温阳健脾法与益气健脾法从瘀毒论治对慢性重型肝炎的疗效观察  

Clinical observation in treating chronic severe hepatitis patients with the principles of detoxicating and stasising combined with warming-Yang and strengthening spleen or combined with nourishing-Qi and invigorate spleen

作　　者：余世敏 胡东辉 张京伟[2] 

机构地区：[1]湖北省中山医院肝病科,武汉430000 [2]武汉大学中南医院感染科,武汉430000

出　　处：《重庆医学》2013年第5期499-501,共3页Chongqing medicine

基　　金：湖北省自然科学基金资助项目(2009CDB222)

摘　　要：目的探讨解毒化瘀联合温阳健脾法与解毒化瘀联合益气健脾法治疗慢性重型肝炎阴阳黄证的临床疗效。方法对该院2009年3月至2012年3月中医辨证属阴阳黄证的慢性重型肝炎患者62例,随机分为温阳健脾组和益气健脾组,其中温阳健脾组在解毒化瘀治法的基础上加用附片、砂仁温阳健脾治疗;益气健脾组在解毒化瘀治法的基础上加用黄芪、白术益气健脾治疗。4周后对临床疗效加以总结分析。结果治疗4周后,温阳健脾组和益气健脾组的治疗有效率分别为86.2%和74.1%。两组总胆红素(TBiL)均明显下降(P<0.05),温阳健脾组下降幅度较益气健脾组明显,治疗前后差值分别为(208.4±67.3)、(139.1±89.7)μmol/L。凝血酶原活动度(PTA)水平都有不同程度的升高,温阳健脾组PTA水平上升幅度大于益气健脾组(P<0.05)。丙氨酸氨基转移酶(ALT)水平治疗前后均明显降低(P<0.05),但两组间比较差异无统计学意义(P>0.05)。温阳健脾组患者自发性腹膜炎发生率低于益气健脾组,未发现出血、黄疸进行性加深等不良反应。结论瘀毒论治温法干预治疗慢性重型肝炎阴阳黄证可提高疗效且安全性较好,值得临床推广。Objective To evaluate the clinical effect and safety on chronic severe hepatitis（CSH） patients of Yang-huang and Yin-huang syndrome type by principles of detoxicating and stasising combined with warming-Yang and strengthening-spleen （PA） or with nourishing-Qi and invigorate spleen （PB） ,respectively. Methods Sixty-two patients with CSH were randomly divided into two groups：group A （31 cases） treated with PA and group B （31 cases） treated with PB for 4 weeks. The levels of serum bilirubin, PTA,ALT and adverse events were observed. The clinic effectiveness was compared. Results The efficient rate was 86.2% （25/ 29） and 74.1 % （20/27） in group A and group B, respectively. Level of serum bilirubin was significantly decreased in both groups, more obvious in group A. The thrombinogen activity was higher in group A than that in group B after treatment（P〈0.05）. No sig- nificant difference in ALT was found between the two groups. The incidence of spontaneous bacterial peritonitis in group A（3/29） was less than that in group B（5/27）. No infection,bleeding or other adverse reactions was observed in group A. Conclusion The method of Warm therapy is efficacy and safety in patients with CSH with Yang-huang and Yin-huang syndrome type and worth to spread.

关 键 词：慢性重型肝炎 阴阳黄证 解毒化瘀法 附片 砂仁 治疗应用 

分 类 号：R259[医药卫生—中西医结合]