肝乐颗粒联合西药治疗慢性乙型肝炎（肝郁脾虚型）临床疗效观察

发布时间：2018-04-25 06:09

  本文选题：慢乙肝 + 肝郁脾虚　； 参考：《安徽中医药大学》2017年硕士论文

【摘要】：1目的通过对肝乐颗粒联合恩替卡韦在肝郁脾虚型慢性乙型肝炎(Chronic Hepatitis B,CHB)临床治疗中作用研究,观察肝乐颗粒对慢乙肝患者临床症状及实验室指标的影响,评价肝乐颗粒的安全性及疗效,探讨肝乐颗粒在慢乙肝治疗中的可能作用机制,为中西医结合治疗慢乙肝提供新的治疗策略,为今后中医临床优化治疗慢乙肝提供更多的选择和科学依据。2方法选取60名慢性HBV感染肝郁脾虚证患者,随机分为对照组与治疗组,治疗组予恩替卡韦联合肝乐颗粒治疗,对照组仅予恩替卡韦治疗。分别于治疗前、治疗24w、治疗48w后观察两组患者中医症状、肝功能(ALT、AST、GGT、AKP、TBIL、ALB)、HBsAg、HBV DNA、肝纤四项(HA、LN、PⅢNP、CⅣ)及相关安全性指标。评估肝乐颗粒治疗慢乙肝的即时疗效。3结果3.1两组治疗后均可明显改善患者总体中医证候,且治疗48w后明显优于治疗24w后(P0.01);两组对比,治疗组对总体中医证候改善明显优于对照组(P0.05)。3.2治疗组治疗24w及48w后在所有症状改善均优于治疗前(P0.05);治疗24w后与治疗48w后比较,治疗48w后在胸胁胀痛、纳差、胃脘胀满、口淡、便溏、嗳气、乳房胀痛改善优于治疗24w后(P0.05),在善太息、乏力、舌脉方面无可比性,差异无统计学意义(P0.05)。3.3对照组治疗24w后,除乳房胀痛外(P0.05),其他症状改善优于未治疗前(P0.05);治疗48w后所有症状改善均优于治疗前(P0.05);治疗24w后与治疗48w后比较,治疗48w后除舌脉外(P0.05),其他症状改善优于治疗24w后(P0.05)。3.4两组治疗24w后比较,治疗组在善太息、胃脘胀满、乏力、口淡、便溏改善方面优于对照组(P0.05),在胸胁胀痛、纳差、嗳气、乳房胀痛、舌脉方面无可比性(P0.05);治疗48w后比较,治疗组在善太息、胃脘胀满、乏力、口淡、便溏改善方面优于对照组(P0.05),在胸胁胀满、纳差、嗳气、乳房胀痛、舌脉方面无可比性(P0.05)。3.5治疗24w及48w后,治疗组总有效率明显优于对照组(P0.01)。3.6治疗组治疗24w及48w后在各个实验室指标方面改善均明显优于治疗前(P0.01);治疗24w与治疗48w后比较,治疗48w后ALB、HBsAg、肝纤四项方面改善优于治疗24w后(P0.05)。3.7对照组治疗24w及48w后在各个实验室指标方面均明显优于治疗前(P0.01);治疗24w与治疗48w后比较,治疗48w后HBsAg、肝纤四项改善优于治疗24w后(P0.05)。3.8两组治疗24w后比较,治疗组在肝纤四项方面改善优于对照组(P0.05);治疗48w后比较,治疗组在肝纤四项及TBIL方面改善优于对照组(P0.05)。3.9两组治疗前后安全性指标均在医学参考值范围内波动,治疗前后无明显变化,无统计学意义。4结论4.1在西医抗病毒的基础上联合肝乐颗粒治疗肝郁脾虚型慢性乙型肝炎疗效确切,肝乐颗粒可有效改善患者临床症状及中医证候。4.2肝乐颗粒可降低患者TBIL及肝纤四项指标,但具体作用机制仍需进一步探讨。4.3肝乐颗粒临床应用无明显不良反应,安全性良好。
[Abstract]:Objective to study the effect of Ganle granule combined with entecavir on the clinical treatment of chronic hepatitis B patients with chronic hepatitis B with liver stagnation and spleen deficiency, and to observe the effect of Ganle granule on the clinical symptoms and laboratory indexes of patients with chronic hepatitis B. To evaluate the safety and efficacy of Ganle granule, to explore the possible mechanism of Ganle granule in the treatment of chronic hepatitis B, and to provide a new therapeutic strategy for the treatment of chronic hepatitis B with integrated Chinese and western medicine. Methods 60 patients with chronic HBV infection with liver stagnation and spleen deficiency syndrome were randomly divided into control group and treatment group. The treatment group was treated with entecavir combined with Ganle granule. The control group was treated only with entecavir. Before treatment, 24 weeks after treatment and 48 weeks after treatment, the TCM symptoms, liver function of the two groups were observed, and the related safety indexes were measured. The liver function of the two groups was compared with that of the control group. The liver function of the two groups was compared with that of the control group. The liver function of the two groups was compared with that of the control group. The liver function of the two groups was compared with that of the control group. The liver function of the two groups was compared with that of the control group. Evaluation of the immediate curative effect of Ganle granule on chronic Hepatitis B results 3.1 after treatment, both groups could obviously improve the overall TCM syndromes of the patients, and after 48 weeks of treatment, it was significantly better than that after 24 weeks of treatment (P 0.01), and the two groups were compared with each other. The improvement of TCM syndromes in the treatment group was obviously better than that in the control group at 24 and 48 weeks after treatment, and after 24 weeks and 48 weeks, the symptoms in the treatment group were better than those in the control group after 24 weeks and 48 weeks respectively, and after 24 weeks and 48 weeks, the symptoms of the treatment group were significantly better than those of the control group, and after 48 weeks of treatment, the symptoms of the treatment group were significantly better than those of the control group. The improvement of loose stools, belching and breast distending pain was better than that of P0.05 after 24 weeks of treatment. The difference was not statistically significant after 24 weeks of treatment in the control group. With the exception of breast distending pain, the improvement of other symptoms was better than that before treatment (P 0.05); after 48 weeks of treatment, all symptoms were improved better than that before treatment (P 0.05); after 24 weeks of treatment, it was compared with that after 48 weeks of treatment. After 48 weeks of treatment, the improvement of other symptoms was better than that of the two groups after 24 weeks of treatment. The treatment group was superior to the control group in terms of good information, full stomach distension, fatigue, light mouth, loose stools, pain in chest and flank, anorexia, belching, and the improvement of loose stools was better than that of the control group in the improvement of P0.05, and the improvement of other symptoms was better than that of the control group after 24 weeks of treatment, and that of the treatment group was better than that of the control group. After 48 weeks of treatment, the treatment group was superior to the control group in terms of good rest, full stomach distension, fatigue, light mouth, loose stool improvement, full chest distention, anorexia, belching, and breast distending pain. After 24 and 48 weeks of treatment, the total effective rate of the treatment group was significantly better than that of the control group after 24 weeks and 48 weeks of treatment, and the improvement of each laboratory index in the treatment group was significantly better than that in the control group at 24 weeks and 48 weeks after treatment, and at 24 weeks after treatment and 48 weeks after treatment, the total effective rate of the treatment group was significantly better than that of the control group. After 48 weeks of treatment, the improvement of four aspects of ALB HBsAg and liver fiber was better than that of 24 weeks after treatment and 48 weeks after treatment. The control group was significantly better than the control group in each laboratory index after 24 weeks and 48 weeks, and 24 weeks after treatment and 48 weeks after treatment, the improvement of liver fiber was significantly better than that of 24 weeks after treatment and 48 weeks after treatment. After 48 weeks of treatment, the four improvements of HBsAg and liver fiber were better than those of the two groups after 24 weeks of treatment (P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, respectively), and the improvement of liver fibrils in the treatment group was better than that in the control group, and after 48 weeks, the improvement was better in the treatment group. The improvement of liver fiber and TBIL in the treatment group was better than that in the control group (P 0.05N. 3.9). The safety indexes of the two groups fluctuated within the medical reference value before and after treatment, but there was no obvious change before and after treatment. Conclusion 4.1 on the basis of western medicine antiviral therapy combined with Ganle granule is effective in the treatment of chronic hepatitis B with liver stagnation and spleen deficiency. Ganle granule can effectively improve the clinical symptoms of patients and TCM syndromes .4.2 Ganle granule can reduce the TBIL and liver fiber four indexes, but the specific mechanism still need to further explore the clinical application of .4.3 Ganle granule no obvious adverse reactions, good safety.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62

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