健脾化湿方加减对乙型肝炎肝硬化合并食道胃底静脉曲张出血患者1年内再出血及内毒素、细胞因子的影响  

Effect of Modified Jianpi Huashi Formula (健脾化湿方) on Rebleeding Rate within One Year and the Levelsof Endotoxin and Cytokines in Patients with HBV-related Liver Cirrhosis and Esophageal Variceal Bleeding

作　　者：于浩[1] 侯艺鑫[1] 江宇泳[1] 杨玉英[1] 孟培培[1] 吴桐 孙乐[1] 冀晓敏 YU Hao;HOU Yixin;JIANG Yuyong;YANG Yuying;MENG Peipei;WU Tong;SUN Le;JI Xiaomin(Beijing Ditan Hospital,Capital Medical University,Beijing,100015)

机构地区：[1]首都医科大学附属北京地坛医院,北京市100015

出　　处：《中医杂志》2022年第15期1456-1462,共7页Journal of Traditional Chinese Medicine

基　　金：北京市医院管理中心青年人才培养“青苗”计划(QML20201802);北京市中医药科技发展资金项目(QN-2020-25)。

摘　　要：目的 探讨基于健脾化湿方的随证加减方案对乙型肝炎肝硬化合并食道胃底静脉曲张破裂出血(EGVB)患者1年内再出血、内毒素及细胞因子水平的影响。方法 将乙型肝炎肝硬化合并EGVB患者110例随机分为中西医结合治疗组和西医对照组各55例,两组均采用西医综合治疗方案进行治疗,活动出血停止1周后,中西医结合治疗组加用健脾化湿方,西医对照组加用卡维地洛片,两组疗程均为12周,治疗结束后随访36周。记录两组患者一般资料情况及生化指标包括肝功能[丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、谷氨酰基转移酶(GGT)、白蛋白(AlB)]、电解质及肾功能、[钠(NA)、肌酐(Cr)]、血糖(GlU)、血常规[白细胞(WBC)、粒淋比(NLR)、血红蛋白(HGB)、血小板(PLT)]、凝血功能[凝血酶原时间(PT)、国际标准化比值(INR)]。将指标进行Cox单因素分析,筛选出具有统计学意义的单因素变量,纳入单因素变量进行Cox多因素分析,确定影响EGVB发生1年内再出血的影响因素。并检测两组治疗前后及随访时血清内毒素、细胞因子[内皮素-1 (ET-1)、肿瘤坏死因子(TNF-α)、一氧化氮(NO)]水平。结果 单因素分析结果显示,TBIL、GGT、GLU、WBC、INR、PT、NA及中药治疗差异具有统计学意义(P<0.05或P<0.01)。多因素分析结果显示,TBIL、GLU、INR、中药治疗是EGVB发生1年内再出血的独立影响因素,其中中药治疗是EGVB再出血的保护因素(P<0.05或P<0.01)。两组治疗后及随访时与治疗前比较ET-1、TNF-α、NO及内毒素水平均明显降低(P<0.05或P<0.01);两组随访时与治疗后比较,ET-1、TNF-α、NO及内毒素水平均明显下降(P<0.01);治疗后及随访时,中西医结合治疗组ET-1、TNF-α、NO及内毒素水平较西医对照组明显降低(P<0.01)。结论 基于健脾化湿方的随证加减方案能够降低乙肝肝硬化合并EGVB患者1年内再出血发生率,且具有降低Objective To investigate the effect of modified Jianpi Huashi Formula(健脾化湿方,JHF)on re⁃bleeding,endotoxin and cytokine levels in patients with HBV-related liver cirrhosis and esophageal variceal bleeding (EGVB)within one year. Methods A randomized controlled study was conducted in 110 patients with HBV-relatedliver cirrhosis and EGVB,who were randomly divided into the integrated traditional Chinese medicine and westernmedicine group(55 cases)and the western medicine control group(55 cases). Both groups received comprehensivewestern medicine treatment,and one week after the bleeding stopped,the integrated treatment group was added withJHF,while the control group received carvedilol tablets additionally,both for 12 weeks with follow-up of 36 weeks.General information and biochemical parameters related to liver function,including alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),glutamyltransferase(GGT)and albumin(AlB),electro⁃lytes and renal function indicators inlcuding sodium(NA),creatinine(Cr)and glucose(GlU),blood routine indica⁃tors including white blood cell(WBC),neutrophil-to-lymphocyte ratio(NLR),hemoglobin(HGB),platelets(PLT),and coagulation function indicators including prothrombin time(PT) and international normalized ratio(INR). Univariate Cox analysis was performed to select the variables that were statistically significant,and those se⁃lected factors were then used for multivariate Cox analysis to determine the influencing factors of the occurrence ofEGVB rebleeding within 1 year. The changes of serum endotoxin and cytokines including endothelin-1(ET-1),tumornecrosis factor(TNF- α),and nitric oxide(NO)before and after treatment and during follow-up were analyzed.Results Univariate analysis showed that there were significant differences in TBIL ,GGT,GLU,WBC,INR,PT,NA and treatment with traditional Chinese medicine(TCM). Multivariate analysis showed that TBIL,GLU,INR andTCM treatment were the independent influencing factors of EGVB rebleeding within 1

关 键 词：乙型肝炎肝硬化 食管胃静脉曲张破裂出血 健脾化湿方 细胞因子 内毒素 随机对照试验 

分 类 号：R575.2[医药卫生—消化系统]