大黄乌梅汤保留灌肠治疗轻微肝性脑病的临床观察与机制研究  

The clinical observation and mechanism of the treatment of minimal hepatic encephalopathy with Da-Huang-Wu-Mei-Decoction with preserved enema

作　　者：张俊 孙克伟[2] 张涛[2] ZHANG Jun;SUN Ke-wei;ZHANG Tao(Department of Hepatic Diseases,Shenzhen City Hospital of Traditional Chinese and Western Medicine(Shenzhen Guangdong,518000),China;不详)

机构地区：[1]深圳市中西医结合医院肝病科,广东深圳518000 [2]湖南中医药大学第一附属医院肝病/感染性疾病科

出　　处：《中西医结合肝病杂志》2024年第6期490-494,共5页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：湖南省中医药科研计划项目(No.D2022081);长沙市自然科学基金(No.kq2208201)。

摘　　要：目的:探讨大黄乌梅汤保留灌肠治疗轻微肝性脑病的临床疗效与机制研究。方法:将34例确诊轻微肝性脑病且中医辨证湿热内蕴兼脾虚证的患者随机分为实验组和对照组各17例,两组均采用常规中西医综合基础治疗,实验组加用大黄乌梅汤保留灌肠;对照组加用利福昔明口服,共治疗两周。比较各组患者治疗前后的NCT-A评分、DST评分、IL-6、IL-1β、TNF-α、血氨、中医证候积分;收集治疗前后的新鲜粪便进行16S rDNA高通量焦磷酸测序检测。结果:两组患者治疗前后NCT-A评分、DST评分、IL-6、IL-1β、TNF-α、血氨、中医证候积分差异具有统计学意义(P<0.05)。与对照组相比,实验组患者治疗后中医证候改善、血氨降低、NCT-A评分、DST评分,IL-6和IL-1β降低差异具有统计学意义(P<0.05)。实验组患者治疗后Shannon指数升高(P=0.036)。结论:大黄乌梅汤保留灌肠能调节轻微肝性脑病患者的肠道菌群、减少促炎因子分泌、降低血氨、改善神经认知功能。Objective:To explore the clinical efficacy and mechanism of Dahuang Wumei Decoction for the treatment of minimal hepatic encephalopathy by preserving the enema.Methods:Thirty-four patients with confirmed minimal hepatic encephalopathy and splenic insufficiency associated with TCM-defined rheumatic fever were randomly divided into experimental group and control group.Both groups were treated with traditional chinese and western comprehensive basic therapy and experiment group were treated with Dahuang Wumei Decoction to preserve enema.The control group was treated with oral rifaximin for two weeks.Comparison of NCT-A score,DST score,IL-6,IL-1β,TNF-α,ammonia,and TCM symptom scores before and after treatment;High-throughput pyrosequencing of 16S rDNA in fresh stools collected before and after treatment.Results:The differences in NCT-A score,DST score,IL-6,IL-1β,TNF-α,ammonia,and TCM symptom scores before and after treatment were statistically significant(P<0.05).Compared with the control group,there were statistically significant differences in TCM symptomatic improvement,lower ammonia levels,NCT-A score,DST score,and lower levels of IL-6 and IL-1β(P<0.05).Shannon index was elevated in the experimental group after treatment(P=0.036).Conclusion:Dahuang Wumei Decoction with preserved enema can regulate the intestinal microflora,Decrease proinflammatory factor secretion,reduce blood ammonia and improve neurocognitive function.

关 键 词：轻微肝性脑病 大黄乌梅汤 肠道菌群 肠源性内毒素血症 

分 类 号：R575[医药卫生—消化系统]