“逍遥散加减”对慢性乙型肝炎“湿瘀郁络证”临床疗效研究

发布时间：2018-01-21 16:03

本文关键词： 肝炎乙型慢性肝纤维化久病入络抗病毒抗肝纤维化免疫调节　出处：《浙江中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的观察“逍遥散加减”对慢性乙型肝炎抗肝纤维化及抗病毒的疗效,总结名老中医学术经验。研究方法将符合纳入标准的60名患者,采用随机数字表法分为治疗组和对照组,每组各30例,治疗组采用恩替卡韦片联合“逍遥散加减方”,对照组单用恩替卡韦片。中药每日一剂,每剂煎200ml,早晚两次分服;恩替卡韦片(博路定),每日0.5mg一次口服(博路定-中美上海施贵宝生产,规格0.5mg/片)。疗程为48周,对比LSM、FIB-4指数、肝纤维化四项,血清HBsAg含量、E抗原、HBV-DNA载量,ALT、C3、C4、IgG、CD19、CD3+4阳性T细胞(CD4)、CD3+8阳性T细胞(CD8)等情况。研究结果(1)生化、病毒血清、免疫学相关指标:治疗48周后比较,ALT:与基线比较,两组的ALT值均能得到显著改善,与对照组比较,治疗组在疗程及疗效上更突显优势,差异有统计学意义(P0.05)。肝纤维化四项:与基线比较,两组纤维化四项均有下降(P0.05),与对照组比较,治疗组对肝纤维四项的改善更明显(P0.05)。HBsAg含量:与基线比较,两组均有改善(P0.05);与对照组比较差异无统计学意义(P0.05)。e抗原:与对照组比较,48周治疗组e抗原血清学转换率高(P0.05)。HBV-DNA载量:与基线比较,两组HBVDNA明显下降,差异均有统计学意义(P0.05),与对照组比较,治疗组结果亦有统计学差异(P0.05)。FIB-4:与基线比较,两组FIB-4均有改善(P0.05),与对照组比较,治疗组在疗程及疗效上差异更明显(P0.01)。CD4、CD8:与基线以及对照组比较,48周后治疗组血清CD4、CD8水平升高,差异均有统计学意义(P0.05)。C3、C4:与基线比较,48周后治疗组补体C3、C4、水平升高;与对照组比较,治疗组C3在48周后增高,差异均有统计学意义(P0.05)。IgG:与对照组比较,治疗后组血清IgG含量降低,差异有统计学意义(P0.05)。(2)影像学指标:LSM:与基线比较,48周后两组肝脏硬度均下降,差异有统计学意义(P0.05),与对照组比较,治疗组48周后肝硬度改善更确切,差异有统计学意义(P0.05)。(3)中医量化积分判定疗效:治疗48周后,与对照组比较,治疗组总显效率显著高于对照组(P0.001)。研究结论(1)逍遥散加减治疗经ETV抗病毒的CHB患者对肝纤维化有良好的改善、缓解作用。(2)“中西联合”治疗CHB患者抗肝纤维化疗效及抗病毒作用较单用抗病毒药治疗优越,更能改善CHB患者生活质量。(3)LSM、FIB-4值与HBsAg含量、HBV-DNA载量有一定的的科学正性相关性,可以从HBsAg含量、HBV-DNA载量间接预测肝纤维化程度。(4)CD4、CD8、C3、C4水平以及IgG反映体液免疫和细胞免疫在CHB疾病过程中发挥作用,中药可以从体液免疫和细胞免疫双方调节机体免疫功能而发挥抗纤维化和抗病毒作用。(5)施**教授辨治慢乙肝肝纤维化的理、法、方、药特点:病因涵盖“邪毒、瘀、湿、滞、热”;病位涉及中下焦气分、血分;病机包括肝脾不调、湿瘀入络、络分气血不足;方药以逍遥散等为主随证治之。
[Abstract]:Objective to observe the curative effect of "Xiaoyao San" on chronic hepatitis B (CHB) and to summarize the academic experience of old Chinese medicine (TCM). The research method will meet the inclusion criteria of 60 patients. The treatment group was divided into treatment group and control group with 30 cases in each group. The treatment group was treated with entecavir tablets combined with "Xiaoyao San decoction", and the control group was only treated with entecavir tablet once a day. Each dose fried 200ml, morning and evening twice divided; Entecavir tablets (Borudine, 0.5mg per day) were produced in Shanghai, China, with a specification of 0.5mg / tablet. The course of treatment was 48 weeks, compared with the LSM FIB-4 index. The contents of serum HBsAg and HBV-DNA in serum of liver fibrosis were compared with that of T cell CD19, CD34 positive T cell (CD19 + CD34). CD3 8 positive T cell CD8). The results were as follows: biochemical, viral serum and immunological indexes: after 48 weeks of treatment, alt was compared with baseline. Compared with the control group, the treatment group had more significant advantages in the course of treatment and curative effect, the difference was statistically significant (P 0.05). Four items of hepatic fibrosis: compared with baseline. Compared with the control group, the improvement of liver fiber in the treatment group was more obvious than that in the control group. The content of P0.05 + HBsAg in the treatment group was higher than that in the baseline. The improvement of P0.05 was found in both groups. Compared with the control group, there was no significant difference in P0.05. E antigen: compared with the control group. At 48 weeks, the serological conversion rate of e antigen in the treatment group was higher than that in the control group (P 0.05). HBV-DNA load: compared with the baseline, the HBVDNA of the two groups was significantly lower than that of the baseline, and the difference was statistically significant (P 0.05). Compared with the control group, the results of the treatment group were also statistically different. FIB-4: compared with the baseline, the two groups of FIB-4 improved P0.05, compared with the control group. Compared with baseline group and control group, the serum CD4 + CD8 level in treatment group was higher than that in baseline and control group after 48 weeks. The difference was statistically significant (P 0.05). C3C4: compared with baseline, the level of C3C4 in the treatment group increased after 48 weeks. Compared with the control group, C3 in the treatment group increased after 48 weeks, the difference was statistically significant (P 0.05). Compared with the control group, the serum IgG content in the treatment group was lower than that in the control group. The difference was statistically significant (P0.05n. 2) Imaging index: LSM: compared with the baseline, the liver hardness of the two groups decreased after 48 weeks, and the difference was statistically significant (P0.05). Compared with the control group, the improvement of liver hardness in the treatment group was more accurate after 48 weeks, the difference was statistically significant (P 0.05. 01. 3) the therapeutic effect was determined by the quantitative integral of TCM: after 48 weeks of treatment, the treatment group was compared with the control group. The total effective rate in the treatment group was significantly higher than that in the control group (P 0.001). Conclusion: Xiaoyao Powder has a good improvement on liver fibrosis in CHB patients treated with ETV antivirus. The effect of "Chinese and Western combination" in treating CHB patients with liver fibrosis and antiviral effects is superior to that of antiviral drugs alone, and can improve the quality of life of patients with CHB. There is a scientific positive correlation between FIB-4 and HBsAg content and HBV-DNA load, which can be derived from the content of HBsAg. The HBV-DNA load indirectly predicted the degree of hepatic fibrosis. The level of CD8C3N4 and IgG reflect the role of humoral immunity and cellular immunity in the process of CHB disease. Traditional Chinese medicine can regulate the immune function of both humoral and cellular immunity and exert anti-fibrosis and antiviral effects. Drug characteristics: the etiology covers "evil poison, stasis, dampness, stagnation, heat"; The disease location involves middle and lower pyrogas, blood; The pathogenesis includes liver and spleen unregulation, dampness and blood stasis into the collaterals, insufficient collaterals and qi and blood; Prescription to Xiaoyao Powder and other main with the treatment of syndrome.
【学位授予单位】：浙江中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62

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