补虚软肝方对熊去氧胆酸应答不佳的原发性胆汁性肝硬化临床疗效观察
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摘要
目的观察补虚软肝方治疗熊去氧胆酸应答不佳的原发性胆汁性肝硬化的临床疗效。方法将62例熊去氧胆酸应答不佳的原发性胆汁性肝硬化患者随机分为治疗组(32例)和对照组(30例)。对照组予常规治疗,治疗组在对照组基础上加用补虚软肝方。两组疗程均为24周,观察临床疗效,比较慢性肝病量表(CLDQ)评分、肝功能、肝纤维化指标、肝脏硬度值的变化情况。结果 (1)治疗组总有效率为87.5%,对照组总有效率为63.3%;组间临床疗效比较,治疗组优于对照组(P<0.05)。(2)治疗前后组内比较,两组患者CLDQ评分均较治疗前降低(P<0.05);组间治疗后比较,CLDQ评分差异有统计学意义(P<0.05)。(3)治疗前后组内比较,两组患者ALT、AST、TBIL、GGT、ALP、TBA水平均较治疗前降低(P<0.05);组间治疗后比较,肝功能各项指标差异均有统计学意义(P<0.05)。(4)治疗前后组内比较,两组患者HA、LN、PC-Ⅲ、Ⅳ-C水平及肝脏硬度值均较治疗前降低(P<0.05);组间治疗后比较,治疗组HA、Ⅳ-C水平及肝脏硬度值低于对照组(P<0.05)。结论补虚软肝方治疗熊去氧胆酸应答不佳的原发性胆汁性肝硬化临床疗效满意,能改善患者的肝功能及肝纤维化指标,降低肝脏硬度值,提高生活质量。
Objective To observe the clinical efficacy of Buxu Ruangan Decoction in the treatment of primary biliary cirrhosis with poor response to ursodeoxycholic acid. Methods Sixty-two patients of primary biliary cirrhosis with poor response to ursodeoxycholic acid were randomly divided into the treatment group( n = 32)and control group( n = 30). The control group was treated with routine therapy,and the treatment group was treated with Buxu Ruangan Decoction based on the treatment for the control group,with a course of 24 weeks. The clinical efficacy was observed,and the changes on the chronic liver disease questionnaire( CLDQ)score,liver function indexes,liver fibrosis indexes and fibroscan test were compared. Results(1)The total effective rates was 87.5% in the treatment group and63.3% in the control group,and the clinical efficacy of the treatment group was better than that of the control group( P<0.05).(2)After treatment,the CLDQ score was decreased in both groups( P<0.05),and there was statistically significant difference on the CLDQ score between the two groups( P<0.05).(3)After treatment,the levels of ALT,AST,TBIL,GGT,ALP and TBA were decreased in both groups( P<0.05),and there were statistically significant differences on the levels of all liver function indexes between the two groups( P<0.05).(4)After treatment,the levels of HA,LN,PC-Ⅲ and Ⅳ-C and the value of liver stiffness measurement( LSM) were decreased in both groups( P<0.05),and the levels of HA and Ⅳ-C and the LSM value in the treatment group were lower than those in the control group( P < 0.05). Conclusion Buxu Ruangan Decoction shows good clinical efficacy in the treatment of primary biliary cirrhosis with poor response to ursodeoxycholic acid,which can improve the liver function and liver fibrosis indexes,decrease the LSM value and enhance the quality of life.
Objective To observe the clinical efficacy of Buxu Ruangan Decoction in the treatment of primary biliary cirrhosis with poor response to ursodeoxycholic acid. Methods Sixty-two patients of primary biliary cirrhosis with poor response to ursodeoxycholic acid were randomly divided into the treatment group( n = 32)and control group( n = 30). The control group was treated with routine therapy,and the treatment group was treated with Buxu Ruangan Decoction based on the treatment for the control group,with a course of 24 weeks. The clinical efficacy was observed,and the changes on the chronic liver disease questionnaire( CLDQ)score,liver function indexes,liver fibrosis indexes and fibroscan test were compared. Results(1)The total effective rates was 87.5% in the treatment group and63.3% in the control group,and the clinical efficacy of the treatment group was better than that of the control group( P<0.05).(2)After treatment,the CLDQ score was decreased in both groups( P<0.05),and there was statistically significant difference on the CLDQ score between the two groups( P<0.05).(3)After treatment,the levels of ALT,AST,TBIL,GGT,ALP and TBA were decreased in both groups( P<0.05),and there were statistically significant differences on the levels of all liver function indexes between the two groups( P<0.05).(4)After treatment,the levels of HA,LN,PC-Ⅲ and Ⅳ-C and the value of liver stiffness measurement( LSM) were decreased in both groups( P<0.05),and the levels of HA and Ⅳ-C and the LSM value in the treatment group were lower than those in the control group( P < 0.05). Conclusion Buxu Ruangan Decoction shows good clinical efficacy in the treatment of primary biliary cirrhosis with poor response to ursodeoxycholic acid,which can improve the liver function and liver fibrosis indexes,decrease the LSM value and enhance the quality of life.
引文
[1]中华医学会肝病学分会,中华医学会消化病学分会,中华医学会感染病学分会.原发性胆汁性肝硬化(又名原发性胆汁性胆管炎)诊断和治疗共识(2015)[J].临床肝胆病杂志,2015,31(12):1980-1988.
[2]WONG L L,HEGADE V S,JONES D E J.What Comes after Ursodeoxycholic Acid in Primary Biliary Cholangitis?[J].Dig Dis,2017,35(4):359-366.
[3]PARéS A.Old and novel therapies for primary biliary cirrhosis[J].Semin Liver Dis,2014,34(3):341-351.
[4]LINDOR K D,GERSHWIN M E,POUPON R,et al.Primary biliary cirrhosis[J].Hepatology,2009,50(1):291-308.
[5]CORPECHOT C,ABENAVOLI L,RABAHI N,et al.Biochemical response to ursodcoxycholic acid and long-term prognosis in primary biliary cirrhosis[J].Hepatology,2008,48(3):871-877.
[6]中华医学会风湿病学分会.自身免疫性肝病诊断和治疗指南[J].中华风湿病学杂志,2011,15(8):556-558.
[7]邱德凯,马雄.自身免疫性肝病基础与临床[M].上海:上海科学技术出版社,2006.
[8]YOUNOSSI Z M,GUYATT G,KIWI M,et al.Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease[J].Gut,1999,45(2):295-300.
[9]CORRIGAN M,HIRSCHFIELD G M.Aspects of the Pathophysiology of Primary Biliary Cirrhosis[J].Dig Dis,2015,33(Suppl 2):102-108.
[10]肝脏硬度评估小组.瞬时弹性成像技术诊断肝纤维化专家意见[J].中华肝脏病杂志,2013,21(6):420-424.
[11]李冰,纪冬,牛小霞,等.Fibro Scan对原发性胆汁性肝硬化患者肝纤维化的诊断价值[J].肝脏,2014,19(8):585-587.
[12]张玉果,赵素贤,周光德,等.Fibro Touch、Fibro Scan与原发性胆汁性肝硬化分期的相关性分析[J].中华肝脏病杂志,2016,24(12):902-906.
[13]ZHANG L N,SHI T Y,SHI X H,et al.Early biochemical response to ursodeoxycholic acid and long-term prognosis of primary biliary cirrhosis:results of a 14-year cohort study[J].Hepatology,2013,58(1):264-272.
[14]蒋健,何淼.原发性胆汁性肝硬化的中医证候特点及疗效分析[J].上海中医药大学学报,2003,17(3):15-17.
[2]WONG L L,HEGADE V S,JONES D E J.What Comes after Ursodeoxycholic Acid in Primary Biliary Cholangitis?[J].Dig Dis,2017,35(4):359-366.
[3]PARéS A.Old and novel therapies for primary biliary cirrhosis[J].Semin Liver Dis,2014,34(3):341-351.
[4]LINDOR K D,GERSHWIN M E,POUPON R,et al.Primary biliary cirrhosis[J].Hepatology,2009,50(1):291-308.
[5]CORPECHOT C,ABENAVOLI L,RABAHI N,et al.Biochemical response to ursodcoxycholic acid and long-term prognosis in primary biliary cirrhosis[J].Hepatology,2008,48(3):871-877.
[6]中华医学会风湿病学分会.自身免疫性肝病诊断和治疗指南[J].中华风湿病学杂志,2011,15(8):556-558.
[7]邱德凯,马雄.自身免疫性肝病基础与临床[M].上海:上海科学技术出版社,2006.
[8]YOUNOSSI Z M,GUYATT G,KIWI M,et al.Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease[J].Gut,1999,45(2):295-300.
[9]CORRIGAN M,HIRSCHFIELD G M.Aspects of the Pathophysiology of Primary Biliary Cirrhosis[J].Dig Dis,2015,33(Suppl 2):102-108.
[10]肝脏硬度评估小组.瞬时弹性成像技术诊断肝纤维化专家意见[J].中华肝脏病杂志,2013,21(6):420-424.
[11]李冰,纪冬,牛小霞,等.Fibro Scan对原发性胆汁性肝硬化患者肝纤维化的诊断价值[J].肝脏,2014,19(8):585-587.
[12]张玉果,赵素贤,周光德,等.Fibro Touch、Fibro Scan与原发性胆汁性肝硬化分期的相关性分析[J].中华肝脏病杂志,2016,24(12):902-906.
[13]ZHANG L N,SHI T Y,SHI X H,et al.Early biochemical response to ursodeoxycholic acid and long-term prognosis of primary biliary cirrhosis:results of a 14-year cohort study[J].Hepatology,2013,58(1):264-272.
[14]蒋健,何淼.原发性胆汁性肝硬化的中医证候特点及疗效分析[J].上海中医药大学学报,2003,17(3):15-17.