不同证型肝硬化腹水利尿剂疗效的临床观察研究

发布时间：2019-02-22 06:52

【摘要】：目的：观察不同证型利尿剂治疗的效果,一方面研究中医证型与利尿剂的疗效关系,另一方面佐证中医证型与疾病发展的关联性。方法：收集乙型肝炎肝硬化腹水且经限钠休息治疗无效的患者,共182名患者,其中90例满足纳入标准,根据肝硬化腹水中医证型诊断标准,气滞湿阻型25例,湿热蕴结型23例,脾肾阳虚型24例,肝肾阴虚型18例。记录每位患者的体重、腹围、尿量、症状、体征、舌脉象,检测各证型肝硬化腹水患者的肝功能、肾功能、电解质,观察证型与电解质和肾功能的关系。按照利尿剂治疗方案治疗,每周复查各项指标,调整利尿剂剂量,总疗程为4周,观察各证型利尿剂治疗的效果。结果：1)电解质方面中医各证型血钠变化趋势为气滞湿阻型湿热蕴结型脾肾阳虚型肝肾阴虚型有统计学意义,气滞湿阻型比其他三型高(P0.05)。血钾比较,气滞湿阻型高于其他三型,无统计学意义。肾功能方面肌酐比较,中医各证型肌酐变化趋势为肝肾阴虚型脾肾阳虚型湿热蕴结型气滞湿阻型,有统计学意义。肝肾阴虚型比其他三型高(P0.05)。中医各证型尿素氮变化趋势为气滞湿阻型湿热蕴结型脾肾阳虚型肝肾阴虚型有统计学意义,其中气滞湿阻型低于脾肾阳虚型、肝肾阴虚型(P0.05),湿热蕴结型低于肝肾阴虚型(P0.05)。2)利尿剂治疗后四组患者体重均有下降,与治疗前自身比较,有统计学意义。其中治疗后气滞湿阻型体重减少量明显高于其他三型(P0.05)。3)利尿剂治疗气滞湿阻型痊愈5例,显效16例,有效3例,无效1例,有效率96%。湿热蕴结型痊愈1例,显效7例,有效12例,无效3例,有效率87%。脾肾阳虚型痊愈1例,显效9例,有效10例,无效4例,有效率83%。肝肾阴虚型痊愈0例,显效1例,有效5例,无效10例,有效率38%。利尿剂疗效从气滞湿阻型向肝肾阴虚型递减有统计学意义,肝肾阴虚型有效率明显低于其他三型(P0.05)。结论：肝硬化腹水疾病发展趋势为气滞湿阻型向脾肾阳虚型、肝肾阴虚型发展。肝硬化腹水利尿剂疗效由气滞湿阻型向肝肾阴虚型递减。
[Abstract]:Objective: to observe the effect of diuretics in different syndromes, to study the relationship between TCM syndromes and diuretics on the one hand, and the relationship between TCM syndromes and disease development on the other. Methods: a total of 182 patients with liver cirrhosis ascites were collected, 90 of whom met the inclusion criteria. According to the criteria of traditional Chinese medicine diagnosis of cirrhosis and ascites, 25 cases were qi stagnation and dampness obstruction type, 23 cases were damp-heat accumulation type. There were 24 cases with deficiency of spleen and kidney yang and 18 cases with deficiency of liver and kidney yin. The body weight, abdominal circumference, urine volume, symptoms, signs and tongue pulse were recorded. The liver function, renal function, electrolyte and the relationship between the syndrome type and electrolytes and renal function were measured. According to the diuretic treatment plan, every index was reviewed every week and the dosage of diuretic was adjusted. The total course of treatment was 4 weeks. Results: 1) the change trend of blood sodium in each syndrome type of traditional Chinese medicine was that the type of stagnation of qi and dampness and heat accumulation of spleen and kidney yang deficiency type had statistical significance, the type of qi stagnation and dampness resistance was higher than that of other three types (P0.05). Compared with other three types of potassium, qi stagnation and dampness resistance type were higher than other three types, and there was no statistical significance. Compared with creatinine in renal function, the creatinine change trend of TCM syndrome type is liver and kidney yin deficiency type spleen and kidney yang deficiency type damp-heat accumulation type Qi stagnation dampness obstruction type, which has statistical significance. Liver and kidney yin deficiency type was higher than other three types (P0.05). The change trend of urea nitrogen in each syndrome type of TCM was that the type of Qi stagnation dampness and damp-heat accumulation type had statistical significance, in which the type of Qi stagnation and dampness obstruction was lower than that of the type of deficiency of spleen and kidney yang, the type of deficiency of liver and kidney yin was lower than that of type of deficiency of spleen and kidney (P0.05). The damp-heat accumulation syndrome was lower than the liver and kidney yin deficiency type (P0.05). 2) after the treatment of diuretics, the weight of the patients in the four groups were all decreased, compared with before treatment, there was statistical significance. After treatment, the weight loss of Qi-stagnation and dampness resistance type was significantly higher than that of other three types (P0.05). Diuretics were used to cure 5 cases of Qi stagnation dampness obstruction type, 16 cases were effective, 3 cases were effective, 1 case was ineffective, and the effective rate was 96.1%. One case was cured with damp-heat accumulation knot, 7 cases were effective, 12 cases were effective, 3 cases were ineffective, and the effective rate was 87 cases. One case was cured with deficiency of spleen and kidney yang, 9 cases were effective, 10 cases were effective, 4 cases were ineffective, and the effective rate was 83%. There were 0 cases of liver and kidney yin deficiency, 1 case of remarkable effect, 5 cases of effective, 10 cases of ineffective, and 38 cases of effective rate. The curative effect of diuretics from stagnation of qi and dampness to yin deficiency of liver and kidney was decreased significantly, and the effective rate of yin deficiency of liver and kidney was significantly lower than that of other three types (P0.05). Conclusion: the development trend of liver cirrhosis ascites disease is qi stagnation and dampness obstruction to spleen and kidney yang deficiency and liver and kidney yin deficiency. The curative effect of ascites diuretic on liver cirrhosis decreased from qi stagnation and dampness obstruction to liver and kidney yin deficiency.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.2

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