疏肝健脾解毒方联合恩替卡韦片治疗肝郁脾虚、正虚邪恋型代偿期乙肝肝硬化的临床观察
发布时间：2018-12-15 00:39
【摘要】：研究目的:通过观察患者治疗前后各项观察指标的变化情况,评价疏肝健脾解毒方治疗肝郁脾虚、正虚邪恋型代偿期乙肝肝硬化患者的临床疗效。研究方法:按纳入标准和排除标准选取50例肝郁脾虚、正虚邪恋型代偿期乙肝肝硬化患者,根据随机数字表法简单随机分为中西药组和纯西药组各25例。纯西药组予口服马来酸恩替卡韦片(天丁),中西药组在口服西药基础上加服疏肝健脾解毒方,疗程均为12周。观察治疗前后两组的中医证候积分、多维疲劳量表得分(MFI-20)、肝功能、HBV-DNA指标的变化情况及不良反应,评估MFI-20得分与肝功能的相关性。运用统计学软件SPSS20.0对全部数据进行相关统计分析,对本方的临床疗效作出评价。研究结果:①中医证候积分的比较:中西药组、纯西药组组内治疗前后对比,证候积分均有下降,差异具有统计学意义(P0.05)。两组治疗前后积分差值对比,差异有统计学意义(P0.05),中西药组中医证候较纯西药组改善更为明显。②两组证候疗效比较:中西药组25例,治愈2例,显效7例,有效13例,无效3例,总有效率88.00%;纯西药组25例,治愈0例,显效3例,有效16例,无效6例,总有效率76.00%。中西药组疗效优于纯西药组,差异具有统计学意义(P0.05)。③两组肝功能比较:治疗后中西药组与纯西药组肝功能均较治疗前有改善,差异具有统计学意义(P0.05);治疗后两组间肝功能比较,除白蛋白水平外,差异均有统计学意义(P0.05),且中西药组改善程度优于纯西药组。④两组HBV-DNA比较:两组治疗后HBV-DNA水平均较治疗前降低,差异具有统计学意义(P0.05);治疗后两组HBV-DNA水平比较,差异无统计学意义(P0.05),中西药组在降低HBV-DNA水平上无明显优越性。⑤两组MFI-20总分比较:两组治疗后MFI-20得分均较治疗前降低,差异具有统计学意义(P0.01)。治疗后,两组间MFI-20总分比较,差异有统计学意义(P0.05),中西药组得分较纯西药组下降更明显。两组心理疲劳、躯体疲劳、精神疲劳评分均较治疗前下降,差异有统计学意义(P0.01)。治疗后,中西药组在躯体疲劳、精神疲劳评分较纯西药组改善程度更大,差异有统计学意义(P0.05)。⑥多维疲劳评分量表与肝功能的相关性分析:多维疲劳评分量表总分情况与肝功能(ALT、AST、TB)水平呈正相关,具有统计学意义(P0.05)。多维疲劳评分量表总分情况与ALB无明显相关性(P0.05)。研究结论:疏肝健脾解毒方治疗肝郁脾虚、正虚邪恋型代偿期乙肝肝硬化患者的临床疗效肯定,与单纯西药治疗相比,可显著改善患者疲劳症状,并能改善多维疲劳量表得分、肝功能、白蛋白、胆红素、HBV-DNA等指标,提高临床有效率,且临床应用安全性良好,值得推广应用。肝功能水平与多维疲劳量表得分呈正相关,改善患者肝功能水平,可降低患者多维疲劳量表得分及改善患者疲劳症状。
[Abstract]:Objective: to evaluate the clinical efficacy of Shugan Jianpi jiedu recipe in treating patients with liver stagnation and spleen deficiency and compensatory hepatitis B cirrhosis by observing the changes of observation indexes before and after treatment. Methods: according to the inclusive criteria and exclusion criteria, 50 patients with liver stagnation and spleen deficiency, positive deficiency and evil love were selected. According to the method of random number table, they were divided into Chinese and western medicine group (25 cases) and pure western medicine group (25 cases). The pure western medicine group was treated with enticavir maleate tablets (Tianding), the Chinese and western medicine group was treated with Shugan Jianpi jiedu recipe on the basis of oral western medicine, the course of treatment was 12 weeks. The changes of TCM syndromes score, multi-dimensional fatigue scale (MFI-20), liver function, HBV-DNA index and adverse reactions were observed before and after treatment, and the correlation between MFI-20 score and liver function was evaluated. Statistical software SPSS20.0 was used to analyze all the data and evaluate the clinical effect. Results: 1 comparison of TCM syndromes integral: the traditional Chinese medicine group, pure western medicine group before and after treatment, syndromes integral decreased, the difference was statistically significant (P0.05). The difference between the two groups before and after treatment, the difference was statistically significant (P0.05), the TCM syndromes were improved more obviously in the traditional Chinese medicine group than in the pure western medicine group. 2 comparison of the curative effect of the two groups: 25 cases in the traditional Chinese medicine group, 2 cases in cure, 7 cases in remarkable effect, 2 cases in traditional Chinese medicine group, 2 cases in cure group, 7 cases in western medicine group. 13 cases were effective, 3 cases were ineffective, the total effective rate was 88.00%. There were 25 cases in pure western medicine group, 0 cases were cured, 3 cases were markedly effective, 16 cases were effective, 6 cases were ineffective, the total effective rate was 76.00%. The curative effect of Chinese and western medicine group was better than that of pure western medicine group, the difference was statistically significant (P0.05). 3 comparison of liver function between the two groups: after treatment, the liver function of Chinese and western medicine group and pure western medicine group were improved compared with that before treatment, the difference was statistically significant (P0.05); After treatment, there were significant differences in liver function between the two groups except albumin level (P0.05). And the improvement degree of Chinese and western medicine group is better than that of pure western medicine group. 4 comparison of HBV-DNA between the two groups: after treatment, the level of HBV-DNA in the two groups was lower than that before treatment, the difference was statistically significant (P0.05); There was no significant difference in the level of HBV-DNA between the two groups after treatment (P0.05). There was no obvious superiority in reducing the level of HBV-DNA in the Chinese and western medicine group. 5 comparison of total MFI-20 scores between the two groups: the MFI-20 scores of the two groups after treatment were lower than those before treatment. The difference was statistically significant (P0.01). After treatment, the total score of MFI-20 between the two groups, the difference was statistically significant (P0.05), the scores of Chinese and western medicine group than pure western medicine group decreased more significantly. The scores of mental fatigue, body fatigue and mental fatigue in the two groups were significantly lower than those before treatment (P0.01). After treatment, the scores of somatic fatigue and mental fatigue in the Chinese and western medicine group were better than those in the pure western medicine group. 6 correlation analysis between multidimensional fatigue score scale and liver function: the total score of multidimensional fatigue score scale was positively correlated with the level of liver function (ALT,AST,TB), and had statistical significance (P0.05). There was no significant correlation between the total score of multi-dimensional fatigue score and ALB (P 0.05). Conclusion: the clinical effect of Shugan Jianpi jiedu recipe in treating liver stagnation and spleen deficiency, positive deficiency and evil love in compensatory hepatitis B cirrhosis patients is definite. Compared with western medicine alone, it can significantly improve the fatigue symptoms of the patients and improve the scores of multidimensional fatigue scale. The indexes of liver function, albumin, bilirubin and HBV-DNA can improve the clinical effective rate, and the safety of clinical application is good, so it is worth popularizing. The level of liver function was positively correlated with the score of multi-dimensional fatigue scale. Improving the level of liver function could reduce the score of multi-dimensional fatigue scale and improve the fatigue symptoms of patients.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259
本文编号：2379615
[Abstract]:Objective: to evaluate the clinical efficacy of Shugan Jianpi jiedu recipe in treating patients with liver stagnation and spleen deficiency and compensatory hepatitis B cirrhosis by observing the changes of observation indexes before and after treatment. Methods: according to the inclusive criteria and exclusion criteria, 50 patients with liver stagnation and spleen deficiency, positive deficiency and evil love were selected. According to the method of random number table, they were divided into Chinese and western medicine group (25 cases) and pure western medicine group (25 cases). The pure western medicine group was treated with enticavir maleate tablets (Tianding), the Chinese and western medicine group was treated with Shugan Jianpi jiedu recipe on the basis of oral western medicine, the course of treatment was 12 weeks. The changes of TCM syndromes score, multi-dimensional fatigue scale (MFI-20), liver function, HBV-DNA index and adverse reactions were observed before and after treatment, and the correlation between MFI-20 score and liver function was evaluated. Statistical software SPSS20.0 was used to analyze all the data and evaluate the clinical effect. Results: 1 comparison of TCM syndromes integral: the traditional Chinese medicine group, pure western medicine group before and after treatment, syndromes integral decreased, the difference was statistically significant (P0.05). The difference between the two groups before and after treatment, the difference was statistically significant (P0.05), the TCM syndromes were improved more obviously in the traditional Chinese medicine group than in the pure western medicine group. 2 comparison of the curative effect of the two groups: 25 cases in the traditional Chinese medicine group, 2 cases in cure, 7 cases in remarkable effect, 2 cases in traditional Chinese medicine group, 2 cases in cure group, 7 cases in western medicine group. 13 cases were effective, 3 cases were ineffective, the total effective rate was 88.00%. There were 25 cases in pure western medicine group, 0 cases were cured, 3 cases were markedly effective, 16 cases were effective, 6 cases were ineffective, the total effective rate was 76.00%. The curative effect of Chinese and western medicine group was better than that of pure western medicine group, the difference was statistically significant (P0.05). 3 comparison of liver function between the two groups: after treatment, the liver function of Chinese and western medicine group and pure western medicine group were improved compared with that before treatment, the difference was statistically significant (P0.05); After treatment, there were significant differences in liver function between the two groups except albumin level (P0.05). And the improvement degree of Chinese and western medicine group is better than that of pure western medicine group. 4 comparison of HBV-DNA between the two groups: after treatment, the level of HBV-DNA in the two groups was lower than that before treatment, the difference was statistically significant (P0.05); There was no significant difference in the level of HBV-DNA between the two groups after treatment (P0.05). There was no obvious superiority in reducing the level of HBV-DNA in the Chinese and western medicine group. 5 comparison of total MFI-20 scores between the two groups: the MFI-20 scores of the two groups after treatment were lower than those before treatment. The difference was statistically significant (P0.01). After treatment, the total score of MFI-20 between the two groups, the difference was statistically significant (P0.05), the scores of Chinese and western medicine group than pure western medicine group decreased more significantly. The scores of mental fatigue, body fatigue and mental fatigue in the two groups were significantly lower than those before treatment (P0.01). After treatment, the scores of somatic fatigue and mental fatigue in the Chinese and western medicine group were better than those in the pure western medicine group. 6 correlation analysis between multidimensional fatigue score scale and liver function: the total score of multidimensional fatigue score scale was positively correlated with the level of liver function (ALT,AST,TB), and had statistical significance (P0.05). There was no significant correlation between the total score of multi-dimensional fatigue score and ALB (P 0.05). Conclusion: the clinical effect of Shugan Jianpi jiedu recipe in treating liver stagnation and spleen deficiency, positive deficiency and evil love in compensatory hepatitis B cirrhosis patients is definite. Compared with western medicine alone, it can significantly improve the fatigue symptoms of the patients and improve the scores of multidimensional fatigue scale. The indexes of liver function, albumin, bilirubin and HBV-DNA can improve the clinical effective rate, and the safety of clinical application is good, so it is worth popularizing. The level of liver function was positively correlated with the score of multi-dimensional fatigue scale. Improving the level of liver function could reduce the score of multi-dimensional fatigue scale and improve the fatigue symptoms of patients.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259
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