健脾护肠解毒汤保留灌肠治疗早期乙型肝炎病毒相关慢加急性肝衰竭肠源性内毒素血症临床研究  

Clinical study of JianpiHuchangJiedu Decoction enema therapy on intestinal endotoxemia in early hepatitis B related chronic plus acute liver failure

作　　者：张向磊 李新焕 卢立伟 王琳[1] 丁广智 ZHANG Xianglei;LI Xinhuan;LU Liwei;WANG Lin;DING Guangzhi(Digestive Center,HISER Hospital Affiliated to Qingdao University(Qingdao Hospital of Traditional Chinese Medicine),Qingdao,Shandong 266000;Department of Disease Control,HISER Hospital Affiliated to Qingdao University(Qingdao Hospital of Traditional Chinese Medicine),Qingdao,Shandong 266000;Second Department of Pediatric,HISER Hospital Affiliated to Qingdao University(Qingdao Hospital of Traditional Chinese Medicine),Qingdao,Shandong 266000)

机构地区：[1]青岛大学附属青岛市海慈医院(青岛市中医医院)消化中心,山东青岛266000 [2]青岛大学附属青岛市海慈医院(青岛市中医医院)疾控科,山东青岛266000 [3]青岛大学附属青岛市海慈医院(青岛市中医医院)小儿二科,山东青岛266000

出　　处：《河北中医》2023年第9期1440-1444,共5页Hebei Journal of Traditional Chinese Medicine

基　　金：青岛市2018年度医药科研指导计划(编号:2018-WJZD028)。

摘　　要：目的 观察健脾护肠解毒汤保留灌肠治疗早期乙型肝炎病毒相关慢加急性肝衰竭肠源性内毒素血症(HBV-ACLF-IETM)的临床疗效。方法 将60例早期HBV-ACLF-IETM患者按照随机数字表法分为2组,治疗组30例予健脾护肠解毒汤保留灌肠治疗,对照组30例予乳果糖口服溶液保留灌肠治疗,2组均治疗28天。比较2组疗效;比较2组治疗前后肝功能指标、内毒素(ET)、凝血酶原活动度(PTA)、炎症因子、肠黏膜通透性、生活质量评分变化。结果 治疗组30例,死亡7例(23.3%);对照组30例,死亡11例(36.7%)。治疗组死亡率低于对照组(P<0.05)。治疗组总有效率95.7%(22/23),对照组总有效率78.9%(15/19),治疗组疗效优于对照组(P<0.05)。2组治疗后丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBiL)均较本组治疗前降低(P<0.05),白蛋白(ALB)较本组治疗前升高(P<0.05);治疗后治疗组TBiL低于对照组(P<0.05)。2组治疗后ET较本组治疗前降低(P<0.05),PTA较本组治疗前升高(P<0.05);治疗后治疗组ET低于对照组(P<0.05),PTA高于对照组(P<0.05)。2组治疗后肿瘤坏死因子α(TNF-α)、白细胞介素1(IL-1)、IL-6、IL-8均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。2组治疗后D-乳酸(D-LAC)、二胺氧化酶(DAO)均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。2组治疗后SF-36评分均较本组治疗前升高(P<0.05),且治疗组升高更明显(P<0.05)。结论 健脾护肠解毒汤保留灌肠治疗早期HBV-ACLF-IETM,可通过清除炎症细胞因子、改善肝功能、纠正肠黏膜通透性,有效治疗IETM,提高疗效。Objective To observe and evaluate the clinical efficacy of JianpiHuchangJiedu Decoction enema therapy on intestinal endotoxemia(IETM)in early hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods Sixty early HBV-ACLF patients with IETM were randomized to receive lactulose oral solution retention enema treatment(control group,n=30)or Jianpi Huchang Jiedu Decoction retention enema treatment(experimental group,n=30)for 28 days.The aiming was compare curative effect,liver function indexes,endotoxin(ET)and prothrombin activity(PTA),inflammatory factors,intestinal mucosal permeability,quality of life before and after treatment between groups.Results The efficacy of the treatment group was better than that of the control group(P<0.05)with mortality for 7(23.3%)vs 11(36.7%),(P<0.05),and total effective rate for 95.7%(22/23)vs 78.9%(15/19),P<0.05).After treatment,alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TBiL)in the two groups were lower(P<0.05),and albumin(ALB)was higher(P<0.05).TBiL in the treatment group was lower than that in the control group(P<0.05).After treatment,ET in the two groups was lower(P<0.05),which in the treatment group was lower more common(P<0.05),and PTA was higher(P<0.05),Which was higher in the treatment group than in the control group(P<0.05).After treatment,the levels of tumor necrosis factor-α(TNF-α),interleukin-1(IL-1),IL-6 and IL-8 in the two groups(P<0.05),and the decrease in the treatment group was more significant(P<0.05).After treatment,D-lactic acid(D-LAC)and diamine oxidase(DAO)in the two groups were lower than those in the group before treatment(P<0.05),and the decrease in the treatment group was more significant(P<0.05).After treatment,the scores of quality of life in the two groups were higher(P<0.05),and the increase in the treatment group was more significant(P<0.05).Conclusion For early HBV-ACLF,Jianpi Huchang Jiedu Decoction retention enema therapy in the treatment of early-can effectively treat IETM and improve the cura

关 键 词：毒血症 灌肠疗法 

分 类 号：R631.1[医药卫生—外科学] R575.3[医药卫生—临床医学]