵台.灵甲柔肝方治疗慢性乙型肝炎肝炎后肝硬化43例[J].中医研究,2005,18(6):28-30.
[39]王红永.参苓白术散加减治疗肝硬化60例疗效观察[J].四川中医, 2008, 26(2): 56.
[40]鲁庆林.穴位贴敷为主治疗肝炎后肝硬化[J].中医外治杂志,1996(4):41.
[41]王利东.经络全息刮痧法在肝硬化腹水中的应用[J].中国民间疗法,2000,8(7):15
[42]吕蔓生.按摩、中药相结合治疗门静脉性肝硬化腹水[J].按摩与导引,2003,20(2):29
[43]陈帅.辨证分型敷脐治疗肝硬化腹水临床体会[J].江苏中医药,2003,24(11):19-20.
[44]林日武.中药灌肠治疗肝硬化难治性腹水[J].浙江中西医结合杂志,2002,12(2):97
[45]吴云忠,王融冰.中药灌肠治疗肝性脑病27例临床疗效分析[J].中华现代中西易杂志,2005,13(3):1220
[46]程井军,吴其恺,孙国杰.灸法治疗乙型肝炎肝硬化高胆红素血症的临床观察[J].湖北中医杂志,2008,30(6):53-54.