解毒凉血健脾方治疗早中期乙型肝炎相关慢加急性肝衰竭的效果观察  

Clinical effect of Jiedu Liangxue Jianpi prescription in treatment of patients with hepatitis B virus-associated acute-on-chronic liver failure in early and middle stages

作　　者：时克 侯艺鑫[1] 侯杰 李玉鑫 冉崇平 王宪波[1] SHI Ke;HOU Yixin;HOU Jie;LI Yuxin;RAN Chongping;WANG Xianbo(Department of Integrative Medicine,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Department of Gastroenterology,The First Clinical Medical College of Beijing University of Chinese Medicine,Beijing 100700,China)

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,北京100015 [2]北京中医药大学第一临床医学院脾胃病科,北京100700

出　　处：《临床肝胆病杂志》2021年第5期1065-1069,共5页Journal of Clinical Hepatology

基　　金：首都卫生发展科研专项(2018-1-2172);北京市科学技术委员会资助(Z191100006619033);国家中医药管理局重大疑难疾病中西医临床协作试点项目(2018-6-4);国家中医药管理局区域中医诊疗中心(2019-3-18)。

摘　　要：目的探究解毒凉血健脾方对早中期乙型肝炎慢加急性肝衰竭患者的疗效。方法选取2017年10月—2019年1月在北京地坛医院诊断为早中期乙型肝炎慢加急性肝衰竭患者75例。将患者随机分为中西医结合组36例,对照组39例。对照组予西医治疗,中西医结合组在西医治疗基础上加用解毒凉血健脾方,两组疗程均为8周。观察两组患者的累积有效率,比较治疗前后两组患者肝功能、凝血功能及血常规指标。组间比较采用重复测量资料方差分析,进行一元方差分析或多元方差分析。计数资料两组间比较采用χ2检验。结果治疗第4周,中西医结合组累积有效率比对照组高,差异有统计学意义(77.7%vs 53.8%,χ2=4.734,P<0.05)。与对照组相比,治疗第1、2周时中西医结合组白蛋白明显升高(P值均<0.05);治疗第1周时中西医结合组凝血酶原活动度水平明显升高(P<0.05);治疗第3、8周时,中西医结合组中性粒细胞计数、中性粒细胞与淋巴细胞比值均明显下降(P值均<0.05)。结论解毒凉血健脾方能提高早中期乙型肝炎慢加急性肝衰竭患者的治疗有效率,改善患者肝功能和凝血功能,降低中性粒细胞与淋巴细胞比值。Objective To investigate the clinical effect of Jiedu Liangxue Jianpi prescription in the treatment of patients with hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF)in early and middle stages.Methods A total of 75 patients who were diagnosed with HBV-ACLF in early and middle stages in Beijing Ditan Hospital from October 2017 to January 2019 were enrolled and randomly divided into integrated traditional Chinese and Western medicine group with 36 patients and control group with 39 patients.The patients in the control group were given Western medicine treatment,and those in the integrated traditional Chinese and Western medicine group were treated with Jiedu Liangxue Jianpi prescription in addition to Western medicine treatment.The course of treatment was 8 weeks for both groups.Cumulative response rate was observed for both groups,and the two groups were compared in terms of liver function,coagulation function,and routine blood test results before and after treatment.A univariate or multivariate analysis of variance with repeated measures was used for comparison between groups,and the chi-square test was used for comparison of categorical data between two groups.Results At week 4 of treatment,the integrated traditional Chinese and Western medicine group had a significantly higher cumulative response rate than the control group(77.7%vs 53.8%,χ2=4.734,P<0.05).Compared with the control group,the integrated traditional Chinese and Western medicine group had a significant increase in albumin at weeks 1 and 2 of treatment(all P<0.05),a significant increase in prothrombin activity at week 1 of treatment(P<0.05),and significant reductions in neutrophil count and neutrophil-lymphocyte ratio at weeks 3 and 8 of treatment(all P<0.05).Conclusion Jiedu Liangxue Jianpi prescription can improve the treatment response,liver function,and coagulation function and reduce neutrophil-lymphocyte ratio in patients with HBV-ACLF in early and middle stages.

关 键 词：乙型肝炎 慢加急性肝功能衰竭 中草药 

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