大黄煎剂保留灌肠治疗慢性乙型肝炎重症化患者的临床疗效及安全性观察  

Clinical Efficacy and Safety of Retention Enema with Dahuang Decoction for Treating Patients with Acute Exacerbation of Chronic Hepatitis B

作　　者：舒发明 黄英[2] 陈玮钰 毛德文[1] 李媛 龙富立[1] SHU Fa-ming;HUANG Ying;CHEN Wei-yu;MAO De-wen;LI Yuan;LONG Fu-li(The First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning Guangxi 530023;Guangxi International Zhuang Medicine Hospital Affiliated to Guangxi University of Chinese Medicine,Nanning Guangxi 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]广西中医药大学附属国际壮医医院,广西南宁530200

出　　处：《世界中西医结合杂志》2023年第6期1186-1190,共5页World Journal of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金项目(81760844);广西自然科学基金创新研究团队项目(2019GXNSFBA245018);广西壮族自治区中青年教师基础能力提升项目(2019KY0336、2021KY0324)。

摘　　要：目的 探讨大黄煎剂保留灌肠治疗慢性乙型肝炎重症化患者的临床疗效。方法 选取2019年6月—2021年6月期间广西中医药大学第一附属医院收治的慢性乙型肝炎重症化患者100例,按随机数字表法分为对照组和治疗组,每组各50例。两组患者均采用常规西医基础治疗,治疗组在对照组基础上加用大黄煎剂保留灌肠。治疗2周后,观察比较两组患者治疗后临床疗效、肝衰竭发生率及治疗期间不良反应,治疗前后证候积分、肝功能指标[总胆红素(Total bilirubin, TBil)、丙氨酸氨基转移酶(Alanine amiotransferase, ALT)、天门冬氨酸氨基转移酶(Aspartate Transaminase, AST)]、凝血功能指标[凝血酶原时间(Prothrombin time, PT)、凝血酶原活动度(Prothrombin time activity, PTA)]、HBV-DNA转阴例数。结果 治疗后治疗组临床疗效总有效率94.00%(47/50)高于对照组82.00%(41/50),差异有统计学意义(P<0.05)。经两个疗程治疗,并进行4周、12周随访,治疗组肝衰竭发生率4.00%(2/50)低于对照组10.00%(5/50),差异有统计学意义(P<0.05)。治疗后两组患者证候积分较治疗前降低,差异有统计学意义(P<0.05);且治疗组低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者肝功能指标TBIL、AST、ALT水平均较治疗前降低,差异有统计学意义(P<0.05);且治疗组低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者凝血功能改善PT较治疗前降低,PTA较治疗前升高,差异有统计学意义(P<0.05);且治疗组PT低于对照组,PTA高于对照组,而两组患者间HBV-DNA转阴例数比较,差异无统计学意义(P>0.05)。两组患者治疗过程中均未见明显不良反应。结论 在慢性乙型肝炎重症化患者临床治疗中,联合应用大黄煎剂保留灌肠技术疗效优于单纯西医基础治疗,值得推广应用。Objective To observe the clinical efficacy of retention enema with Dahuang Decoction in treating the patients with acute exacerbation of chronic hepatitis B.Methods A total of 100 patients with acute exacerbation of chronic hepatitis B treated in the First Affiliated Hospital of Guangxi University of Chinese Medicine from June 2019 to June 2021 were randomized into a control group(n=50)and an observation group(n=50)according to the random number table method.The control group was treated with western medicine and the observation group with western medicine combined with retention enema with Dahuang Decoction.After 2 weeks of treatment,the overall efficacy,incidence of liver failure and adverse reactions,and positive-to-negative cases of HBV-DNA were compared between the two groups.The symptoms scores,liver function indicators[total bilirubin(TBIL),alanine aminotransferase(ALT),and aspartate transaminase(AST)],and coagulation function indicators[prothrombin time(PT)and prothrombin time activity(PTA)]were measured before and after treatment.Results The total response rates of the observation group and the control group were 94.00%(47/50)and 82.00%(41/50),respectively,with a significant difference(P<0.05).The incidence of liver failure of the treatment group and control group during the two courses of treatment and the follow-up at the 4th and 12th weeks were 4.00%(2/50)and 10.00%(5/50),respectively,with a significant difference(P<0.05).The symptom scores in both groups decreased after treatment and were lower in the observation group than in the control group(P<0.05).Compared with those before treatment,the liver function indicators(TBIL,AST,and ALT)decreased after treatment,and the decreases were more significant in the observation group(P<0.05).The treatment reduced PT and increased PTA,and the observation group had lower PT and higher PTA than the control group after treatment(P<0.05).The number of positive-to-negative cases of HBV-DNA showed no significant difference between the two groups(

关 键 词：慢性乙型肝炎重症化 中西医结合疗法 大黄煎剂保留灌肠技术 

分 类 号：R373.21[医药卫生—病原生物学]