痰湿方联合健康管理治疗非酒精性脂肪性肝炎的临床观察
发布时间：2018-08-04 18:59
【摘要】：目的观察痰湿方联合健康管理治疗非酒精性脂肪性肝炎(痰湿内阻证)的临床治疗效果及评价其应用安全性。方法将2014年11月至2016年11月期间于湖北省中医院光谷院区肝病科门诊就诊的90例非酒精性脂肪性肝炎患者(痰湿内阻证)随机分为3组,其中西药组30例患者予口服多烯磷脂酰胆碱胶囊,2颗/次,3次/日治疗,并进行口头健康宣教;中药组30例患者予口服中药散装配方颗粒痰湿方1剂/日治疗,并进行口头健康宣教;联合组30例患者予口服中药散装配方颗粒痰湿方1剂/日治疗,及基于“肝好”APP实施的个体化饮食、运动方案。总疗程3个月,观察治疗前后3组患者临床证候积分变化,检测腰臀比(WHR)、体重指数(BMI)、实施脂肪衰减参数(FAI)、肝功能(ALT、AST、GGT)、血脂(TC、TG、HDL-C、LDL-C)及超声影像学变化情况,并于治疗过程中第0、1、2、3个月对中药组及联合组进行生命体征及心电图、肾功能、血常规、尿常规、粪常规检查,通过SPSS17.0软件系统对上述所得数据进行分析,比较3组临床疗效并评价痰湿方安全性。结果(1)治疗前,90例非酒精性脂肪性肝炎患者,各项观测指标比较,差异皆没有统计学意义(P0.05),具有可比性。(2)疗程结束后,组内比较结果如下1.西药组ALT、AST、GGT、证候积分与治疗前相比降低,差异有统计学意义(P0.05);其他观测指标与治疗前相比,差异皆没有统计学意义(P0.05)。2.中药组ALT、AST、GGT、TG、LDL-C、FAI、证候积分与治疗前相比皆降低,差异皆有统计学意义(P0.05);HDL-C较治疗前升高,差异具有统计学意义(p0.05);余观测指标较治疗前差异无统计学意义(p0.05)。3.联合组alt、ast、ggt、tc、tg、ldl-c、fai、whr、bmi与治疗前相比降低,差异有统计学意义(p0.05);hdl-c较治疗前升高,差异有统计学意义(p0.05),b超分度较治疗前降低,差异有统计学意义(p0.05)。(3)疗程结束后,组间比较结果如下1.总有效率比较西药组总有效率为40.0%,中药组为46.7%,联合组为83.3%。中药组总体疗效优于西药组,但差异无统计学意义(p0.05);联合组总体疗效优于中药组、西药组,差异具有统计学意义(p0.05)。2.肥胖指标及fai比较中药组bmi、whr与西药组比较,差异无统计学意义(p0.05);中药组fai较西药组降低,差异具有统计学意义(p0.05);联合组bmi、whr、fai与中药组、西药组比较明显降低,差异均具有统计学意义(p0.05)。3.肝功能指标比较中药组alt、ast、ggt与西药组比较均降低,差异有统计学意义(p0.05);联合组alt、ast、ggt与中药组相比,差异无统计学意义(p0.05)。4.血脂指标比较中药组tg、ldl-c与西药组相比降低,差异有统计学意义(p0.05);中药组hdl-c较西药组升高,差异有统计学意义(p0.05);联合组tg、tc、ldl-c与中药组相比降低,差异有统计学意义(p0.05);联合组hdl-c较中药组升高,差异有统计学意义(p0.05)。5.b超分度比较中药组b超分度与西药组比较,差异无统计学意义(p0.05);联合组与中药组、西药组比较b超分度降低,差异均具有统计学意义(p0.05)。联合组及中药组的中医证候积分与西药组比较均明显降低,差异均具有统计学意义(P0.05);联合组证候积分与中药组比较降低,差异无统计学意义(P0.05)。6.中医证候积分比较(4)安全性评价中药组及联合组患者第0、1、2、3个月生命体征稳定,心电图、肾功能、血常规、尿常规、粪常规等检查均未发现明显异常。结论1.痰湿方联合基于“肝好”APP实施的健康管理,治疗非酒精性脂肪性肝炎的总体疗效明显优于痰湿方组及多烯磷脂酰胆碱胶囊组,其作用体现在改善患者的临床症状、腰臀比、体重指数、脂肪衰减参数、肝功能指标、血脂指标及肝脏超声影像学表现方面;优势体现在改善腰臀比、体重指数、脂肪衰减参数、血脂指标(TC)、肝脏超声影像学表现等方面,对非酒精性脂肪性肝炎有较好治疗作用。2.单用痰湿方能够很好地改善患者的临床症状、肝功能指标、血脂指标(TG、LDL-C、HDL-C)及降低脂肪衰减参数。3.疗程中,未发现与痰湿方明显相关不良反应,痰湿方用于治疗非酒精性脂肪性肝炎安全性良好。
[Abstract]:Objective To observe the clinical effect of phlegm dampness prescription combined with health management in the treatment of nonalcoholic steatohepatitis (phlegm dampness syndrome) and evaluate its application safety. Methods 90 patients with non-alcoholic steatohepatitis (phlegm dampness syndrome) were randomly selected from November 2014 to November 2016 in the clinic of Optics Valley Hospital of Hubei Provincial Traditional Chinese Medical Hospital. The western medicine group was divided into 3 groups, of which 30 patients in the western medicine group were given oral Polyene Phosphatidylcholine Capsules, 2 / times, 3 times / day, and oral health education. 30 patients in the Chinese medicine group were given oral traditional Chinese medicine granule Phlegm Recipe 1 / day treatment and oral health education, and 30 patients in the combined group were given oral traditional Chinese medicine granule phlegm dampness recipe 1 doses orally. Daily treatment, and the individualized diet based on "liver good" APP, a total course of exercise. The total course of treatment was 3 months. The changes of clinical syndrome scores in 3 groups of patients were observed before and after treatment. The waist to hip ratio (WHR), body mass index (BMI), fat attenuation parameter (FAI), liver function (ALT, AST, GGT), blood lipid (TC, TG, HDL-C, LDL-C), and ultrasonic imaging changes, and the treatment of ultrasound imaging, were treated and treated. In the course of the treatment, the life signs and electrocardiogram, renal function, blood routine, urine routine and fecal routine examination were performed on the Chinese medicine group and the combined group during the 0,1,2,3 month. The above data were analyzed by the SPSS17.0 software system, and the 3 groups of clinical effects were compared and the safety of the phlegm dampness was evaluated. Before the treatment, 90 cases of non alcoholic steatohepatitis were treated. The differences were not statistically significant (P0.05). (2) after the end of the course, the results were as follows: ALT, AST, GGT, compared with before treatment, and the difference was statistically significant (P0.05). The difference was not statistically significant (P0.05).2. traditional Chinese medicine compared with before treatment (P0.05). Group ALT, AST, GGT, TG, LDL-C, FAI, the syndrome scores were all lower than those before treatment, and the difference was statistically significant (P0.05); HDL-C was higher than before the treatment (P0.05), and there was no significant difference between the Yu Guance index and before the treatment (P0.05). There was statistical significance (P0.05); the difference was statistically significant (P0.05) compared with before treatment (P0.05), and the difference was statistically significant (P0.05). (3) after the end of the course, the total effective rate between the group and the western medicine group was 40%, the traditional Chinese medicine group was 46.7%, and the combined group was better than the 83.3%. group after the end of the treatment. Western medicine group, but the difference was not statistically significant (P0.05), the overall effect of the combined group was better than the traditional Chinese medicine group, the western medicine group, the difference had statistical significance (P0.05).2. obesity index and Fai compared with the Chinese medicine group BMI, WHR and Western medicine group, the difference was not statistically significant (P0.05); traditional Chinese medicine group Fai compared with western medicine group, the difference was statistically significant (P0.05); joint group BMI, BMI, WHR, FAI and traditional Chinese medicine group, the western medicine group was significantly lower, the difference was statistically significant (P0.05).3. liver function indexes compared with the Chinese medicine group alt, AST, GGT and Western medicine group were lower, the difference was statistically significant (P0.05), the group alt, AST, GGT compared with the traditional Chinese medicine group, there was no statistical significance (P0.05) compared with the Chinese medicine group Compared with the western medicine group, the difference was statistically significant (P0.05); the HDL-C in the Chinese medicine group was higher than the western medicine group, the difference was statistically significant (P0.05); the combination group TG, TC, LDL-C and the traditional Chinese medicine group were lower, the difference was statistically significant (P0.05); the joint group HDL-C was higher than the traditional Chinese medicine group, the difference was statistically significant (P0.05).5. B Ultrasound fraction compared with the Chinese medicine group B Ultrasound score. Compared with the western medicine group, the difference was not statistically significant (P0.05). Compared with the traditional Chinese medicine group and the western medicine group, the difference of B Ultrasound scores was statistically significant (P0.05). The TCM syndrome scores of the combined group and the Chinese medicine group were significantly lower than those in the western medicine group (P0.05); the syndrome scores of the combined group and the Chinese medicine group were compared. The difference was not statistically significant (P0.05).6. TCM syndrome score comparison (4) safety evaluation of the safety evaluation of the Chinese medicine group and the combined group of patients for 0,1,2,3 months of life signs stability, electrocardiogram, renal function, blood routine, urine routine, fecal routine examination have not found obvious abnormalities. Conclusion the 1. phlegm wet prescription based on "liver good" APP implementation of health management, treatment The overall effect of non-alcoholic steatohepatitis was obviously better than that of the phlegm and Polyene Phosphatidylcholine Capsules group. The effect was manifested in improving the patient's clinical symptoms, waist to hip ratio, body mass index, fat attenuation parameters, liver function index, blood lipid index and liver ultrasound imaging. The advantage is to improve the waist to hip ratio and body mass index. Fat attenuation parameters, blood lipid index (TC), liver ultrasound imaging and other aspects, it has a good therapeutic effect on non-alcoholic steatohepatitis,.2. can improve the clinical symptoms, liver function index, blood lipid index (TG, LDL-C, HDL-C) and decrease the adipose attenuation parameters in.3. course, and not found with phlegm dampness prescription. The side effects of phlegm dampness decoction are effective in the treatment of nonalcoholic steatohepatitis.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259
本文编号：2164816
[Abstract]:Objective To observe the clinical effect of phlegm dampness prescription combined with health management in the treatment of nonalcoholic steatohepatitis (phlegm dampness syndrome) and evaluate its application safety. Methods 90 patients with non-alcoholic steatohepatitis (phlegm dampness syndrome) were randomly selected from November 2014 to November 2016 in the clinic of Optics Valley Hospital of Hubei Provincial Traditional Chinese Medical Hospital. The western medicine group was divided into 3 groups, of which 30 patients in the western medicine group were given oral Polyene Phosphatidylcholine Capsules, 2 / times, 3 times / day, and oral health education. 30 patients in the Chinese medicine group were given oral traditional Chinese medicine granule Phlegm Recipe 1 / day treatment and oral health education, and 30 patients in the combined group were given oral traditional Chinese medicine granule phlegm dampness recipe 1 doses orally. Daily treatment, and the individualized diet based on "liver good" APP, a total course of exercise. The total course of treatment was 3 months. The changes of clinical syndrome scores in 3 groups of patients were observed before and after treatment. The waist to hip ratio (WHR), body mass index (BMI), fat attenuation parameter (FAI), liver function (ALT, AST, GGT), blood lipid (TC, TG, HDL-C, LDL-C), and ultrasonic imaging changes, and the treatment of ultrasound imaging, were treated and treated. In the course of the treatment, the life signs and electrocardiogram, renal function, blood routine, urine routine and fecal routine examination were performed on the Chinese medicine group and the combined group during the 0,1,2,3 month. The above data were analyzed by the SPSS17.0 software system, and the 3 groups of clinical effects were compared and the safety of the phlegm dampness was evaluated. Before the treatment, 90 cases of non alcoholic steatohepatitis were treated. The differences were not statistically significant (P0.05). (2) after the end of the course, the results were as follows: ALT, AST, GGT, compared with before treatment, and the difference was statistically significant (P0.05). The difference was not statistically significant (P0.05).2. traditional Chinese medicine compared with before treatment (P0.05). Group ALT, AST, GGT, TG, LDL-C, FAI, the syndrome scores were all lower than those before treatment, and the difference was statistically significant (P0.05); HDL-C was higher than before the treatment (P0.05), and there was no significant difference between the Yu Guance index and before the treatment (P0.05). There was statistical significance (P0.05); the difference was statistically significant (P0.05) compared with before treatment (P0.05), and the difference was statistically significant (P0.05). (3) after the end of the course, the total effective rate between the group and the western medicine group was 40%, the traditional Chinese medicine group was 46.7%, and the combined group was better than the 83.3%. group after the end of the treatment. Western medicine group, but the difference was not statistically significant (P0.05), the overall effect of the combined group was better than the traditional Chinese medicine group, the western medicine group, the difference had statistical significance (P0.05).2. obesity index and Fai compared with the Chinese medicine group BMI, WHR and Western medicine group, the difference was not statistically significant (P0.05); traditional Chinese medicine group Fai compared with western medicine group, the difference was statistically significant (P0.05); joint group BMI, BMI, WHR, FAI and traditional Chinese medicine group, the western medicine group was significantly lower, the difference was statistically significant (P0.05).3. liver function indexes compared with the Chinese medicine group alt, AST, GGT and Western medicine group were lower, the difference was statistically significant (P0.05), the group alt, AST, GGT compared with the traditional Chinese medicine group, there was no statistical significance (P0.05) compared with the Chinese medicine group Compared with the western medicine group, the difference was statistically significant (P0.05); the HDL-C in the Chinese medicine group was higher than the western medicine group, the difference was statistically significant (P0.05); the combination group TG, TC, LDL-C and the traditional Chinese medicine group were lower, the difference was statistically significant (P0.05); the joint group HDL-C was higher than the traditional Chinese medicine group, the difference was statistically significant (P0.05).5. B Ultrasound fraction compared with the Chinese medicine group B Ultrasound score. Compared with the western medicine group, the difference was not statistically significant (P0.05). Compared with the traditional Chinese medicine group and the western medicine group, the difference of B Ultrasound scores was statistically significant (P0.05). The TCM syndrome scores of the combined group and the Chinese medicine group were significantly lower than those in the western medicine group (P0.05); the syndrome scores of the combined group and the Chinese medicine group were compared. The difference was not statistically significant (P0.05).6. TCM syndrome score comparison (4) safety evaluation of the safety evaluation of the Chinese medicine group and the combined group of patients for 0,1,2,3 months of life signs stability, electrocardiogram, renal function, blood routine, urine routine, fecal routine examination have not found obvious abnormalities. Conclusion the 1. phlegm wet prescription based on "liver good" APP implementation of health management, treatment The overall effect of non-alcoholic steatohepatitis was obviously better than that of the phlegm and Polyene Phosphatidylcholine Capsules group. The effect was manifested in improving the patient's clinical symptoms, waist to hip ratio, body mass index, fat attenuation parameters, liver function index, blood lipid index and liver ultrasound imaging. The advantage is to improve the waist to hip ratio and body mass index. Fat attenuation parameters, blood lipid index (TC), liver ultrasound imaging and other aspects, it has a good therapeutic effect on non-alcoholic steatohepatitis,.2. can improve the clinical symptoms, liver function index, blood lipid index (TG, LDL-C, HDL-C) and decrease the adipose attenuation parameters in.3. course, and not found with phlegm dampness prescription. The side effects of phlegm dampness decoction are effective in the treatment of nonalcoholic steatohepatitis.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259
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