解毒凉血方联合西药治疗乙型肝炎慢加急性肝衰竭患者64例临床观察  

Clinical Observation on Toxin-Resolving Blood-Cooling Formula Combined with Western Medicine for 64 Cases of Hepatitis B Related Acute-on-Chronic Liver Failure

作　　者：刘慧敏[1] 王宪波[1] 侯艺鑫[1] 高方媛[1] 孙凤霞[1] 江宇泳[1] 杨志云[1] 杜宏波[1] 王晓静[1] 周桂琴[1] 杨玉英[1] 王融冰[1] 

机构地区：[1]首都医科大学附属北京地坛医院中西医结合中心,北京市朝阳区京顺东街8号100015

出　　处：《中医杂志》2013年第21期1829-1833,共5页Journal of Traditional Chinese Medicine

基　　金：国家"十一五"中医药防治传染病重大科技专项资助项目(2008ZX10005-007);北京市科技计划资助项目(Z111107056811044);北京市中医药科技发展基金资助项目(KJTS2011-05)

摘　　要：目的观察解毒凉血方联合西药治疗乙型肝炎慢加急性肝衰竭(ACLF)热毒瘀结证的临床疗效,并探讨其有效患者群。方法将105例热毒瘀结证乙型肝炎ACLF患者随机分为中西医结合组64例与西医治疗组41例。西医治疗组给予西医内科综合治疗,中西医结合组在西医治疗的基础上加用解毒凉血方,共治疗8周,随访40周。比较两组治疗后第8、48周时的临床疗效,观察两组患者治疗第0、2、4、6、8、12、24、48周时中医证候积分及终末期肝病模型(MELD)评分,并根据MELD评分探讨有效患者群。结果治疗8周时,中西医结合组和西医治疗组总有效率分别为75.00%和51.22%,病死率分别为15.63%和34.15%,两组总有效率和病死率比较差异均有统计学意义(P<0.05);随访至48周时,中西医结合组和西医治疗组总有效率分别为70.31%和51.22%,病死率分别为21.88%和39.02%,两组总有效率和病死率比较差异均有统计学意义(P<0.05)。中西医结合组治疗后及随访时各时间点中医证候评分、MELD评分均较治疗开始时下降(P<0.05),西医治疗组治疗第8周及随访各时间点中医证候评分、治疗第4周后及随访各时间点MELD评分较治疗开始时下降(P<0.05);组间比较,中西医结合组治疗后第2～12周中医证候评分及第2、4、6、8周MELD评分均较同时间点西医治疗组降低(P<0.05)。MELD评分在22.6～29.9分的患者,中西医结合组的病死率为23.81%,西医治疗组为58.82%,两组比较差异有统计学意义(P<0.05)。结论解毒凉血方联合西医综合治疗能够提高乙型肝炎ACLF的临床疗效,降低MELD评分介于22.6～29.9分的患者的病死率。Objective To observe the therapeutic effect of Toxin-Resolving Blood-Cooling Formula （TRBCF） combined with western medicine for hepatitis B related acute-on-chronic liver failure （HB-ACLF） with heat-toxin stasis bind pattern and research its effective patient population. Methods Totally 105 HB-ACLF patients with heat-toxin stasis bind pattern were randomized into the integrative medicine group of 64 cases and western medicine group of 41 cases. The western medicine group was given western comprehensive treatment. The integrative medicine group was added with TRBCF. The treatment lasted for 8 weeks and the follow-up lasted for 40 weeks. The clinical efficacy in both groups was compared in the 8th and 48th week. The TCM pattern scores and model for end-stage liver disease （MELD） scores in both groups were observed in the 0, 2nd, 4th, 6th, 8th, 12th, 24th and 48th week. The effective patient population was analyzed according to MELD score. Results After 8-week treatment, the total effective rate of the integrative medicine group and western medicine group was 75.00% and 51.22% respectively and the mortality rate was 15.63% and 34.15% respectively, with a significant difference between groups （P〈0.05）. In the 48th week, the total effective rate of the integrative medicine group and western medicine group was 70.31% and 51.22% respectively and the mortality rate was 21.88% and 39.02% respectively, with a significant difference between groups （P〈0.05）. The TCM pattern score and MELD score at each time point of treatment and follow-up was significantly decreased in the integrative medicine group （P〈0.05）. The TCM pattern score was significantly decreased in the 8th week and at each time point of follow-up and MELD score was significantly deceased in the 6th and 8th week and at each time point of follow-up in the western medicine group （P〈0.05）. Comparing with the western medicine group, the TCM pattern score was significantly decreased from the 2nd to 12th week and MELD score was sign

关 键 词：解毒凉血方 乙型肝炎 慢加急性肝衰竭 终末期肝病模型 病死率 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]