膈下逐瘀汤加减联合西药治疗乙肝肝硬化临床研究  

Clinical Study on Modified Gexia Zhuyu Tang Combined with Western Medicine for Hepatitis B Cirrhosis

作　　者：严秀芝 余小翠 YAN Xiuzhi;YU Xiaocui

机构地区：[1]衢州市人民医院肝胆外科,浙江衢州324000

出　　处：《新中医》2022年第8期45-49,共5页New Chinese Medicine

摘　　要：目的:观察膈下逐瘀汤加减联合西药治疗乙肝肝硬化的临床疗效。方法:选取120例乙肝肝硬化患者,按随机数字表法分为观察组和对照组各60例。对照组给予西药治疗,观察组在对照组基础上加用膈下逐瘀汤加减治疗,2组均治疗24周。比较2组临床疗效、不良反应;比较2组治疗前后中医证候积分、血流动力学指标[门静脉内径(Dpv)、脾静脉内径(Dsv)、脾静脉平均血流速度(Ssv)、门静脉血流量(Qpv)]、肝纤维化指标[血清透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原蛋白(Ⅳ-C)、层粘连蛋白(LN)]、肝功能指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、白蛋白(Alb)、总胆红素(TBil)]及血清转化生长因子-β1 (TGF-β1)、基质金属蛋白酶抑制因子-1 (TIMP-1)水平。结果:观察组总有效率88.33%,高于对照组68.33%(P<0.05)。治疗后,2组中医证候积分均较治疗前降低(P<0.05),观察组中医证候积分低于对照组(P<0.05)。治疗后,2组Dpv、Dsv、Qpv均较治疗前减小(P<0.05),Ssv均较治疗前增大(P<0.05);观察组Dpv、Dsv、Qpv均小于对照组(P<0.05),Ssv大于对照组(P<0.05)。治疗后,2组HA、LN、PCⅢ、Ⅳ-C、ALT、AST、TBil、TGF-β1、TIMP-1水平均较治疗前降低(P<0.05),观察组HA、LN、PCⅢ、Ⅳ-C、ALT、AST、TBil、TGF-β1、TIMP-1水平均低于对照组(P<0.05);2组Alb水平均较治疗前升高(P<0.05),观察组Alb水平高于对照组(P<0.05)。治疗过程中,2组均未发生与药物相关的严重不良反应。结论:膈下逐瘀汤加减联合西药治疗乙肝肝硬化,可有效改善患者的临床症状、血流动力学及肝纤维化,促进肝功能恢复,降低血清TGF-β1、TIMP-1水平,安全性高。Objective:To observe the clinical effect of the therapy of modified Gexia Zhuyu tang combined with western medicine for hepatitis B cirrhosis. Methods:A total of 120 patients with hepatitis B cirrhosis were selected and divided into the observation group and the control group according to the random number table method,with 60 cases in each group. The control group was treated with western medicine,and the observation group was additionally treated with modified Gexia Zhuyu tang based on the treatment of the control group. Both groups were treated for 24 weeks. The clinical effects and adverse reactions in the two groups were compared;before and after treatment, the Chinese medicine syndrome scores and levels of hemodynamic indexes[diameter of portal vein(Dpv),diameter of splenic vein(Dsv),mean blood velocity of splenic vein(Ssv) and blood flow volume of portal vein(Qpv)], liver fibrosis indexes[serum hyaluronic acid(HA),procollagen Ⅲ(PCⅢ),typeⅣcollagen(Ⅳ-C) and laminin(LN)],liver function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST), albumin(Alb) and total bilirubin(TBil)], serum transforming growth factor-β1(TGF-β1) and tissue inhibitor of metalloproteinase-1(TIMP-1) were compared between the two groups. Results: The total effective rate was88.33% in the observation group,higher than that of 68.33% in the control group(P<0.05). After treatment,the Chinese medicine syndrome scores in the two groups were decreased when compared with those before treatment(P<0.05),and the Chinese medicine syndrome score in the observation group was lower than that in the control group(P<0.05). After treatment, the Dpv, Dsv and Qpv in the two groups were decreased when compared with those before treatment(P<0.05),and the Ssv was increased(P<0.05);the Dpv,Dsv and Qpv in the observation group were lower than those in the control group(P<0.05),and the Ssv was higher(P<0.05). After treatment,the levels of HA,LN,PCⅢ,Ⅳ-C,ALT,AST,TBil,TGF-β1 and TIMP-1 in the two groups were decreased when compared

关 键 词：乙肝肝硬化 膈下逐瘀汤 中医证候 血流动力学 肝纤维化 肝功能 转化生长因子-Β1 基质金属蛋白酶抑制因子-1 

分 类 号：R575.29[医药卫生—消化系统]