炙甘草汤合猪苓汤加减联合呋塞米治疗肝硬化腹腔积液临床研究
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摘要
目的探讨炙甘草汤合猪苓汤加减联合呋塞米治疗肝硬化腹腔积液的临床疗效。方法选取两医院2016年9月至2018年1月收治的肝硬化腹腔积液患者82例,按随机数字表法分为对照组(39例)和观察组(43例)。两组患者均给予常规西医治疗(包括口服呋塞米),治疗组患者在此基础上加服炙甘草汤合猪苓汤加减治疗。结果观察组总有效率为83. 72%,明显高于对照组的46. 15%(P <0. 05);与治疗前比较,两组患者治疗后血液各项指标均明显改善(P <0. 05);观察组患者丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、尿素氮、血清肌酐、血管紧张素Ⅱ(AngⅡ)和醛固酮(Aldo)水平均明显低于对照组(P <0. 05);经多因素Cox比例风险模型分析,AngⅡ和Aldo是影响治疗效果的独立因素(P <0. 05)。结论炙甘草汤合猪苓汤加减联合呋塞米可用于肝硬化腹腔积液的治疗,改善肝功能指标,其机制与抑制肾素-血管紧张素-醛固酮系统激活有关。
Objective To investigate the clinical effect of Zhigancao Decoction and Zhuling Decoction combined with furosemide in the treatment of hepatocirrhosis with seroperitoneum. Methods Totally 82 patients with hepatocirrhosis with seroperitoneum admitted to our hospital from September 2016 to January 2018 were selected and divided into the control group( n = 39) and the observation group( n =43) according to the random number table method. The patients in the two groups were given routine Western medicine treatment( including oral administration of furosemide), on this basis, the patients in the observation group were treated with modified Zhigancao Decoction and Zhuling Decoction. Results The total effective rate of the observation group was 83. 72%,which was significantly higher than 46. 15% of the control group( P < 0. 05). Compared with before treatment,the blood indexes of the two groups were significantly improved after treatment( P < 0. 05). The levels of alanine aminotransferase( ALT), aspartate aminotransferase( AST), blood urea nitrogen( BUN), serum creatinine( SCr), angiotensin Ⅱ( Ang Ⅱ) and aldosterone( Aldo) in the observation group were significantly lower than those in the control group( P < 0. 05). Multivariate Cox proportional hazard model analysis showed that Ang Ⅱ and Aldol were independent factors influencing the clinical effect( P < 0. 05). Conclusion Modified Zhigancao Decoction and Zhuling Decoction combined with furosemide can be used in the treatment of hepatocirrhosis with seroperitoneum, and it can improve liver function. Its mechanism is related to inhibiting the activation of the renin-angiotensin-aldosterone system( RAAS).
Objective To investigate the clinical effect of Zhigancao Decoction and Zhuling Decoction combined with furosemide in the treatment of hepatocirrhosis with seroperitoneum. Methods Totally 82 patients with hepatocirrhosis with seroperitoneum admitted to our hospital from September 2016 to January 2018 were selected and divided into the control group( n = 39) and the observation group( n =43) according to the random number table method. The patients in the two groups were given routine Western medicine treatment( including oral administration of furosemide), on this basis, the patients in the observation group were treated with modified Zhigancao Decoction and Zhuling Decoction. Results The total effective rate of the observation group was 83. 72%,which was significantly higher than 46. 15% of the control group( P < 0. 05). Compared with before treatment,the blood indexes of the two groups were significantly improved after treatment( P < 0. 05). The levels of alanine aminotransferase( ALT), aspartate aminotransferase( AST), blood urea nitrogen( BUN), serum creatinine( SCr), angiotensin Ⅱ( Ang Ⅱ) and aldosterone( Aldo) in the observation group were significantly lower than those in the control group( P < 0. 05). Multivariate Cox proportional hazard model analysis showed that Ang Ⅱ and Aldol were independent factors influencing the clinical effect( P < 0. 05). Conclusion Modified Zhigancao Decoction and Zhuling Decoction combined with furosemide can be used in the treatment of hepatocirrhosis with seroperitoneum, and it can improve liver function. Its mechanism is related to inhibiting the activation of the renin-angiotensin-aldosterone system( RAAS).
引文
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[10] BERNARDI M,RICCI CS,ZACCHERINI G,et al. Role of human albumin in the management of complications of liver cirrhosis[J].J Clin Exp Hepatol,2014,4(4):302-311.
[11] VINOD P,KRISHNAPPA V,CHAUVIN AM,et al. Cardiorenal syndrome:role of arginine vasopressin and vaptans in heart failure[J]. Cardiol Res,2017,8(3):87-95.
[12] KALAMBOKIS GN,TSIAKAS I,CHRISTAKI M,et al. Systemic hemodynamic response to terlipressin predicts development of hepatorenal syndrome and survival in advanced cirrhosis[J]. Eur J Gastroenterol Hepatol,2018,30(6):659-667.
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[14]刘礼剑,黄晓燕,杨成宁,等.炙甘草汤合猪苓汤治疗乙型肝炎肝硬化腹水的临床疗效观察[J].中国中西医结合消化杂志,2017,25(2):93-96.
[15]张声生,王宪波,江宇泳.肝硬化腹水中医诊疗专家共识意见(2017)[J].中华中医药杂志,2017,32(7):3065-3068.
[2]徐小元,丁惠国,李文刚,等.肝硬化腹水及相关并发症的诊疗指南[J].临床肝胆病杂志,2017,33(10):1847-1863.
[3]胡绍君,骆勇,屈小平.丹参注射液联合多巴胺与利尿剂治疗肝硬化腹腔积液临床评价[J].中国药业,2017,26(18):37-39.
[4]张声生,李乾构,王宪波,等.肝硬化腹水中医诊疗规范专家共识意见(2011年,海南)[J].中国中西医结合杂志,2012,32(12):1692-1696.
[5] FIALLA AD,THIESSON HC,BIE P,et al. Internal dysregulation of the renin system in patients with stable liver cirrhosis[J]. Scand J Clin Lab Invest,2017,77(4):298-309.
[6]王浩.中西医结合疗法对乙肝肝硬化的治疗价值探析[J].中国中西医结合消化杂志,2018,26(4):354-356.
[7] RUNYON BA,AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis:an update[J].Hepatology,2009,49(6):2087-2107.
[8] TSAI TY,HUNG TH,LIVNEH H,et al. Chinese herbal medicine therapy and the risk of mortality for chronic hepatitis B patients with concurrent liver cirrhosis:a nationwide population-based cohort study[J]. Oncotarget,2018,9(26):18214-18223.
[9]陈煜,周莉.肝硬化腹水治疗的新进展[J].临床肝胆病杂志,2016,32(6):1069-1074.
[10] BERNARDI M,RICCI CS,ZACCHERINI G,et al. Role of human albumin in the management of complications of liver cirrhosis[J].J Clin Exp Hepatol,2014,4(4):302-311.
[11] VINOD P,KRISHNAPPA V,CHAUVIN AM,et al. Cardiorenal syndrome:role of arginine vasopressin and vaptans in heart failure[J]. Cardiol Res,2017,8(3):87-95.
[12] KALAMBOKIS GN,TSIAKAS I,CHRISTAKI M,et al. Systemic hemodynamic response to terlipressin predicts development of hepatorenal syndrome and survival in advanced cirrhosis[J]. Eur J Gastroenterol Hepatol,2018,30(6):659-667.
[13] MANTAKA A,AUGOUSTAKI A,KOUROUMALIS EA,et al.Portal vein thrombosis in cirrhosis:diagnosis,natural history,and therapeutic challenges[J]. Ann Gastroenterol,2018,31(3):315-329.
[14]刘礼剑,黄晓燕,杨成宁,等.炙甘草汤合猪苓汤治疗乙型肝炎肝硬化腹水的临床疗效观察[J].中国中西医结合消化杂志,2017,25(2):93-96.
[15]张声生,王宪波,江宇泳.肝硬化腹水中医诊疗专家共识意见(2017)[J].中华中医药杂志,2017,32(7):3065-3068.