疏肝健脾活血解毒法联合饮食调节改善HBV相关慢性肝病代谢异常研究

发布时间：2018-05-14 09:36

本文选题：HBV相关 + 疏肝健脾　；参考：《山东中医药大学》2016年博士论文

【摘要】：目的:以中药疏肝健脾、活血解毒法联合饮食调节,观察其改善HBV相关慢性肝病代谢异常的临床疗效,探讨HBV相关慢性肝病患者代谢异常营养需求,为HBV相关慢性肝病患者提供准确的饮食指导。方法:本课题将符合纳入标准的180例分成三组,划分为对照组、中药组和中药联合饮食调节组,进行临床资料采集,全部纳入患者均予常规内科治疗,对照组予常规内科治疗和常规饮食,中药组予疏肝健脾、活血解毒法中药复方制剂,中药联合饮食调节组组予疏肝健脾、活血解毒法中药复方制剂联合饮食调节。对所有患者进行连续4个周次的各项数据的采集,通过系统的临床资料包括人体测量学、血清学和生活质量等方面的采集,总结出中药疏肝健脾、活血解毒法联合饮食调节HBV相关慢性肝病营养代谢异常的临床疗效,以完成三组患者营养代谢异常的临床研究。结果:疏肝健脾、活血解毒法联合饮食调节有效的改善了HBV相关慢性肝病营养代谢异常。从营养代谢指标来看,在人体测量学方面表现为消瘦、低重、肌蛋白消耗的患者,对照组患者出现加重的情况,而中药组和中药联合饮食调节组消瘦、低重、肌蛋白消耗患者逐渐得到缓解,并且中药联合饮食调节组的疗效要高于中药组;对脂代谢异常患者,从统计结果可以看出对照组患者脂代谢异常未得到改善,而是加重,中药组和中药联合饮食调节组改善血脂效果明显,并且中药联合饮食调节组的疗效要高于中药组。在糖代谢方面,从统计结果可以看到,对照组是呈现加重趋势的,中药组的血糖均数水平呈现下降趋势,在第四周时血糖均值接近正常,中药联合饮食调节组的血糖均数水平下降趋势更明显,在第四周时血糖均值呈现为正常。慢性肝病量表积分方面,通过4周的观察,对照组的得分呈现升高的趋势,对照组和中药联合饮食调节组均表现为降低趋势,并且中药联合饮食调节组降低趋势更明显;在疲劳自评量表方面,对照组的疲劳自评量表得分逐渐升高,疲劳状况加重,在中药组和中药联合饮食调节组疲劳状态得到减轻,中药联合饮食调节组更明显;在中医症状积分方面,对照组四周的积分逐渐升高,中药组合中药联合饮食调节组逐渐降低。从肝脏炎性指标显示看,对照组ALT、AST、ALP、GGT、TB治疗后较治疗前升高,特别是第四周升至最高;中药组和中药联合饮食调节组ALT、AST、ALP、GGT、TB治疗后均有不同程度的降低,并且中药联合饮食调节组降低更显著。从肝脏合成指标可以看出,HBV相关慢性肝病合并蛋白代谢异常者,主要表现为蛋白质的合成功能下降,包括各种血清蛋白,诸如白蛋白、前白蛋白、视黄醇结合蛋白,对照组中肝脏合成功能指标下降明显,第四周时各种蛋白指标显著低中药组和中药联合饮食调节组;中药组和中药联合饮食调节组各项肝功能合成指标均升高,并且在第四周时中药联合饮食调节组显著高于中药组。结论:疏肝健脾、活血解毒法中药复方联合饮食调节临床疗效显著,有效的改善HBV相关慢性肝病患者三大营养物质代谢,提高肝脏调节糖代谢紊乱、脂质代谢异常的能力,促进肝脏的合成功能,修复肝脏炎症,改善临床症状体征和血清学指标,提高生活质量。
[Abstract]:Objective: To observe the clinical curative effect of improving the metabolic abnormality of HBV related chronic liver diseases with the combination of traditional Chinese medicine and liver invigorating the spleen and activating blood and detoxifying method, to explore the metabolic abnormal nutritional requirements of the patients with HBV related chronic liver disease, and to provide accurate dietary guidance for the patients with HBV related chronic liver disease. Methods: the subject will be divided into 180 cases in accordance with the standard of three. Group, divided into control group, traditional Chinese medicine group and Chinese medicine combined diet control group, all the patients were collected, all the patients were given conventional medical treatment, the control group was given conventional medical treatment and routine diet, the Chinese medicine group was given the liver and spleen, the method of activating blood and detoxifying the Chinese medicine compound preparation, and the combination diet regulation group of the Chinese medicine group was given to the liver and spleen strengthening and the method of activating blood and detoxifying the spleen. The data of all the patients were collected for 4 consecutive weeks. Through the collection of systematic clinical data including anthropometry, serology and quality of life, we summed up the presence of traditional Chinese medicine to regulate the liver and invigorate the spleen, and to regulate the nutrition and metabolism of HBV related chronic liver diseases with the combined diet of activating blood and detoxifying. The clinical study of three groups of patients with abnormality of nutritional metabolism was completed. Results: the abnormal metabolism of HBV related chronic liver diseases was effectively improved by regulating the liver and invigorating the spleen, activating blood and detoxifying methods combined with dietary regulation. From the point of the index of nutrition metabolism, the patients with weight loss, low weight, muscle protein consumption and the control group appeared in the anthropometry. Aggravation of the situation, but the Chinese medicine group and the combination of traditional Chinese medicine diet control group of thin, low weight, muscle protein consumption patients gradually relieved, and the effect of Chinese medicine combined diet regulation group is higher than the traditional Chinese medicine group; for patients with abnormal lipid metabolism, it can be seen from the statistical results that the abnormal lipid metabolism in the control group is not improved, but it is aggravated, Chinese medicine group and the middle of the Chinese medicine group. The effect of medicine combined with diet regulation group was obvious, and the effect of Chinese medicine combined diet regulation group was higher than that of the traditional Chinese medicine group. In the aspect of sugar metabolism, it can be seen from the statistical results that the control group showed the tendency of aggravation, the level of blood sugar average of the Chinese medicine group showed a downward trend, the mean blood sugar was close to normal in the fourth week, and the combined diet of Chinese medicine was used. The decreasing trend of blood glucose level in the control group was more obvious. The mean blood sugar was normal at the fourth week. The score of the chronic liver disease scale was higher than that of the control group and the combination diet control group of the control group and the traditional Chinese medicine group by 4 weeks of observation. Obviously, the fatigue self rating scale of the control group increased gradually, the fatigue condition was aggravated, the fatigue state of the traditional Chinese medicine group and the Chinese traditional Chinese medicine combined diet control group were relieved, and the combination of traditional Chinese medicine diet regulation group was more obvious. The diet control group gradually decreased. From the liver inflammatory index, the control group ALT, AST, ALP, GGT, TB were higher than before the treatment, especially fourth weeks to the highest. The traditional Chinese medicine group and the combination of traditional Chinese medicine diet control group ALT, AST, ALP, GGT, TB were reduced to a different degree after treatment, and the combination of traditional Chinese medicine diet control group decreased more significantly. From liver combination. It can be seen that the HBV related chronic liver disease associated with abnormal protein metabolism is mainly manifested in the decrease of protein synthesis function, including all kinds of serum albumin, such as albumin, prealbumin, retinol binding protein, and the decrease of liver synthetic function in the control group, and the various protein indexes in the fourth week are significantly lower in Chinese medicine and traditional Chinese medicine. The combination diet regulation group, Chinese medicine group and the combination of traditional Chinese medicine diet regulation group increased the liver function synthesis index, and in the fourth week, the Chinese medicine combined diet regulation group was significantly higher than the traditional Chinese medicine group. Conclusion: the clinical effect of regulating the liver and invigorating the spleen, activating blood and detoxifying the traditional Chinese medicine compound diet is significant, effectively improving the HBV related chronic liver disease patients three The metabolism of large nutrients can improve the liver regulation of glucose metabolism disorder, the ability of abnormal lipid metabolism, promote liver synthesis, repair liver inflammation, improve clinical symptoms, signs and serological indexes, and improve the quality of life.

【学位授予单位】：山东中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R259

【参考文献】