益气活血化浊法治疗Wilson病肝纤维化的疗效观察  

Observation on the Therapeutic Effect of Yiqi Huoxue Huazhuo Therapy on Hepatic Fibrosis in Wilson’s Disease

作　　者：张路芹 韩咏竹 程楠 董健健 ZHANG Lu-Qin;HAN Yong-Zhu;CHENG Nan;DONG Jian-Jian(Institute of Neurology,Anhui University of Chinese Medicine,Hefei 230061 Anhui,China;Affiliated Hospital of the Institute of Neurology,Anhui University of Chinese Medicine,Hefei 230061 Anhui,China)

机构地区：[1]安徽中医药大学神经病学研究所,安徽合肥230061 [2]安徽中医药大学神经病学研究所附属医院,安徽合肥230061

出　　处：《广州中医药大学学报》2024年第4期822-828,共7页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(编号:81603596);大健康研究院新安医学与中医药现代化研究所专项基金资助项目(编号:2023CXMMTCM002)。

摘　　要：【目的】评估益气活血化浊法治疗Wilson病(也称肝豆状核变性,Wilson’s disease,WD)肝纤维化的临床效果。【方法】采用回顾性研究方法,根据治疗方法的不同,将52例气虚血瘀型WD肝纤维化患者分为对照组24例和治疗组28例。对照组采用西药常规驱铜治疗,治疗组在对照组的基础上联合益气活血化浊法中药汤剂治疗,共治疗4周。观察2组患者治疗前后中医证候积分、统一肝豆状核变性评分量表(UWDRS)肝脏症状评分、血清肝纤维化指标[Ⅲ型前胶原(PCⅢ)、透明质酸(HA)、Ⅳ型胶原(CⅣ)、层粘连蛋白(LN)]和CXC基序趋化因子配体10(CXCL10)水平以及基于声脉冲辐射力成像技术(ARFI)的肝脏超声点剪波弹性成像(pSWE)值的变化情况,并评价2组患者的临床疗效。【结果】(1)疗效方面:治疗4周后,治疗组的总有效率为85.71%(24/28),对照组为54.17%(13/24),组间比较(χ2检验),治疗组的疗效明显优于对照组(P<0.05)。(2)中医证候积分方面:治疗后,2组患者的中医证候积分均较治疗前降低(P<0.01),且治疗组对中医证候积分的降低幅度明显优于对照组(P<0.05)。(3)肝脏症状评分方面:治疗后,2组患者的UWDRS肝脏症状评分均较治疗前降低(P<0.01),但治疗后组间比较,差异无统计学意义(P>0.05)。(4)肝纤维化指标方面:治疗后,治疗组的血清HA、LN、CⅣ、PCⅢ水平均较治疗前降低(P<0.01),而对照组仅血清LN、PCⅢ水平较治疗前降低(P<0.05);组间比较,治疗组对血清HA、LN、PCⅢ水平的降低幅度均明显优于对照组(P<0.05或P<0.01),而对血清CⅣ水平的降低幅度有优于对照组趋势,但差异无统计学意义(P>0.05)。(5)趋化因子方面:治疗后,治疗组的血清CXCL10水平较治疗前明显降低(P<0.01),而对照组较治疗前有降低趋势,但差异无统计意义(P>0.05);组间比较,治疗组对血清CXCL10水平的降低幅度明显优于对照组(P<0.05)。(6)影像学方面:治疗后,2组患者的�Objective To assess the clinical effect of the Yiqi Huoxue Huazhuo therapy(the therapy for replenishing qi,activating blood and resolving turbidity)for the treatment of hepatic fibrosis in Wilson’s disease(WD,also known as hepatolenticular degeneration).Methods Using retrospective research method,52 patients with liver fibrosis in WD of qi deficiency and blood stasis type were divided into 24 cases in the control group and 28 cases in the treatment group according to the treatment method.The control group was treated with conventional decopper therapy with western medicines,and the treatment group was treated with Chinese herbal decoction based on Yiqi Huoxue Huazhuo therapy together with conventional decopper therapy.Both groups were treated for a total of 4 weeks.Before and after the treatment,the two groups were observed in the changes of traditional Chinese medicine(TCM)syndrome scores,Unified Wilson’s Disease Rating Scale(UWDRS)hepatic symptom scores,serum levels of liver fibrosis indicators of pre-collagen typeⅢ(PCⅢ),hyaluronic acid(HA),collagenⅣ(CⅣ),and laminin(LN),C-X-C motif chemokine ligand 10(CXCL10)level,and the point shear-wave elastography(pSWE)values of hepatic ultrasound based on acoustic radiation force impulse imaging(ARFI).After treatment,the clinical efficacy of the two groups was evaluated.Results(1)After 4 weeks of treatment,the total effective rate of the treatment group was 85.71%(24/28),while that of the control group was 54.17%(13/24),and the intergroup comparison(tested by chi-square test)showed that the therapeutic efficacy of the treatment group was significantly superior to that of the control group(P<0.05).(2)After treatment,the TCM syndrome scores in both groups were decreased compared with those before treatment(P<0.01),and the decrease of TCM syndrome scores in the treatment group was significantly superior to that in the control group(P<0.05).(3)After treatment,the UWDRS liver symptom scores in the two groups were decreased compared with those before treatment(P<0.01

关 键 词：WILSON病 肝豆状核变性 肝纤维化 益气活血化浊法 声脉冲辐射力成像(ARFI)技术 CXC基序趋化因子配体10(CXCL10) 

分 类 号：R259.752[医药卫生—中西医结合]