柔肝化纤颗粒联合BMSCs治疗乙肝肝硬化肝肾阴虚证的临床观察

发布时间：2018-06-07 01:32

本文选题：柔肝化纤颗粒 + 骨髓间充质干细胞移植　；参考：《广西中医药大学》2017年硕士论文

【摘要】：目的:本研究重点探讨柔肝化纤颗粒联合骨髓间充质干细胞治疗乙肝肝硬化肝肾阴虚证的临床疗效及安全性,以期为中医药干预骨髓间充质干细胞移植治疗乙肝肝硬化提供临床依据。方法:采用随机分组的方法,选取符合纳入标准的乙肝肝硬化肝肾阴虚证患者90例。随机分为2组,各45例,对照组予常规内科综合治疗及自体骨髓间充质干细胞移植,治疗组在对照组的基础上给予柔肝化纤颗粒治疗。观察两组在治疗后4周、12周、24周、48周肝功能(ALT、AST、TBIL、ALB)和凝血功能指标变化以及治疗前后肝脏MRI-DWI的ADC值的变化。结果:(1)治疗组41例,总有效率90.24%,对照组42例,总有效率为71.43%,两组比较有明显差异(P0.05),柔肝化纤颗粒可以提高骨髓间充质干细胞移植治疗乙肝肝硬化(肝肾阴虚证)的临床疗效,改善患者临床症状。(2)在改善肝脏功能方面:在治疗后第4周,治疗组ALT、AST指标下降较对照组明显,差异具有统计学意义(P0.05);在治疗后第12周、24周、48周,治疗组患者在改善ALT、AST、TBIL、ALB指标方面优于对照组,差异有统计学意义(P0.05或P0.01)。在治疗第24周、48周后,治疗组在改善凝血功能方面较对照组明显,差异具有统计学意义(P0.05),提示柔肝化纤颗粒可以改善骨髓间充质干细胞移植患者的肝脏功能。(3)在延缓肝纤维化进展方面:两组治疗后ADC值与治疗前相比均有所上升,差异具有统计学意义(P0.01)。在治疗后第48周复查MRI-DWI,治疗组的ADC值上升至1.38±0.02(×10㧟3mm2/s),对照组ADC值上升至1.37±0.01(×10㧟3mm2/s),差异具有统计学意义(P0.05)。提示骨髓间质干细胞移植可以延缓乙肝肝硬化患者肝纤维化进程,柔肝化纤颗粒可以进一步提高其移植治疗效果。(4)安全性:两组的移植患者在术中及术后均未发生严重不良反应及细胞移植的并发症,提示柔肝化纤颗粒联合骨髓间质干细胞移植安全可靠。结论:(1)测量的ADC值与肝功能常规检查的标志物有一定关联性,肝脏功能改善时,ADC值会随之升高。(2)骨髓间质充干细胞移植可以改善患者的肝脏功能、延缓肝纤维化进展,柔肝化纤颗粒可以提高其移植治疗效果。(3)柔肝化纤颗粒联合骨髓间充质干细胞治疗乙肝肝硬化肝肾阴虚证患者较安全,无明显不良反应。
[Abstract]:Objective: This study focuses on the clinical efficacy and safety of the combination of soft liver and chemical fiber particles combined with bone marrow mesenchymal stem cells in the treatment of liver and kidney yin deficiency syndrome of hepatitis B liver cirrhosis, in order to provide a clinical basis for the intervention of bone marrow mesenchymal stem cell transplantation in the treatment of hepatitis B cirrhosis. 90 patients with liver kidney yin deficiency syndrome of liver cirrhosis were randomly divided into 2 groups, each 45 cases, the control group was given conventional comprehensive treatment and autologous bone marrow mesenchymal stem cell transplantation, and the treatment group was treated with soft liver chemical Granule on the basis of the control group. The liver function (ALT, AST, TBIL, ALB) and coagulation function indexes were observed at 4 weeks, 12 weeks, 24 weeks and 48 weeks after treatment. Changes and changes in the ADC value of liver MRI-DWI before and after treatment. Results: (1) 41 cases in the treatment group, the total effective rate is 90.24%, the control group 42 cases, the total effective rate is 71.43%, the two groups have obvious difference (P0.05), the soft liver chemical fiber granule can improve the clinical effect of the bone marrow mesenchymal stem cell transplantation for hepatitis B liver cirrhosis (liver kidney yin deficiency syndrome) and improve the patients. Clinical symptoms. (2) in the improvement of liver function: in the fourth week after treatment, the treatment group ALT, AST index decreased significantly than the control group, the difference was statistically significant (P0.05). After twelfth weeks, 24 weeks, 48 weeks after treatment, the treatment group was better than the control group in the improvement of ALT, AST, TBIL, ALB. The difference was statistically significant (P0.05 or P0.01). In the treatment of the first group. 24 weeks, 48 weeks later, the treatment group was better than the control group in improving the coagulation function, the difference was statistically significant (P0.05), suggesting that the soft liver chemical fiber granule could improve the liver function of the patients with bone marrow mesenchymal stem cells transplantation. (3) to delay the progression of liver fibrosis: the value of ADC was higher after treatment than before treatment. Statistical significance (P0.01). The ADC value of the treatment group increased to 1.38 + 0.02 (x 10? 3mm2/s) in the treatment group forty-eighth weeks after treatment. The ADC value of the control group increased to 1.37 + 0.01 (x 10? 3mm2/s), and the difference was statistically significant (P0.05). It suggested that the transplantation of mesenchymal stem cells could delay the process of liver fibrosis in patients with hepatitis B liver cirrhosis, and the soft liver chemical fiber granules could be used. In order to further improve the effect of transplantation treatment. (4) safety: two groups of transplanted patients had no serious adverse reactions and cell transplantation complications during and after operation, suggesting that the combination of Soft Liver chemical fiber particles and bone marrow mesenchymal stem cells transplantation was safe and reliable. Conclusion: (1) the ADC value measured is related to the marker of liver function routine examination. When the liver function is improved, the ADC value will increase. (2) bone marrow mesenchymal stem cell transplantation can improve the liver function of the patients and delay the progress of liver fibrosis. (3) the combination of Soft Liver chemical fiber particles and bone marrow mesenchymal stem cells in the treatment of hepatitis B liver kidney yin deficiency syndrome patients with hepatitis B liver cirrhosis is safer and less clear. Adverse reaction.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62;R575.2

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