自拟清肝方治疗酒精性肝病临床疗效观察

发布时间：2018-04-09 10:26

本文选题：酒精性肝病　切入点：肝胆湿热　出处：《南京中医药大学》2017年硕士论文

【摘要】：尽管目前现代医学对酒精性肝病的病因、发病机理、诊断、治疗等方面都已经取得诸多进展,但临床如何最大限度的控制酒精性肝病的发生率?如何截断或扭转酒精性肝病病情的不断进展?如何防控酒精性肝硬化各种严重并发症进而延长其生存期?甚至如何采用更为低廉或方便的药物治疗手段等等,都是当今酒精肝病研究领域值得关注的重点问题。前期,我们依据中医理论,结合临床观察发现各型酒精性肝病以肝胆湿热为基本病机的临床特点,研制出"自拟清肝方"作为院内制剂常规治疗各型酒精性肝病,取得良好的临床效果,本课题对该方进行初步临床疗效评价。目的:观察自拟清肝方治疗肝胆湿热型酒精性肝病患者的临床疗效。方法:全部患者均来自徐州市传染病医院肝病科门诊,并符合纳入标准的80例的肝胆湿热型酒精性肝病患者,采用随机对照分组法,分成治疗组和对照组,各40例。治疗组采用自拟清肝方(茵陈25g、栀子10g、葛根15g,枳i子15g、虎杖10g、金钱草15g、郁金10g、茯苓10g、泽泻10g、柴胡6g)煎剂200ml/次,日2次口服,日服一剂。对照组采用多烯磷脂酰胆碱胶囊,每次456mg,每日3次口服,两组疗程均为4周。观察指标:两组治疗前后中医症候积分的变化,检测并记录肝功能、消化系超声的变化。结果:(1)治疗组显效率为92.5%,总有效率为97.5%;对照组显效率为87.5%,总有效率为95%。两组间总疗效差异无统计学意义,P0.05。(2)比较治疗组治疗前后、对照组治疗前后的指标变化情况,两组病例的ALT、AST、TBIL、GGT在水平方向上进行比较,P0.05,有统计学差异。所以,治疗组在改善肝功能方面要优于对照组。(3)在改善胁肋胀痛、身目发黄、尿黄等证候积分方面,治疗组明显优于对照组,两组比较有统计学意义(P0.05);在恶心、呕吐、厌油、大便秘结等证候积分方面,无统计学意义(P0.05)。结论:(1)理论研究初步揭示了酒精性肝病不同阶段的病机特点,并提出肝胆湿热是酒精肝病的基本病理因素,清化肝胆湿热法是基本治法。(2)自拟清肝方治疗酒精性肝病的总体疗效优于多烯磷脂酰胶囊对照组;(3)自拟清肝方能够有效减轻酒精性肝病患者的胁肋胀痛、身目发黄、尿黄等主要症状;(4)自拟清肝方能改善酒精性肝病肝功能,包括有效降低血清总胆红素、谷丙转氨酶、谷草转氨酶、谷氨酰转肽酶等水平;(5)自拟清肝方对于改善酒精性肝病患者肝脏超声肿胀及肝损伤的征象也有一定作用;(6)自拟清肝方在治疗过程中无明显不良反应的发生。
[Abstract]:Although many advances have been made in the etiology, pathogenesis, diagnosis and treatment of alcoholic liver disease in modern medicine, how to control the incidence of alcoholic liver disease in clinic?How to cut off or reverse the progress of alcoholic liver disease?How to prevent and control various serious complications of alcoholic cirrhosis and prolong their survival?Even how to use cheaper or more convenient drug treatment is a key issue in the research field of alcoholic liver disease.In the early stage, according to the theory of traditional Chinese medicine and clinical observation, we found that various types of alcoholic liver diseases were characterized by dampness and heat of liver and gallbladder as the basic pathogenesis, and we developed "self-made Qinggan recipe" as a routine treatment for various types of alcoholic liver diseases.Good clinical effect has been obtained.Objective: to observe the clinical effect of Qinggan prescription in treating alcoholic liver disease of damp-heat type of liver and gallbladder.Methods: all the patients were from the Department of Hepatology, Xuzhou Infectious Disease Hospital, and 80 patients with alcoholic liver disease of damp-heat type of liver and gallbladder were divided into treatment group and control group with 40 cases each.The treatment group was treated with 200ml/ decoction (Yinchen 25g, Gardenia 10g, Pueraria lobata 15g, Trifoliate trifoliata 15g, Polygonum cuspidatum 10g, Poria cocos 10g, Radix Alismatis 10g, Chaihu 6g).The control group was treated with polyenylphosphatidylcholine capsule, 456mg / time, 3 times a day. The course of treatment in both groups was 4 weeks.Observation measures: changes of TCM symptom score, liver function and digestive system ultrasonic changes were detected and recorded before and after treatment in the two groups.Results the effective rate of the treatment group was 92.5 and the total effective rate was 97.5.The control group was 87.5and the total effective rate was 950.Results the effective rate of the treatment group was 92.5 and the total effective rate was 97.5.There was no significant difference in the total curative effect between the two groups (P 0.05). The changes of the indexes before and after treatment in the treatment group and in the control group were compared. The two groups were compared in the horizontal direction between the two groups (P 0.05).Therefore, the treatment group is superior to the control group in improving liver function.) in terms of improving symptoms such as pain in the ribs, yellowness of the body and eyes, and yellowish urine, the treatment group is obviously superior to the control group. The two groups have statistical significance in improving liver function. In terms of nausea, vomiting, and oil weariness, the treatment group is obviously superior to the control group.Big constipation knot and other syndromes integral, there is no statistical significance (P 0.05).Conclusion the theoretical study reveals the pathogenesis of alcoholic liver disease at different stages, and points out that dampness and heat of liver and gallbladder are the basic pathological factors of alcoholic liver disease.Qinghua liver-gallbladder damp-heat method is the basic treatment method. 2) the overall curative effect of self-made Qinggan recipe for alcoholic liver disease is better than that for the control group of polyenylphosphatidyl capsule (Phosphatidyl capsule). The self-made Qinggan recipe can effectively alleviate the pain of flank swelling and yellowness of body and eyes in patients with alcoholic liver disease.Qinggan prescription can improve liver function of alcoholic liver disease, including reducing serum total bilirubin, alanine aminotransferase, alanine aminotransferase, and alanine aminotransferase.Glutamyl transpeptidase et al.) the self-made Qinggan prescription has a certain effect on improving the signs of liver ultrasonic swelling and liver injury in patients with alcoholic liver disease. 6) the self-formulated Qinggan recipe has no obvious adverse reactions during the treatment.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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