消黄方治疗慢性乙型肝炎(湿热瘀阻型)轻度黄疸的临床疗效  

Therapeutic efficacy of Xiaohuang Decotion in chronic hepatitis B patients(damp-heat blood stasis syndrome) with low-grade jaundice

作　　者：杨宗国[1] 陈晓蓉[1] 陆云飞[1] 刘成[1] 

机构地区：[1]上海市公共卫生临床中心,上海201508

出　　处：《临床肝胆病杂志》2012年第10期771-774,784,共5页Journal of Clinical Hepatology

基　　金：中医药防治艾滋病;病毒性肝炎等疾病临床科研一体化技术平台体系构建及应用研究(2009ZX10005-019)

摘　　要：目的评价消黄方治疗慢性乙型肝炎(湿热瘀阻型)轻度黄疸的临床疗效。方法慢性乙型肝炎(湿热瘀阻型)轻度黄疸患者68例,随机数字表简单随机分组,消黄方组38例,熊去氧胆酸(UDCA)组30例。两组基础治疗方案为拉米夫定100 mg,每天1次,口服(或替比夫定600 mg,每天1次,口服);复方甘草酸苷60 ml,每天1次,静滴;还原型谷胱甘肽1.2 g,每天1次,静滴。UDCA组加UDCA 250 mg,每天3次,口服;消黄方组加消黄方100 ml,每天2次,口服。疗程4周。治疗前后观察两组中医证候、肝功能、肝纤维化指标及APRI指数变化。结果 (1)与UDCA组相比,消黄方治疗慢性乙型肝炎(湿热瘀阻型)轻度黄疸的有效率略高(89.5%vs76.7%),但差异无统计学意义(P>0.05)。(2)与治疗前相比,消黄方在改善性乙型肝炎轻度黄疸患者肝功能及血脂水平(ALT、AST、GGT、LDH、TBil、DBil、pre-A、TBA、TC、apo-A、HDL等)方面差异有统计学意义(P<0.01或P<0.05)。与UDCA组相比,消黄方可有效降低TBil、DBil、TBA、TC水平,提高apo-A含量(P<0.05)。(3)与治疗前相比,两组患者透明质酸(HA)均降低,差异具有统计学意义(P<0.05),消黄方对C-IV也显示出较好的改善作用(P<0.05)。(4)与治疗前相比,消黄方组可显著降低患者APRI指数(P<0.01),且与UDCA组比较差异有统计学意义(P<0.05)。结论消黄方可缓解慢性乙型肝炎(湿热瘀阻型)轻度黄疸患者临床症状,改善肝功能、肝纤维化指标,对肝内胆汁淤积性黄疸有较好的临床疗效。Objective To evaluate the therapeutic efficacy of Xiaohuang Decotion （XHD） in chronic hepatitis B （CHB） patients （ damp - heat blood stasis syndrome） with low - grade jaundice. Methods Sixty - eight CHB patients （ damp - heat blood stasis syndrome） with low - grade jaundice were assigned to one of two groups by using a random number table ： XHD treatment group （ n = 38 ） , and ursodeoxycholic acid （UDCA） treatment group （n = 30）. All patients received the same basic therapeutic regimen, which included once daily oral 100 mg lamivudine （ or 600 mg telbivudine） , once daily injection of 60 ml compound glycyrrhizin, and once daily injection of 1.2 g reduced gluta- thione. The patients in the UDCA group received 250 mg of UDCA thrice daily. The patients in the XHD group received 100 ml of XHD twice daily. In all cases, the treatment course was four weeks. Traditional Chinese medicine （TCM） clinical symptoms and signs, liver function, liver fibrosis index, and aspartate aminotransferase （AST） -to- platelet ratio index （APRI） score were evaluated in both groups before and after treatment. Results The XHD group showed a higher improvement in TCM symptoms and signs than the UDCA group （89. 5% vs 76. 7% ）, but the difference was not significant （P 〉 0.05 ）. The XHD group showed significantly greater improvement in liver function and blood lipid levels （ including alanine aminotransferase, AST, gamma - glutamyltransferase, lactate dehydrogenase, total biliru- bin （TBil）, direct reaction bilibrubin （DBil）, pre- A, total bile acid （TBA） , total cholesterol （TC）, apolipoprotein al （apo- A）, and high density lipoprotein; P 〈 0.01 or P 〈 0.05）. XHD treatment produced a significantly greater reduction in TBil, DBil, TBA and TC lev- els, and elevation in the apo - A level （ vs UDCA, P 〈 0.05 ）. Both treatments significantly reduced the hyaluronic acid level （ vs before treatment, P 〈 0.05 ）, but only the XHD treatment significantly red

关 键 词：消黄方 肝炎 乙型 慢性 黄疸 胆汁淤积 肝内 

分 类 号：R259[医药卫生—中西医结合]