柔肝健脾清化法治疗乙肝肝硬化肝脾两虚，湿热瘀结证的临床研究

发布时间：2019-01-23 21:34

【摘要】：目的：观察柔肝健脾清化法治疗乙肝肝硬化肝脾两虚,湿热瘀结证的临床疗效。通过收集临床病例,比较治疗前后症状及体征、血清指标、腹部B超等变化情况,验证本法在治疗乙肝肝硬化肝脾两虚,湿热瘀结证的有效性,规范化评估本法在治疗中的优势点,继而发掘中医药联合西药治疗的优势面,提高患者的生存质量,为中医药治疗乙肝肝硬化提供临床参考。方法：采取简单随机对照原则,将收集的63例乙肝肝硬化患者分成治疗组38例,对照组25例。对照组给予抗病毒或基础对症治疗,治疗组在对照组的基础上加用以柔肝健脾清化为治疗大法的汤剂；观察治疗前、治疗后3个月、6个月时肝生化指标、肝纤三项、凝血指标、肿瘤指标等实验室指标变化,肝脾B超变化,以及治疗前后临床症状、体征的变化。采用SPSS17.0对收集的数据进行统计与分析。结果：症状及体征的影响：治疗组和对照组都可减轻患者乏力、胁痛、纳差、口干口苦、腹水的表现,结果具有统计学意义(P0.01)；两组对比治疗效果时,治疗组更能改善患者的乏力、腹胀、胁痛、纳差、口干口苦及腹水(P＜0.01),身目黄染及肝脾肿大(P0.05)具有统计学意义。肝生化功能的影响：治疗组和对照组均可以降低患者ALT、AST、 ALP (P0.01),治疗组在降低ALT水平(P0.01), AST、TBIL水平(P0.05)优于对照组；相比对照组,治疗组可以提高肝硬化患者ALB和pALB水平(P0.01)；对于肝纤维化三项指标,两组治疗后均有下降(P0.05),在降低PC III与IV-C方面,治疗组要优于对照组(P0.05)；在改善凝血指标方面,治疗组可缩短PT,提高PTA与PLT(P0.01),对照组仅可有效缩短PT(P0.05),治疗组比对照组更能改善PT与PLT(P0.05)；比较肿瘤指标,两组均可降低AFP水平(P0.05)而且治疗组优于对照组(P0.01)。肝脾B超的影响：两组对于改善肝右叶斜径、门静脉内径无统计学意义(P0.05),治疗组可缩短脾静脉内径(P0.05),效果优于对照组(P0.05)。总有效率的评估：治疗组总有效率89.47%,对照组总有效率72.00%,两组对比有差异(P＜0.05),说明治疗组治疗效果优于对照组。结论：治疗组和对照组都可以有效治疗乙肝肝硬化,在改善症状及体征、肝生化指标、肝纤三项、凝血指标、AFP及腹部B超各方面,治疗组要优于对照组。说明柔肝健脾清化法联合西药治疗可以更好地改善肝纤维化,保护肝细胞,减轻临床症状,疗效肯定。
[Abstract]:Objective: to observe the clinical effect of the treatment of liver and spleen deficiency and damp-heat stasis syndrome in liver cirrhosis. By collecting clinical cases and comparing the changes of symptoms and signs, serum indexes, abdominal B ultrasound before and after treatment, the effectiveness of this method in the treatment of liver and spleen deficiency and damp-heat stasis syndrome of hepatitis B cirrhosis was verified. Standardized evaluation of the advantages of this method in the treatment, and then explore the advantages of traditional Chinese medicine combined with western medicine treatment, improve the quality of life of patients, and provide a clinical reference for the treatment of liver cirrhosis with traditional Chinese medicine. Methods: 63 patients with hepatitis B cirrhosis were divided into treatment group (n = 38) and control group (n = 25). The control group was treated with anti-virus or basic symptomatic therapy, and the treatment group was treated with the decoction of treating dafa on the basis of the control group. Before treatment, 3 months after treatment, 6 months after treatment, the changes of biochemical indexes of liver, three items of liver fiber, coagulation index, tumor index and other laboratory indexes, changes of B-ultrasound in liver and spleen, and changes of clinical symptoms and signs before and after treatment were observed. SPSS17.0 was used to analyze the collected data. Results: the effects of symptoms and signs: both the treatment group and the control group could alleviate the symptoms of fatigue, hypochondria, anorexia, dry mouth and bitter mouth, ascites, the results were statistically significant (P0.01). Compared with the treatment effect, the treatment group can improve the patient's fatigue, abdominal distension, hypochondria, anorexia, dry mouth and bitter mouth and ascites (P < 0.01), yellow stain of body and eyes and hepatosplenomegaly (P0.05). The effect of liver biochemical function: the treatment group and the control group can reduce the ALT,AST, ALP (P0.01), the treatment group in reducing the level of ALT (P0.01), AST,TBIL level (P0.05) is better than the control group; Compared with the control group, the treatment group could increase the levels of ALB and pALB in patients with liver cirrhosis (P0.01). For the three indexes of hepatic fibrosis, the two groups were decreased after treatment (P0.05), in terms of reducing PC III and IV-C, the treatment group was better than the control group (P0.05); In improving coagulation index, the treatment group can shorten PT, to increase PTA and PLT (P0.01), the control group can only shorten PT (P0.05), the treatment group can improve PT and PLT (P0.05); Compared with tumor index, both groups could decrease AFP level (P0.05) and the treatment group was superior to the control group (P0.01). The effect of liver and spleen B ultrasound: two groups for improving the right lobe oblique diameter, portal vein diameter has no statistical significance (P0.05), the treatment group can shorten the splenic vein diameter (P0.05), the effect is better than the control group (P0.05). Evaluation of total effective rate: the total effective rate of the treatment group was 89.47 and that of the control group was 72.00. There was a difference between the two groups (P < 0.05), which indicated that the therapeutic effect of the treatment group was better than that of the control group. Conclusion: both the treatment group and the control group can effectively treat hepatitis B cirrhosis. The treatment group is superior to the control group in improving symptoms and signs, liver biochemical index, liver fibrin three, coagulation index, AFP and abdominal B ultrasound. It is concluded that the combination of the method of strengthening liver and strengthening spleen with western medicine can improve liver fibrosis, protect liver cells, alleviate clinical symptoms and have definite curative effect.
【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】：2016
【分类号】：R259

【相似文献】