解毒化瘀护肾方治疗慢加急性肝衰竭并发肝肾综合征的效果观察  

Clinical efficacy of Jiedu Huayu Hushen prescription in treatment of acute-on-chronic liver failure complicated by hepatorenal syndrome

作　　者：李晏杰 王沙[1] 王娜[1] 莫展进 毛德文[1] 石清兰[1] 黄祖鸿 柏文婕[2] 龙富立[1] 唐鲲 封佩佩 杨敏 LI Yanjie;WANG Sha;WANG Na;MO Zhanjin;MAO Dewen;SHI Qinglan;HUANG Zuhong;BO Wenjie;LONG Fuli;TANG Kun;FENG Peipei;YANG Min(Department of Liver Diseases,The First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning 530023,China;Guangxi University of Chinese Medicine,Nanning 530022,China)

机构地区：[1]广西中医药大学第一附属医院肝病科,南宁530023 [2]广西中医药大学,南宁530022

出　　处：《临床肝胆病杂志》2023年第9期2151-2157,共7页Journal of Clinical Hepatology

基　　金：广西自然科学基金创新团队项目(2018GXNFSFGA281002);广西自然科学基金(2020GXNSFAA297070);广西科技基地和人才专项(桂科AD17129001);国家中医药管理局第五批全国中医临床优秀人才研修项目(国中医药人教函[2022]1号);广西高校中青年教师科研基础能力提升项目(2022KY0284);广西中医药适宜技术开发与推广项目(GZSY21-12)。

摘　　要：目的探讨解毒化瘀护肾方治疗慢加急性肝衰竭(ACLF)并发肝肾综合征(HRS)的临床疗效以及对内毒素血症的影响。方法收集2020年3月—2022年6月在广西中医药大学第一附属医院诊治的96例ACLF并发HRS患者的临床资料,按随机数字表法分为对照组及观察组,每组48例。两组均给予西医综合治疗,对照组单给予去甲肾上腺素及白蛋白治疗,观察组予解毒化瘀护肾方联合去甲肾上腺素、白蛋白治疗,疗程均为2周。比较治疗前后两组患者血清内毒素水平、证候积分、24 h尿量、肾功能、肝功能、凝血功能以及临床疗效的差异。计量资料2组间比较采用成组t检验,组内治疗前后比较采用配对t检验;计数资料2组间比较采用χ^(2)检验。结果治疗2周后,观察组中医证候积分显著低于对照组(P<0.05);观察组内毒素水平、尿素、肌酐、胱抑素C、凝血酶原时间较对照组降低,差异均有统计学意义(P值均<0.05),观察组肾小球滤过率、24 h尿量、血清Alb、凝血酶原时间活动度较对照组升高,差异均有统计学意义(P值均<0.05);治疗2周后观察组总有效率(87.50%)高于对照组(66.67%),差异有统计学意义(P<0.05)。结论在西医综合治疗的基础上,解毒化瘀护肾方能降低ACLF并发HRS患者的血清内毒素水平,改善其肝肾功能、凝血功能及增加尿量,疗效优于单纯西医治疗。Objective To investigate the clinical efficacy of Jiedu Huayu Hushen prescription in the treatment of acute-onchronic liver failure(ACLF)complicated by hepatorenal syndrome(HRS)and its effect on endotoxemia.Methods Clinical data were collected from 96 patients with ACLF complicated by HRS who were diagnosed and treated in The First Affiliated Hospital of Guangxi University of Chinese Medicine from March 2020 to June 2022,and they were divided into observation group and control group using a random number table,with 48 patients in each group.In addition to comprehensive Western medicine therapy,the patients in the control group were given norepinephrine and albumin,while those in the observation group were given Jiedu Huayu Hushen prescription combined with norepinephrine and albumin,and the course of treatment was 2 weeks for both groups.The two groups were compared in terms of serum endotoxin level,traditional Chinese medicine(TCM)syndrome score,24-hour urine volume,renal function,liver function,coagulation function,and clinical outcome.The independent-samples t test was used for comparison of continuous data between two groups,paired t-test was used for comparison before and after treatment within the group;and the chi-square test was used for comparison of categorical data between two groups.Results Compared with the control group after 2 weeks of treatment,the observation group had a significantly lower TCM syndromes core(P<0.05),significantly lower levels of endotoxin,blood urea nitrogen,serum creatinine,cystatin C,and prothrombin time(all P<0.05),and significantly higher levels of glomerular filtration rate,24-hour urine volume,serum albumin,and prothrombin time activity(all P<0.05).After 2 weeks of treatment,the observation group had a significantly higher overall response rate than the control group(87.50%vs 66.67%,P<0.05).Conclusion Based on comprehensive Western medicine therapy,Jiedu Huayu Hushen prescription can reduce serum endotoxin level,improve liver and renal function and coagulation function,and

关 键 词：慢加急性肝功能衰竭 肝肾综合征 解毒化瘀护肾方 内毒素血症 

分 类 号：R259[医药卫生—中西医结合]