抗肝纤维化中药治疗对肝硬化并发肠系膜上静脉栓塞患者预后的影响  

Effect of anti-liver fibrosis traditional Chinese medicine therapy on the prognosis of patients with liver cirrhosis and superior mesenteric venous thrombosis

作　　者：冯颖[1] 时克 张晓华 杨莉[1] 王宪波[1] FENG Ying;SHI Ke;ZHANG Xiaohua;YANG Li;WANG Xianbo(Center of Integrative Medicine,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,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

出　　处：《临床肝胆病杂志》2022年第7期1534-1539,共6页Journal of Clinical Hepatology

基　　金：国家自然科学基金(82004153);北京市科学技术委员会项目(Z191100006619033)。

摘　　要：目的通过抗肝纤维化中药治疗,分析对肝硬化并发肠系膜上静脉栓塞(SMVT)患者生存情况的影响。方法回顾性分析2017年1月—2020年6月在首都医科大学附属北京地坛医院住院治疗的231例肝硬化合并SMVT的患者临床资料,分为中药组(114例)和对照组(117例)。所有患者在针对原发病的常规治疗方案基础上,充分评估抗血栓指征,有必要者均应用标准抗血栓治疗;中药组在此基础上服用抗肝纤维化中药≥6个月。正态分布的计量资料两组间比较采用独立样本t检验;非正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ^(2)检验。采用Cox回归模型分析影响患者预后的独立性因素;观察患者发生终点事件(死亡)的情况,采用Kaplan-Meier法描绘生存曲线,用log-rank法进行比较检验;根据Child评分分层分析抗肝纤维化中药对不同级别肝功能患者预后的影响,以及不同种类抗肝纤维化中药对患者预后的影响。结果多因素分析显示年龄[风险比(HR)=1.039,95%CI:1.001~1.078,P=0.041]、CRP(HR=1.025,95%CI:1.009~1.041,P=0.003)是患者死亡的独立危险因素,而口服抗肝纤维化中药是保护性因素(HR=0.148,95%CI:0.051~0.429,P=0.001)。生存曲线分析显示中药组生存率高于对照组(95.6%vs 81.2%,χ^(2)=17.032,P<0.0001);进一步分析显示,Child-Pugh A级患者的生存率中药组高于对照组(100%vs 66.7%,χ^(2)=4.003,P=0.045);Child-Pugh B级患者的生存率中药组亦高于对照组(96.7%vs 85.1%,χ^(2)=10.788,P=0.002)。3种抗肝纤维化中药对患者预后影响差异无统计学意义(P>0.05)。结论年龄、CRP是影响肝硬化并发SMVT患者预后的独立危险因素;抗肝纤维化中药治疗能降低患者的病死率,特别是在Child-Pugh A级及B级患者中疗效更明显。Objective To investigate the effect of anti-liver fibrosis traditional Chinese medicine(TCM)therapy on the prognosis of patients with liver cirrhosis and superior mesenteric venous thrombosis(SMVT).Methods A retrospective analysis was performed for the clinical data of 231 patients with liver cirrhosis and SMVT who were hospitalized and treated in Beijing Ditan Hospital,Capital Medical University,from January 2017 to June 2020,and the patients were divided into TCM group with 114 patients and control group with 117 patients.In addition to the conventional treatment regimen for primary diseases,antithrombotic indications were fully evaluated,and standard antithrombotic treatment was applied if necessary;the patients in the TCM group were given anti-liver fibrosis TCM therapy for≥6 months.The independent samples t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.The Cox regression model was used to analyze the independent influencing factors for prognosis;outcome events(death)were observed,the Kaplan-Meier method was used to plot survival curves,and the log-rank test was used for comparison;a stratified analysis based on Child score was performed to investigate the effect of anti-liver fibrosis TCM therapy on the prognosis of patients with different liver function grades and the effect of different anti-liver fibrosis TCM drugs on the prognosis of patients.Results The multivariate analysis showed that age(hazard ratio 0x09[HR]=1.039,95%confidence interval[CI]:1.001-1.078,P=0.041)and C-reactive protein(CRP)(HR=1.025,95%CI:1.009-1.041,P=0.003)were independent risk factors for death,while oral administration of anti-liver fibrosis TCM drugs was a protective factor(HR=0.148,95%CI:0.051-0.429,P=0.001).The survival curve analysis showed that the TCM group had a significantly higher surv

关 键 词：肝硬化 肠系膜静脉 静脉血栓栓塞 中草药 

分 类 号：R259[医药卫生—中西医结合]