解氏软肝利水方治疗乙肝后肝硬化顽固性腹水65例临床观察

发布时间：2018-05-13 12:01

本文选题：乙型肝炎 + 肝硬化　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的:乙肝后肝硬化是由于乙肝病毒引起的肝细胞变性坏死,肝组织弥漫性纤维化,以肝细胞增生形成再生结节,最后形成假小叶为病理特征的慢性肝病。腹水是肝硬化最突出的临床表现,为门静脉高压所致,75%以上的失代偿期患者有腹水。顽固性腹水是终末期肝硬化的常见并发症,不但严重影响患者的生活质量,而且可以导致感染、上消化道出血、肝昏迷、肾功能衰竭等严重的并发症,病死率高,目前西医尚无有效的方法改善临床症状,控制疾病的进展及复发。本研究以中医理论为指导,应用以解氏软肝利水方为主的中西医结合方法治疗乙肝后肝硬化顽固性腹水,观察及评价临床疗效,探讨可能的机制,为乙肝后肝硬化顽固性腹水的治疗提供部分理论及实践依据。方法:本研究所有病例为大连市第六人民医院2013年1月~2014年9月住院的乙肝后肝硬化顽固性腹水患者,按照诊断标准、纳入标准及排除标准选取患者65例,经知情同意,采用随机对照研究方法,分为对照组30例,治疗组35例。对照组及治疗组在治疗前临床参数无统计学差异。对照组采用西药抗病毒、护肝、利尿、对症和支持治疗,治疗组在抗病毒及一般支持治疗基础上加用解氏软肝利水方,两组均治疗1月,治疗结束后随诊1个月。观察两组治疗前后的显效率、有效率、临床症状改善率、复发率,观测两组治疗前后的肝功能指标(谷丙转氨酶、血清总胆红素、白蛋白)及腹水量(以患者平卧位超声下测量腹水深度为标准)的变化,观测两组治疗前后细胞免疫功能变化。各组间比较采用t检验及x2检验。探讨以解氏软肝利水方为主的中西医结合治疗措施是否优于单纯西医治疗乙肝后肝硬化顽固性腹水,为临床治疗提供有益的参考。结果:1病例入选情况:治疗组及对照组均无治疗终止及死亡病例,无失访病例,65例病例均按研究方案完成治疗及随访。2治疗组与对照组比较:显效率68.3%vs 35.5%(P0.05),有效率85.2%vs64.4%(P0.05),临床症状改善率87.2%vs 54.1%(P0.05),复发率12.5%vs 33.4%(P0.05)。上述指标差异有统计学意义,均显示治疗组的疗效优于对照组。3治疗组患者肝功能指标显示:治疗组在黄疸消退及白蛋白升高方面疗效优于对照组,差异有统计学意义(P0.05)。在谷丙转氨酶降低方面两组差异无统计学意义(P0.05)。4腹水减少指标:治疗组在腹水消退的疗效优于对照组,差异有统计学意义(P0.05)。5细胞免疫功能指标:治疗组白介素-2及干扰素水平明显升高,与于对照组比较,差异有统计学意义(P0.05)。结论:解氏软肝利水方治疗乙肝后肝硬化顽固性腹水疗效优于单纯西医治疗。治疗组无因中药发生不良反应,明显改善患者的症状和肝功能,缩短住院时间,节省住院治疗费用,减少复发,近期及远期疗效均肯定,为乙肝后肝硬化顽固性腹水的临床治疗提供更广阔的思路和有效的方法。
[Abstract]:Objective: hepatitis B cirrhosis is due to liver cell degeneration and necrosis caused by HBV, diffuse fibrosis of liver tissue, the formation of regenerative nodules from hepatocyte proliferation, and chronic liver disease characterized by false lobule. Ascites is the most prominent clinical manifestation of liver cirrhosis, which is caused by portal hypertension, and more than 75% of the decompensated patients have abdomen. Water. Refractory ascites is a common complication of end-stage liver cirrhosis. It not only seriously affects the quality of life of the patients, but also leads to infection, upper gastrointestinal bleeding, liver coma, renal failure and other serious complications and high mortality. At present, there is no effective method to improve the clinical symptoms and control the progress and recurrence of the disease. The theory of traditional Chinese medicine (TCM) was used as the guidance to treat the refractory ascites of liver cirrhosis after hepatitis B with the method of combining Chinese and Western medicine with the decoction of soft liver and Leishui. The clinical effect was observed and evaluated, and the possible mechanism was discussed. Some theory and practice were provided for the treatment of intractable ascites of hepatitis B after hepatitis B. Methods: all cases in this study were sixth in Dalian. In people's Hospital, 65 patients with HBV refractory ascites hospitalized in September ~2014 January 2013 were selected according to the criteria of diagnosis, and the patients were divided into 30 cases in the control group and 35 in the treatment group by informed consent. There was no statistical difference between the control group and the treatment group before the treatment. The group was treated with western medicine antiviral, liver protection, diuresis, symptomatic and supportive treatment. The treatment group was treated with the anti virus and general support treatment on the basis of the combination of the soft liver and Leishui recipe. The two groups were treated in January and the treatment was followed for 1 months. The effective, effective, clinical symptoms, recurrence rate, and the observation of two groups of treatment were observed before and after the treatment of the two groups. The changes in the liver function index (alanine aminotransferase, serum total bilirubin, albumin) and the amount of ascites were observed in the two groups of patients before and after treatment. The changes of cellular immune function before and after treatment were observed. T test and X2 test were used in each group. No better than the simple western medicine treatment of hepatitis B cirrhosis refractory ascites, for clinical treatment to provide useful reference. Results: 1 cases were selected: the treatment group and the control group had no treatment termination and death cases, no lost cases, 65 cases were completed according to the study scheme and compared with the.2 treatment group and the control group: the effective rate of 68.3%vs 35.5% ( P0.05), the effective rate of 85.2%vs64.4% (P0.05), the improvement rate of clinical symptoms was 87.2%vs 54.1% (P0.05), and the recurrence rate was 12.5%vs 33.4% (P0.05). The difference of the above indexes was statistically significant, all showed that the curative effect of the treatment group was better than that of the control group. The therapeutic effect of the treatment group was better than the control group in the treatment group in the jaundice decline and the increase of albumin. The difference was statistically significant (P0.05). There was no significant difference between the two groups in the reduction of alanine transaminase (P0.05).4 ascites reduction index: the curative effect of the treatment group was better than the control group, and the difference was statistically significant (P0.05).5 cell immune function index: the level of interleukin -2 and interferon in the treatment group was significantly increased, compared with the control group. The difference is statistically significant (P0.05). Conclusion: the curative effect of the decoction of "lihi Ligan Lishui" is better than that of the simple western medicine. The treatment group has no adverse reaction, obviously improves the symptoms and liver function, shortens the hospitalization time, saves the cost of hospitalization and reduces the recurrence, the short-term and long-term effect are affirmative, It provides a broader thinking and effective method for the treatment of refractory ascites after hepatitis B cirrhosis.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.62;R575.2

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