婴儿巨细胞病毒肝炎湿热内蕴证维持治疗期中药替代治疗方案疗效观察  

Effect of Replacement Therapy of Chinese Medicine in the Maintenance Treatment Period of Infant Cytomegalovirus Hepatitis with Dampness-heat Accumulation Syndrome

作　　者：张慧芳 胡艳[1] 何强[1] ZHANG Hui-fang;HU Yan;HE Qiang(Department of Traditional Chinese Medicine,Beijing Children’s Hospital,Capital Medical University,National Center for Children’s Health,Beijing,100045)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院中医科,北京100045

出　　处：《中国中西医结合杂志》2021年第5期548-553,共6页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：首都临床特色应用研究与成果推广项目(No.Z171100001017049)。

摘　　要：目的评价婴儿巨细胞病毒肝炎湿热内蕴证维持治疗期采用中药替代更昔洛韦的临床疗效和安全性。方法选择首都医科大学附属北京儿童医院2017年2月—2019年7月符合巨细胞病毒肝炎(湿热内蕴证)诊断标准,并完成更昔洛韦足量诱导期治疗2周的患儿120例,按随机对照表分为治疗组(60例)和对照组(60例)。治疗组予中药汤剂口服清热化湿、利胆退黄治疗;对照组予更昔洛韦[5 mg/(kg·d)]静脉滴注2周维持治疗。同时两组均给予葡醛内酯、熊去氧胆酸基础治疗,疗程均为6周。分别于治疗后2、6周对患儿胆汁淤积指标[包括总胆红素(TBIL)、直接胆红素(DBIL)、γ谷氨酰转肽酶(GGT)、总胆汁酸(TBA)]恢复情况、肝脾大小及肝功能(包括ALT、AST、ALP)恢复情况进行判定。结果最终完成治疗组57例,对照组58例,5例退出观察,结果采用意向性分析。治疗组总有效率为93.3%(56/60)优于对照组的总有效率为86.7%(52/60,χ^(2)=11.484,P=0.009)。与本组治疗前比较,治疗后2、6周,两组TBIL、DBIL、GGT、TBA、ALP、ALT、AST水平均下降(P<0.05),肝脾均有明显减小(P<0.05)。与对照组同期比较,治疗2、6周后治疗组TBIL、DBIL、GGT、TBA下降明显(P<0.05),治疗6周后,治疗组ALT、AST水平降低(P<0.05)。肝脾大小比较,差异无统计学意义(P>0.05)。研究中治疗组3例患儿因自行停止服药脱落,对照组2例患儿出现白细胞减少,考虑更昔洛韦不良反应退出观察。治疗组有4例、对照组有2例服药后出现大便次数明显增多,予蒙脱石散后症状缓解。结论婴儿巨细胞病毒性肝炎湿热内蕴证在维持治疗期采用清热化湿、利胆退黄中药替代更昔洛韦治疗临床疗效优于更昔洛韦治疗,且临床安全可靠。Objective To evaluate the clinical efficacy and safety of Chinese medicine instead of ganciclovir in the maintenance treatment of infant cytomegalovirus hepatitis(dampness-heat accumulaiton syndrome). Methods A total of 120 cytomegalovirus hepatitis children with dampness-heat accumulation syndrome were recrutied,who were outpatients of Beijing Children’s Hospital affiliated to Capital Medical University from February 2017 to July 2019,and all of them received 2 weeks of ganciclovir induction therapy. These patients were assigned to the treatment group(60 cases)and the control group(60 cases)according to the randomized controlled table. The treatment group was given oral Chinese medicine decoction to remove heat and dampness,and normalize the gallbladder function to treat jaundice;the control group was given intravenous ganciclovir(5 mg·kg-1·d-1)2 weeks for maintenance treatment. Both groups were treated with glucurolactone and ursodeoxycholic acid,the therapeutic course for all was 6 weeks. The recovery of cholestasis [including the levels of total bilirubin(TBIL),direct bilirubin(DBIL),γ-glutamyl transpeptidase(GGT),and total bile acid(TBA)],the contraction of liver and spleen,and the recovery of liver function [including alanine aminotransferase(AST),aspartate aminotransferase(ALT)and alkaline phosphatase(ALP)] were compared at 2 and 6 weeks after treatment. Results Finally,there were 57 cases in the treatment group and 58 cases in the control group completed the study,while 5 patients withdrew from the observation. The results were analyzed by intention analysis. The total efficiency rate in the treatment group was 93.3%(56/60),while the control group was 86.7%(52/60). There was significant difference between the two groups(χ^(2)=11.484,P=0.009). Compared with the same group before treatment,the levels of TBIL,DBIL,GGT,TBA,ALP,ALT,and AST of the two groups decreased at 2 and 6 weeks after treatment(P<0.05). The liver and spleen were obviously retracted(P<0.05). Compared with the control group in the sam

关 键 词：婴儿 巨细胞病毒肝炎 中药替代治疗 

分 类 号：R272[医药卫生—中医儿科学]