中药辨证论治联合美他多辛与还原型谷胱甘肽治疗酒精性肝病临床观察  

Clinical observation on treatment of alcoholic liver diseases with syndrome differentiation of Chinese Medicine combined with metadoxine and reductive glutathione

作　　者：韦璐莹 甘昌鑫[1] 陈志芬 李刘贞 张荣臻[1] WEI Luying;GAN Changxin;CHEN Zhifen;LI Liuzhen;ZHANG Rongzhen(The First Affiliated Hospital of Guangxi University of Chinese Medicine,Guangxi Nanning 530023;Guangxi Uni-versity of Chinese Medicine,Guangxi Nanning 530200)

机构地区：[1]广西中医药大学第一附属医院,广西南宁530023 [2]广西中医药大学,广西南宁530200

出　　处：《广西中医药》2021年第3期1-5,共5页Guangxi Journal of Traditional Chinese Medicine

基　　金：广西科技计划项目(编号:桂科AD17129001);广西中医药民族医药传承创新专项立项课题(编号:GZZX15-09)。

摘　　要：目的:观察中药辨证论治联合美他多辛与还原型谷胱甘肽治疗酒精性肝病的疗效。方法:将80例诊断为酒精性肝病患者随机分成观察组与对照组,每组40例。两组均在严格戒酒及高蛋白、低脂饮食的基础干预措施上,给予口服美他多辛片和还原型谷胱甘肽片。观察组在上述治疗基础上,采用中药辨证论治,湿热蕴结型予中满分消丸合茵陈蒿汤加减,肝郁脾虚型予柴芍六君子汤加减,肝胆湿热型予茵陈蒿汤合大柴胡汤加减,肝肾阴虚型予柴胡疏肝散合一贯煎加减,气滞血瘀型予逍遥散合失笑散加减。两组疗程均为1个月。检测两组治疗前后血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酰转肽酶(GGT)、总胆红素(TBIL)和白/球蛋白比例(A/G)等肝功能指标水平及层黏连蛋白(LN)、透明质酸酶(HA)、Ⅲ型前胶原(PC-Ⅲ)和Ⅳ型胶原(Ⅳ-C)等肝纤维化指标水平,比较两组的临床疗效。结果:观察组总有效率为95.0%,对照组总有效率为77.5%,观察组疗效优于对照组(P<0.05);两组治疗后血清ALT、AST、GGT、TBIL等肝功能指标水平均降低,白/球蛋白比例升高,与同组治疗前比较,差异均具有显著性(P<0.05),但观察组改善较对照组更为显著(P<0.05);治疗后两组LN、HA、PC-Ⅲ和Ⅳ-C等肝纤维化指标水平均降低,与同组治疗前比较,差异均具有显著性(P<0.05),但观察组中改善较对照组更为显著(P<0.05)。结论:在西医治疗基础上结合中药辨证治疗酒精性肝病能进一步提高疗效,值得临床推广应用。Objective:To observe the therapeutic effect of treatment of alcoholic liver diseases with syndrome dif⁃ferentiation of Chinese Medicine combined with metadoxine and reductive reductive glutathione.Methods:A total of 80 outpatients diagnosed with alcoholic liver disease were randomly divided into observation group and control group,with 40 cases in each group.Both groups were given oral metadoxine tablets and reductive glutathione tablets based on the basic intervention measures of strictly abstaining from alcohol and high-protein,low-fat diet.On the basis of above-mentioned treatment,traditional Chinese Medicine was applied to treat syndromes.The damp-heat accumulation type was treated with Zhongfenxiao pills combined with Yinchenhao Decoction;the liver depression and spleen de⁃ficiency type was treated with Chaishao Liujunzi decoction;the liver and gallbladder damp-heat type was treated with Yinchenhao decoction and modifed Dachaihu decoction;yin deficiency of liver and kidney type was modified with Chai⁃hu Shugan powder combined with modifed Yiguan decoction,and Qi stagnation type was modified with Xiaoyao powder combined with modified Shixiao powder.Both groups were treated for one month,Serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),glutamyl transpeptide(GGT)and total bilirubin(TBIL)were detected before and after treatment in the two groups.And white/globulin ratio(A/G)and other liver function indicators,as well as lam⁃inin(LN),hyaluronidase(HA),typeⅢprocollagen(PCⅢ)and typeⅣcollagen(Ⅳ-C),The clinical efficacy of the two groups was compared with the level of liver fibrosis indicators.Results:The total effective rate of the observation group was 95.0%,and the total effective rate of the control group was 77.5%.The therapeutic effect of the observation group was better than that of the control group(P<0.05);the levels of serum ALT,AST,GGT,TBIL and other liver func⁃tion indexes decreased in the two groups after treatment,the white/globulin ratio increased,compared with the

关 键 词：酒精性肝病 美多他辛 还原型谷胱甘肽 辨证论治 中西医结合疗法 

分 类 号：R575.5[医药卫生—消化系统]