中药辨证治疗中重度慢性乙肝临床疗效对照分析  

Therapeutic-effect analysis of chronic hepatitis B treated by traditional Chinese medicine based on differentiation of symptoms and signs

作　　者：何义华[1] 潘志恒[1] 李林[1] 关卫兵[1] 王拥泽[1] 李永伟[1] 杨跃武[1] 

机构地区：[1]中山大学第三附属医院中医科,广东省广州市510630

出　　处：《世界华人消化杂志》2007年第28期3006-3010,共5页World Chinese Journal of Digestology

摘　　要：目的:按照循证医学方法观察评价中医辨证用药与常规用药治疗中、重度慢性乙肝的临床疗效差异.方法:选择2003年我院中医科所有慢性乙肝住院患者89例(中度57例,重度32例)作为治疗组,在常规治疗基础上加用中医辨证治疗;按分层随机的原则选择同期本院传染科慢性乙肝住院患者89例(中度57例,重度32例)作为对照组,采用常规治疗.观察治疗前后两组患者肝功能(ALT、AST、ALB、A/G、TBIL、GGT、CHE)、肝纤维化标志物(HA、PC-Ⅲ、Ⅳ-C、LN)、凝血功能(PT、PTA)、腹部B超(MPV、脾厚、脾长、SPV、胆囊壁厚度)等指标.结果:治疗前后两组肝功指标(CHE除外)均改善(P<0.05),其中中、重度乙肝治疗组ALB、A/G、GGT改变幅度优于对照组(ALB:1.72±0.64,1.21±0.85vs1.32±0.57,1.06±0.12;A/G:0.085±0.030,0.105±0.039vs0.036±0.007,0.069±0.034;GGT:-154.14±30.69,-151.06±31.16vs-20.90±7.17,-54.86±20.64,均P<0.05);两组CHE均呈下降趋势,但治疗组下降幅度小于对照组(-835.08±241.61,-228.95±113.26vs-2488.79±356.73,-765.14±261.90,均P<0.05);治疗组慢性乙肝(中度)患者PT、PTA改善优于对照组(PT:-1.31±0.24vs-0.38±0.18;PTA:11.96±2.04vs5.32±2.58,均P<0.05);治疗组B超胆囊壁厚度减小幅度大于对照组(P<0.05),其他指标两组无差异.结论:中药辨证治疗的介入对改善中重度慢性乙肝患者肝脏炎症坏死,蛋白合成功能和减轻胆囊炎症方面优于常规治疗.AIM： To observe and evaluate the differences in therapeutic effects between traditional Chinese medicine （TCM） and conventional practice on treating chronic hepatitis B. METHODS： Eighty nine hospitalized patients with CHB in the department of TCM made up the study group; the same number of randomly selected hospitalized patients in the department of infectious diseases made up the control group. Liver functional indexes （ALT, AST, ALB, A/G, TBIL, GGT, CHE）, blood coagulation indexes （PT, PTA）, liver fibrosis indexes （HA, PCⅢ, Ⅳ-C, LN） and ultrasonography indexes （the diameter of main portal vein, the diameter of spleen vein, spleen thickness, spleen length, gallbladder wall thickness） were measured before and after treatment. RESULTS： After treatment, all liver functional indexes improved （P 〈 0.05）, but CHE continued to decrease （P 〈 0.05）. The extents of improvement in ALB, A/G and GGT were greater in the study group than in the control group （ALB： 1.72 ± 0.64, 1.21 ± 0.85 vs 1.32 ± 0.57, 1.06 ± 0.12; A/G： 0.085 ± 0.030, 0.105 ＋ 0.039 vs 0.036 ＋ 0.007, 0.069 ± 0.034; GGT： -154.14 ± 30.69, -151.06 ± 31.16 vs -20.90 ± 7.17, -54.86 ± 20.64, all P 〈 0.05）. The blood coagulation indexes were also improved after treatment （P 〈 0.05）, but the cases of CHE （mid-range） in the study group showed smaller improvements than those in the control group （P 〈 0.05）. The ultrasonography indexes were not obviously improved, but gallbladder wall thickness was better in the study group than in the control group （P 〈 0.05）. CONCLUSION： TCM treatment based on differentiation of symptoms and signs has a better effect than conventional practice in terms of improving liver synthesis function, lessening hepatic inflammation and necrosis, and relieving cholecystitis.

关 键 词：慢性乙型肝炎 中药 辨证治疗 常规治疗 

分 类 号：R259[医药卫生—中西医结合]