中西医结合治疗方案干预乙型肝炎病毒相关慢加急性肝衰竭的疗效分析  

Study on the intervention of integrated traditional Chinese and Western medicine therapy in patients with hepatitis B virus-related acute-on-chronic liver failure

作　　者：周超 宫嫚 张宁 何婷婷 孙克伟 张振刚 李瀚旻[4] 李秀惠[5] 杨宏志 李芹 王林 周小舟[9] 毛德文 过建春 卓蕴慧[12] 王宪波[13] 邓欣[14] 王介非 曹武奎[16] 张淑琴 张明香[18] 李筠 ZHOU Chao;GONG Man;ZHANG Ning;LI Yun(Integrative Medical Department for Liver Diseases,the 5t Medical Center of PLA General Hospital,Beijing (100039),China)

机构地区：[1]解放军总医院第五医学中心中西医结合科,北京100039 [10]广西中医药大学第一附属医院 [11]杭州市西溪医院 [12]上海中医药大学附属曙光医院 [13]首都医科大学附属北京地坛医院 [14]深圳市第三人民医院 [15]上海公共卫生临床中心 [16]天津市第二人民医院 [17]吉林省肝胆病医院 [18]沈阳市第六人民医院 [2]湖南中医药大学第一附属医院 [3]华中科技大学附属同济医院 [4]湖北省中医院 [5]首都医科大学附属北京佑安医院 [6]中山大学附属第三医院 [7]福建医科大学孟超肝胆医院 [8]成都市公共卫生临床医疗中心 [9]深圳市中医院

出　　处：《中西医结合肝病杂志》2019年第3期203-207,共5页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：国家传染病科技重大专项(No.2018ZX10725506-002,2012ZX10005-005)

摘　　要：目的:比较中西医结合治疗与单纯西药治疗方案对48周乙型肝炎病毒(HBV)相关慢加急性肝衰竭(ACLF)患者病死率的影响。方法:934例HBV-ACLF患者为研究对象,按照实际接受的治疗方案分为中西医结合治疗组(593例)、西药治疗组(341例),采用Kaplan-Meier方法及log-rank检验比较两组患者4、8、12、24、48周终点事件累积发生率,通过Cox比例风险回归计算分析影响HBV ACLF预后的独立因素。结果:中西医结合治疗组患者4、8、12、24、48周病死率分别为11.6%、17.9%、20.6%、24.5%、27.0%,显著低于西药治疗组的19.1%、25.5%、27.3%、31.4%、32.0%(P<0.05);经校正混杂因素后,中西医结合治疗组患者4、8、12、24、48周时死亡风险分别是西药组的0.57、0.63、0.72、0.65、0.73倍(P<0.05);年龄、总胆红素、国际标准化比值、肝性脑病、肝肾综合征、血小板计数是影响HBV ACLF预后的独立因素。结论:中西医结合治疗方案能降低HBV-ACLF人群的4~48周病死率;与西药治疗方案相比,中西医结合治疗方案在改善HBV-ACLF患者预后方面具有优势作用。Objective:To investigate the effects of the integrated Traditional Chinese Medicine(TCM) for the treatment of hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods:We performed an analysis of the "Study on HBV-ACLF treated with integrated Traditional Chinese Medicine and western medicine". According to the actual therapy, HBV-ACLF patients were divided into the TCM group and the western medicine(WM) group. Compared the 48-week mortality rate of patients in the two groups. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups;the chi-square test was used for comparison of categorical data between groups;the Kaplan-Meier method and the log-rank test were used for survival analysis;the Cox proportional hazards regression model was used for the evaluation of HR and adjusted HR.Results: The mortality rates of patients in TCM group(11.6%, 17.9%, 20.6%, 24.5%, 27%) were significantly lower than those in the WM group(19.1%, 25.5%, 27.3%, 31.4%, 32%) at 4 weeks, 8 weeks, 12 weeks, 24 weeks and 48 weeks(P<0.05). The relative mortality risks of patients in TCM group, compared with those in WM group were respectively 0.57, 0.63, 0.72, 0.65, 0.73(P<0.05). Age, serum bilirubin, international normalized ratio, hepatic encephalopathy, hepatic renal syndrome, and platelet count were independent prognostic factors.Conclusion:Our study proved that the integrated TCM and WM could decease the mortality rate of HBV-ACLF patients. The integrated TCM and WM used for the treatment of HBV-ACLF patients was useful.

关 键 词：肝功能衰竭 乙型肝炎病毒 中西医结合疗法 

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