中西医结合治疗慢性肝衰竭规律及疗效的单中心回顾性研究  

A single center retrospective study of integrated traditional Chinese and western medicine in the diagnosis and treatment of chronic liver failure

作　　者：蒙荫杰 邱华 孟晨炜 吕翰林 李旺 朱玟霜 王梓塨 王倩倩 毛德文[4] MENG Yin-jie;QIU Hua;MENG Chen-wei(Graduate School of Guangxi University of traditional Chinese Medicine(Nanning Guangxi,530001),China;不详)

机构地区：[1]广西中医药大学研究生院,广西南宁530023 [2]广西医科大学附属肿瘤医院 [3]广西华大基因科技有限公司 [4]广西中医药大学第一附属医院肝病科

出　　处：《中西医结合肝病杂志》2023年第6期484-487,495,共5页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：国家科技重大专项课题(No.2018ZX10725506-002);国家中医临床研究基地建设项目(No.国中医药科技函[2018]131号);广西中医药大学一流学科建设开放课题(No.2019XK020)。

摘　　要：目的:基于真实世界数据分析中西医结合诊疗慢性肝衰竭(CLF)的规律并评估其疗效。方法:借助临床科研一体化系统,回顾性分析广西中医药大学第一附属医院2014年9月至2020年9月CLF患者的临床资料,统计患者的中医证型及中药用药规律;评价人工肝治疗和抗病毒治疗对不同CTP评分等级的CLF患者预后的影响;比较入院治疗2、4周后患者的疗效。结果:纳入194例CLF患者,90 d内死亡42例(21.13%),合并HBV感染111例(57.22%)。CLF患者实证证型前5位为气滞湿阻证、湿热蕴结证、湿热内阻证、肝脾血瘀证、寒湿发黄证,虚证/虚实夹杂证证型前5位为肝郁脾虚证、脾肾阳虚证、脾虚湿盛证、气虚不摄证、阳虚水泛证;使用频次前5位的中药为白术、茯苓、茵陈、泽泻、炙甘草。CTP评分为B和C级的CLF患者行人工肝治疗(人工肝组),未行人工肝治疗(非人工肝组),B、C级患者90 d预后比较差异均无统计学意义(P>0.05)。CLF组行抗病毒治疗的患者72例(抗病毒组),未行抗病毒治疗39例(非抗病毒组),两组患者90 d预后比较差异有统计学意义(P<0.05)。CLF患者(55例)治疗2、4周后,Alb、PTA分别与治疗前比较差异有统计学意义(P<0.05);PT、INR、TBil、肌酐(Cr)、MELD评分在治疗2、4周后与治疗前比较,治疗2周后与治疗4周后比较,差异均无统计学意义(P>0.05)。结论:CLF主要病因为HBV感染;CLF患者的中医证型分布及遣用中药有规律可循;人工肝对CLF患者有一定的疗效,但不能改善肝衰竭患者的临床结局;抗病毒治疗能有效地降低CLF患者的病死率,改善肝衰竭患者的临床预后;内科综合治疗后,短期内(治疗后2、4周)CLF患者治疗后MELD评分改善不明显。Objective:To analyze the rule of integrated Chinese and western medicine in the diagnosis and treatment of chronic liver failure(CLF)and evaluate its efficacy based on the real world.Methods:The clinical data of CLF patients in the First Affiliated Hospital of Guangxi University of Chinese Medicine from September 2014 to September 2020 were retrospectively analyzed with the aid of the integrated clinical scientific research system,and the TCM syndrome types and drug use rules of the patients were statistically analyzed.To evaluate the effects of artificial liver therapy and antiviral therapy on the prognosis of CLF patients with different CTP scores.The curative effects were compared after 2 weeks and 4 weeks.Results:Among 194 patients with CLF,42 died within 90 days,the fatality rate was 21.13%,and 111 patients were complicated with HBV infection,accounting for 57.22%.The top 5 cases of CLF patients were qi stagnation and dampness resistance,dampness and heat accumulation,dampness and heat internal resistance,blood stasis of liver and spleen,cold and dampness yellow,and the top 5 cases of deficiency syndrome/deficiency and combination syndrome were liver stagnation and spleen deficiency,spleen and kidney Yang deficiency,spleen deficiency and dampness,qi deficiency and Yang deficiency.The top 5 traditional Chinese medicines in use frequency were Atractylodes macrocephala,Poria cocos,Rhizome Rhizoma alismatifolia,prepared glycyrrhiza glycyrrhiza.A total of 72 patients in the CLF group received antiviral therapy(antiviral group)and 39 patients in the CLF group did not receive antiviral therapy(non-antiviral group)(P<0.05).After 2 weeks and 4 weeks of treatment,Alb and PTA of 55 CLF patients were compared with those before treatment,and the differences were statistically significant(P<0.05);There were no significant differences in PT,INR,TBiL,Cr and MELD scores between 2 and 4 weeks after treatment and between 2 and 4 weeks after treatment(P>0.05).Conclusion:THE main cause of CLF is HBV infection.There are rules for

关 键 词：慢性肝衰竭 中医证型 中药用药规律 人工肝 抗病毒治疗 

分 类 号：R512.62[医药卫生—内科学]