败黄肝宁合剂联合思美泰治疗乙肝肝硬化黄疸（湿热瘀阻型）的疗效观察

发布时间：2018-05-03 05:06

本文选题：败黄肝宁合剂 + 思美泰　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的通过随机对照研究,观察败黄肝宁合剂联合思美泰治疗乙肝肝硬化黄疸(湿热瘀阻型)的临床疗效及应用安全性。方法1.分组方法:将90例在武汉市中西医结合医院消化科门诊及肝病门诊就诊,诊断为乙型肝炎后肝硬化黄疸(湿热瘀阻型)并符合入组标准的患者,根据随机分配原则分成三组,分为中西药联合组(败黄肝宁合剂+思美泰组)、西药组(思美泰组)和中药组(败黄肝宁合剂组),每组各30例。2.治疗方案:三组均用基础治疗(保肝药物用还原型谷胱甘肽;并常规予以恩替卡韦抗病毒治疗,必要时输注血浆或白蛋白等对症支持治疗)。中西药联合组在基础治疗的同时给予口服思美泰片(丁二磺酸腺苷蛋氨酸肠溶片,每次500mg,每天两次)和败黄肝宁合剂(组成:茵陈、栀子、大黄、龙胆草、赤芍、败酱草、白茅根、金钱草、北柴胡、厚朴、山楂、神曲、炙甘草。每次50ml,每日两次)。西药组在基础治疗上加思美泰口服(每次500mg,每天两次)治疗。中药组在基础治疗上加本院自制中药复方制剂败黄肝宁合剂(每次50ml,每日两次)进行治疗。三组疗程均为4周。3.观察指标:观察三组治疗前后主要中医症候变化,肝功能指标变化(包括TBIL、TBA、ALT、AST、γ-GT、ALP,主要为TBIL、γ-GT),安全性指标变化,并根据相应疗效评价标准,作出疗效评价。同时观察三组治疗过程中的不良反应。4.统计方法:使用SPSS 17.0统计学软件对数据进行统计学分析,记录所有数据。计量资料均以(?x±s)表示,组间比较采用单因素方差分析,组内治疗前后比较采用配对t检验;计数资料以例数或百分比(%)表示,采用χ~2检验,等级资料采用H检验,两两比较用Nemenyi检验。以p0.05为差异具有统计学意义,p0.05为无统计学意义。结果1.综合疗效评价:中西药联合组总有效率为89.3%,西药组总有效率为46.7%,中药组总有效率为48.3%。组间比较,西药组与中药组总有效率差异无统计学意义(p0.05)。中西药联合组总有效率优于中药组及西药组,差异具有统计学意义(p0.05)。2.肝功能指标变化:经过4周治疗,三组在治疗后肝功能指标(tbil、alt、ast、tba、γ-gt、alp)均有明显改善,与治疗前相比差异具有统计学意义(p0.05);疗程结束后,西药组与中药组肝功能指标差异无统计学意义(p0.05),而中西药联合组肝功能指标明显低于西药组和中药组,且差异具有统计学意义(p0.05)。3.各单项中医症状评分比较:三组治疗后单项症状均有改善,与治疗前相比差异具有统计学意义(p0.05)。对治疗后三组结果比较,中西药联合组各症状评分较中药组和西药组低,且差异均有统计学意义(p0.05),中药组各症状评分与西药组比较,身目黄染、小便黄赤、恶心呕吐、倦怠乏力的症状评分无差异(p0.05),而脘腹胀闷、胁肋疼痛、食欲不振、口干口苦的症状评分在中药组更低,且差异具有统计学意义(p0.05)。4.治疗前后中医症候总积分比较:治疗前三组症候总积分差异无统计学意义(p0.05),三组在治疗后积分均有所下降且差异具有统计学意义(p0.05),中西药联合组症候总积分明显低于中药组及西药组且差异具有统计学意义(p0.05),中药组症候总积分较西药组低且差异有统计学意义(p0.05)。5.安全性观察:各组患者生命体征平稳,血尿粪三大常规、肾功能、凝血功能、电解质、肝胆彩超等均未出现明显变化,2例病例出现轻微腹泻,停药后好转,其它病例均未出现明显的不良反应及副作用。结论:败黄肝宁合剂联合思美泰治疗肝硬化黄疸(湿热瘀阻型),在退黄、促进肝功能恢复、改善中医症候等方面均取得了良好的效果,且疗效明显优于单用西药及单用中药,说明败黄肝宁合剂和思美泰具有协同治疗作用,且安全性高。
[Abstract]:Objective To observe the clinical efficacy and safety of the treatment of hepatitis B liver cirrhosis jaundice (damp heat stasis type) in the treatment of liver cirrhosis and jaundice (damp heat stasis type) in the treatment of hepatitis B cirrhosis by a randomized controlled study. Methods 1. groups of methods: 90 cases were diagnosed as jaundice of liver cirrhosis after hepatitis B (damp heat stasis) in the outpatient and liver disease out-patient of Wuhan integrated traditional Chinese and Western medicine. The patients were divided into three groups according to the principle of random distribution. They were divided into three groups according to the principle of random distribution, which were divided into two groups: the combination group of Chinese and Western Medicine (Huang Ganning mixture + Si), the western medicine group (MATTEL group) and the Chinese Medicine group (the group of the Huang Gan Ning Mixture), each group had 30 cases of.2. treatment: the three groups were treated with the basic treatment for the liver and the glutathione. At the same time, the combination group of Chinese and Western medicine combined with oral MATTEL tablets (adenosine methionine methionine enteric coated tablets two, each time 500mg, two times a day) and Huang Gan Ning Mixture (composition: Artemisia capillaris, gardenia, rhubarb, gentian, Radix Paeoniae, Rhizoma Paeoniae, Rhizoma Alba root). Strychna, bupleurum, haw, hawthorn, Crataegus, Divine Comedy and licorice. Every time 50ml, two times a day). The western medicine group was treated with Garth MATTEL (500mg every time, every day) on basic treatment. The Chinese medicine group was treated by the Chinese medicine group in the basic treatment. The Chinese medicine compound preparation was treated by the compound preparation of Chinese herbal medicine (50ml each time, two times a day). The three courses were all 4 weeks.3. view. Inspection index: the changes of the main TCM syndrome before and after treatment were observed, and the changes of liver function indexes (including TBIL, TBA, ALT, AST, -GT, ALP, TBIL, gamma -GT), the changes of the safety indexes, and the evaluation of the curative effect according to the evaluation criteria of the corresponding curative effect. Meanwhile, the statistical methods of adverse reactions in the three groups were observed: using SPSS 17 statistics. The data were statistically analyzed and all the data were recorded. The measurement data were expressed as (? X + s). The single factor variance analysis was used in the group. The paired t test was used before and after the treatment in the group. The count data were represented by the number or percentage (%), using the chi square ~2 test, the H test for the grade data, and the Nemenyi test in 22. P0.05 was used as the test. The difference was statistically significant, P0.05 was not statistically significant. Results 1. comprehensive efficacy evaluation: the total effective rate of Chinese and Western medicine combined group was 89.3%, the total effective rate of Western medicine group was 46.7%, the total effective rate of the Chinese medicine group was compared with the 48.3%. group, the total effective difference between the western medicine group and the Chinese medicine group was not statistically significant (P0.05). The total effective rate of the combination group of Chinese and Western medicine group was better than that of the middle and Western medicine group. The difference had statistical significance (P0.05).2. liver function index changes: after 4 weeks treatment, the liver function indexes (TBIL, alt, AST, TBA, gamma -gt, ALP) after treatment were significantly improved after treatment, and the difference was statistically significant compared with that before treatment (P0.05). There was no statistical difference between the western medicine group and the traditional Chinese medicine group after the course of treatment. Significance (P0.05), while the liver function index of the Chinese and Western medicine group was significantly lower than that of the western medicine group and the traditional Chinese medicine group, and the difference had statistical significance (P0.05) the symptom score of each single Chinese medicine in.3.: the three groups improved after the treatment, and the difference was statistically significant compared with that before the treatment (P0.05). The comparison of the results of the three groups after the treatment, the combination of Chinese and Western medicine. The symptoms score of the group was lower than that of the traditional Chinese medicine group and the western medicine group (P0.05). The symptoms score of the Chinese medicine group and the western medicine group were compared with the western medicine group. The symptoms score of the body and eye yellow dye, the nausea and yellow red, the nausea and vomiting, the fatigue and fatigue were not different (P0.05), but the abdominal distension and stuffiness, the rib pain, the loss of appetite, and the symptom score of the dry mouth were lower in the Chinese medicine group. And the difference was statistically significant (P0.05) before and after.4. treatment: the total score of TCM syndrome was not statistically significant before and after treatment (P0.05). The scores of the three groups were decreased and the difference was statistically significant (P0.05) after treatment (P0.05). The total score of the syndrome in the combination group of Chinese and Western medicine was significantly lower than that of the traditional Chinese medicine group and the western medicine group. Statistical significance (P0.05), the total score of TCM syndrome was lower than that of the western medicine group and the difference was statistically significant (P0.05).5. safety observation: the life signs of the patients in each group were stable, the three major routine of blood urine, kidney function, coagulation function, electrolyte, liver and bile color ultrasound were not obvious changes, 2 cases had mild diarrhea, after withdrawal, other diseases, other diseases. No obvious adverse reactions and side effects were found in all cases. Conclusion: yhuang Gan Ning Mixture Combined with thinking MATTEL in the treatment of liver cirrhosis jaundice (damp heat stasis type) has achieved good results in retreating yellow, promoting liver function recovery and improving TCM syndrome, and the curative effect is obviously better than single use of Western medicine and single use of traditional Chinese medicine. Thailand has a synergistic effect and has high safety.

【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62;R575.2

【参考文献】