加味苓桂术甘颗粒治疗非酒精性单纯性脂肪肝的中医证效研究

发布时间：2018-04-25 02:35

本文选题：加味苓桂术甘颗粒 + 非酒精性单纯性脂肪肝　；参考：《广西中医药大学》2016年硕士论文

【摘要】：目的:观察加味苓桂术甘颗粒治疗非酒精性单纯性脂肪肝中三个常见中医证型的临床疗效,从以方测证的角度探讨加味苓桂术甘颗粒与非酒精性单纯性脂肪肝不同证型间的证效关系;进一步阐明中医在临床应用中需辨病辨证相结合以指导组方遣药。方法:采集符合纳入标准的90例非酒精性单纯性脂肪肝患者,痰湿内阻证、湿热内蕴证及痰瘀互结证三个证型,每组各30例。各组均予加味苓桂术甘颗粒,开水冲服,每日一剂,早晚各一次,同时进行相同的基础治疗方案,连续治疗12周。观察三组治疗前后肝/脾CT值、中医证侯评分、体重指数、甘油三酯(TG)、总胆固醇(TC)等相关指标,采用SPSS17.0进行统计分析,评价加味苓桂术甘颗粒治疗非酒精性单纯性脂肪肝三个证型间证效关系。结果:1、临床综合疗效比较:痰湿内阻证、湿热内蕴证及痰瘀互结证的临床综合疗效总有效率分别为67.86%、42.86%、78.57%。组间两两比较分析,痰瘀互结证组与湿热内蕴证组及痰湿内阻证组比较,差异均具有统计学意义(P0.01,P0.05),痰湿内阻证组与湿热内蕴证组比较,差异亦具有统计学意义(P0.05)。2、CT比较:(1)CT疗效比较:研究中痰湿内阻证总有效率为64.27%;湿热内蕴证组总有效率为57.14%;痰瘀互结证总有效率为82.14%。组间两两比较,痰瘀互结证组与湿热内蕴证组及痰湿内阻证组比较,差异具有统计学意义(P0.01,P0.05),痰湿内阻证组与湿热内蕴证组比较,差异不具有统计学意义(P0.05)。(2)CT比值变化比较:痰瘀互结证组治疗前后组内CT比值比较,差异具有显著性意义(P0.01),痰湿内阻证组及湿热内蕴证组CT比值治疗前后组内比较,差异均有统计学意义(P0.05);治疗后CT比值组间两两比较,痰瘀互结证与痰湿内阻证及湿热内蕴证比较,差异均具有显著性意义(P0.05),而痰湿内阻证与湿热内蕴证比较,差异不具有统计学意义(P0.05)。3、中医症候比较:痰湿内阻证、湿热内蕴证及痰瘀互结证的中医症候总有效率分别为71.43%、53.57%、82.14%。组间两两比较分析,痰瘀互结证组与湿热内蕴证组及痰湿内阻证组比较,差异均具有统计学意义(P0.01,P0.05),痰湿内阻证组与湿热内蕴证组比较,差异不具有统计学意义(P0.05);三组证型组内治疗前后的症候积分比较差异均具有统计学意义(P0.01);治疗前后的中医症候积分差值组间比较,痰瘀互结证与痰湿内阻证及湿热内蕴证比较,差异均具有非常显著性意义(P0.01),痰湿内阻证与湿热内蕴证比较,差异不具有统计学意义(P0.05)。4、血脂(TC、TG)比较:痰湿内阻证、湿热内蕴证及痰瘀互结证总有效率分别为67.88%、60.71%、85.71%,组间两两比较,痰瘀互结证组与湿热内蕴证组及痰湿内阻证组比较,差异均具有统计学意义(P0.01,P0.05),痰湿内阻证组与湿热内蕴证组疗效相当(P0.05)。三个证型血脂指标组内治疗前后比较,差异均具有统计学意义(P0.01,P0.05)。5、体重指数比较:三组证型的体重指数治疗前后比较,差异具有非常显著性意义(P0.01)。6、安全性检测:三个证型治疗前后进行安全性指标检测,均未发现异常;三组患者未发现不良事件和不良反应。结论:1、加味苓桂术甘颗粒治疗非酒精性单纯性脂肪肝具有确切的临床疗效,可明显改善患者的临床症状,降低血脂及体重指数,改善病情程度,延缓疾病进展。2、加味苓桂术甘颗粒对非酒精性单纯性脂肪肝中痰湿内阻证、湿热内蕴证及痰瘀互结证均有明显的临床疗效,以痰瘀互结证疗效最佳。3、加味苓桂术甘颗粒治疗非酒精性单纯性脂肪肝痰湿内阻证、湿热内蕴证及痰瘀互结证患者安全,未发现药物不良反应。
[Abstract]:Objective: To observe the clinical efficacy of Jiawei Ling Gump granule in the treatment of three common TCM Syndromes of nonalcoholic fatty liver, and to explore the relationship between the different syndromes of different syndromes of Gump granule and nonalcoholic fatty liver, and further clarify the combination of syndrome differentiation and syndrome differentiation in clinical application. Methods: 90 cases of non alcoholic simple fatty liver, phlegm dampness syndrome, damp heat syndrome, phlegm and stasis syndrome were collected and three syndrome types were collected in each group. Each group was given 30 cases in each group. All groups were given Jiawei Luli Gump granules, boiled water, one dose a day, once a day, and the same basic treatment scheme at the same time, and the same basic treatment scheme was carried out simultaneously. After 12 weeks of treatment, the liver / spleen CT value, TCM syndrome score, body mass index, triglyceride (TG), total cholesterol (TC) and other related indexes were observed before and after treatment, and SPSS17.0 was used for statistical analysis to evaluate the relationship between three syndromes of nonalcoholic simple fatty liver with Gump granule in Jiawei Ling Guangxi operation. Results: 1, the clinical comprehensive curative effect was compared: sputum The total effective rate of clinical comprehensive efficacy of damp heat syndrome, damp heat syndrome and phlegm and blood stasis syndrome was 67.86%, 42.86%, 22 comparison between group 78.57%., the difference of phlegm stasis syndrome group and damp heat syndrome group and phlegm damp internal resistance syndrome group, the difference was statistically significant (P0.01, P0.05), and the difference between the phlegm damp internal resistance syndrome group and the damp heat syndrome group was the difference. Also had statistical significance (P0.05).2, CT comparison: (1) CT curative effect comparison: the total effective rate of phlegm dampness syndrome was 64.27%, the total effective rate of damp heat syndrome group was 57.14%, the total effective rate of phlegm and blood stasis syndrome was 22 in 82.14%. group, and the difference between phlegm and blood stasis syndrome group and damp heat internal syndrome group and phlegm damp internal resistance syndrome group was statistically significant (P 0.01, P0.05), compared with the damp heat syndrome group, the difference was not statistically significant (P0.05). (2) the comparison of the ratio of CT: the difference of the ratio of CT in the group of phlegm and stasis syndrome group before and after treatment was significant (P0.01). The difference was statistically significant between the group of phlegm damp internal resistance and the CT ratio in the damp heat syndrome group before and after the treatment. Significance (P0.05), after the treatment of CT ratio between the 22 groups, phlegm stasis syndrome and phlegm damp internal resistance syndrome and damp heat syndrome, the difference has significant significance (P0.05), but the difference of phlegm damp internal resistance and damp heat syndrome is not statistically significant (P0.05).3, the syndrome of TCM syndrome: phlegm damp internal resistance syndrome, damp heat internal syndrome and phlegm stasis syndrome The total effective rate of TCM syndrome was 71.43%, 53.57%, 22 comparison between group 82.14%., the difference of phlegm and blood stasis syndrome group and damp heat syndrome group and phlegm damp internal resistance syndrome group, the difference was statistically significant (P0.01, P0.05), and the difference of phlegm damp internal resistance syndrome group and damp heat syndrome group was not statistically significant (P0.05); the treatment group was treated with the internal treatment in the group of syndrome types. The difference of syndrome scores before and after treatment was statistically significant (P0.01); before and after treatment, the difference of TCM syndrome score difference between groups, phlegm stasis syndrome and phlegm damp internal resistance syndrome and damp heat syndrome were significantly different (P0.01), and the difference between phlegm damp internal resistance syndrome and damp heat syndrome was not statistically significant (P0.05) .4, blood lipid (TC, TG) comparison: the total effective rate of phlegm damp internal resistance syndrome, damp heat internal syndrome and phlegm stasis syndrome was 67.88%, 60.71%, 85.71% respectively, and 22 compared with the group of damp heat internal syndrome and phlegm damp internal resistance syndrome group (P0.01, P0.05), and the curative effect of phlegm damp internal resistance syndrome group and damp heat syndrome group was equivalent (P0. 05). Compared before and after treatment, the difference was statistically significant (P0.01, P0.05).5, and the body mass index (BMI) was compared before and after treatment. The difference between the three groups was very significant (P0.01).6, and the safety was detected before and after the treatment of three syndrome types; three The group patients had no adverse events and adverse reactions. Conclusions: 1, Jiawei Luli Gump granule has definite clinical efficacy in the treatment of nonalcoholic fatty liver. It can obviously improve the clinical symptoms, reduce the blood lipid and body mass index, improve the degree of the disease, delay the.2 of the disease, and add the Gump granule to nonalcoholic simple fat. The syndrome of phlegm damp internal resistance in the fatty liver, damp heat internal syndrome and phlegm and stasis syndrome have obvious clinical curative effect. The best.3 for the syndrome of phlegm and blood stasis syndrome, the treatment of non alcoholic simple fatty liver phlegm dampness syndrome, damp heat syndrome and phlegm stasis syndrome were safe and no adverse drug reaction was found.

【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】：2016
【分类号】：R259

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