清热利湿逐水加减方治疗湿热蕴结证肝硬化腹水患者的临床疗效及安全性  

Clinical Efficacy and Safety of the Qingre Lishi Zhushui Modified Formula in Treating Patients with Dampness-Heat Accumulated Liver Cirrhosis Ascites

作　　者：朱欧鸰[1] 张艳彬[2] 王立业[2] 朱亚楠[2] 柳康康 郑彩华[2] ZHU Ou-ling;ZHANG Yan-bin;WANG Li-ye;ZHU Ya-nan;LIU Kang-kang;ZHENG Cai-hua(Department of Endocrinology II,Shijiazhuang Hospital of Traditional Chinese Medicine,Shijiazhuang Hebei 050000;Department of Spleen and Gastroenterology,Shijiazhuang Hospital of Traditional Chinese Medicine,Shijiazhuang Hebei 050000)

机构地区：[1]石家庄市中医院内分泌二科,河北石家庄050000 [2]石家庄市中医院脾胃病科,河北石家庄050000

出　　处：《世界中西医结合杂志》2024年第11期2251-2256,共6页World Journal of Integrated Traditional and Western Medicine

基　　金：第七批全国老中医药专家学术经验继承项目(国中医药人教函[2022]76号)。

摘　　要：目的观察清热利湿逐水加减方治疗湿热蕴结证肝硬化腹水患者的临床效果及安全性。方法选取2020年1月—2023年5月期间石家庄市中医院收治的86例肝硬化腹水患者,依据简单随机数字表法分为对照组和研究组,每组各43例。对照组采取常规治疗,研究组在对照组基础上采取清热利湿逐水加减方,均治疗4周。观察比较两组患者治疗前后中医证候积分、机体状况(腹水深度、24 h平均尿量、腹围、空腹体质量)、肝功能指标[总胆红素(Total bilirubin,TBil)、谷氨酰转肽酶(Glutamyltranspeptidase,GGT)、天冬氨酸氨基转移酶(Aspartate aminotransferase,AST)、丙氨酸氨基转移酶(Alanine aminotransferase,ALT)]水平,比较治疗后临床疗效及不良反应发生率。结果治疗后研究组临床总有效率93.02%(40/43)明显高于对照组76.74%(33/43),差异有统计学意义(P<0.05)。治疗后两组患者脘腹胀急、腹大坚满及大便秘结、小便赤涩、渴不欲饮、烦热口苦、身目发黄分值均较治疗前降低,差异有统计学意义(P<0.05);且研究组中医证候积分低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者腹水深度、腹围、空腹体重较治疗前降低,24 h平均尿量较治疗前增多,差异有统计学意义(P<0.05);且研究组腹水深度、腹围、空腹体质量低于对照组,24 h平均尿量多于对照组,差异有统计学意义(P<0.05)。治疗后两组患者TBIL、GGT、AST、ALT水平较治疗前降低,差异有统计学意义(P<0.05);且研究组肝功能低于对照组,差异有统计学意义(P<0.05)。治疗后研究组不良反应发生率11.63%(5/43)与对照组6.98%(3/43)比较,差异无统计学意义(P>0.05)。结论采取清热利湿逐水加减方治疗肝硬化腹水湿热蕴结证可有效缓解临床症状,减少腹水,改善机体状况与肝功能,提升疾病治疗效果,且具有安全性。Objective To explore the clinical effect and safety of Qingre Lishi Zhushui modified formula in treating patients with dampness-heat accumulated liver cirrhosis ascites.Methods From January 2020 to May 2023,86 patients with liver cirrhosis ascites treated at Shijiazhuang Hospital of Traditional Chinese Medicine were selected and divided into a control group and a study group according to a simple random number table method,with 43 cases in each group.The control group received conventional treatment,while the study group received the Qingre Lishi Zhushui modified formula in addition to the conventional treatment.Both groups were treated for 4 weeks.The study assessed traditional Chinese medicine(TCM)syndrome scores,physical condition(ascites depth,24-hour average urine output,abdominal circumference,and fasting body weight),liver function indicators[total bilirubin(TBil),glutamyltranspeptidase(GGT),aspartate aminotransferase(AST),alanine aminotransferase(ALT)],clinical efficacy,and incidence of adverse reactions before and after treatment.Results After treatment,the overall clinical efficacy in the study group was 93.02%(40/43),significantly higher than 76.74%(33/43)in the control group,with a statistically significant difference(P<0.05).After treatment,the TCM syndrome scores,including symptoms such as epigastric and abdominal distension,hardened and full abdomen,constipation,reddish and scanty urine,lack of thirst,fever with bitter mouth,and yellowish complexion,were significantly reduced in both groups compared to pre-treatment levels,with statistically significant differences(P<0.05).The TCM syndrome scores in the study group were significantly lower than those in the control group,with statistically significant differences(P<0.05).After treatment,both groups showed significant reductions in ascites depth,abdominal circumference,and fasting body weight,and an increase in 24-hour urine output,with statistically significant differences(P<0.05).The ascites depth,abdominal circumference,and fasting body weight in

关 键 词：清热利湿逐水加减方 肝硬化腹水 湿热蕴结 肝功能 

分 类 号：R657.31[医药卫生—外科学] R442.5[医药卫生—临床医学]