中西医结合治疗乙型肝炎相关肝衰竭临床研究

Treatment of HBV-related liver failure with integrated Traditional Chinese and Western Medicine

目的观察中西医结合疗法对乙型肝炎相关肝衰竭的临床疗效。方法收集入组乙型肝炎相关慢性肝衰竭(HBV-relatedchronic liver failure,HBV-CLF)患者51例及乙型肝炎相关慢加急性肝衰竭(HBV-related acute on chronic liver failure,HBV-ACLF)患者52例。HBV-CLF对照组24例,治疗组27例;HBV-ACLF对照组26例,治疗组26例。对照组给予常规保肝、抗病毒、对症支持等治疗,疗程4周。治疗组在对照组相同治疗基础上给予辨证中药治疗。结果 HBV-CLF治疗组临床有效率为63.0%,对照组为54.2%(P>0.05);治疗组凝血酶原活动度(PTA)恢复情况更好,肝性脑病发生率有所降低(P<0.05)。HBV-ACLF治疗组临床有效率为80.8%,对照组为53.8%(P<0.05);治疗组总胆红素(TBil)、PTA、胆碱酯酶(CHE)、白蛋白(ALB)恢复情况更好,腹水、肝性脑病发生率有所降低(P<0.05)。结论中西医结合治疗可提高HBV-ACLF临床疗效;对HBV-CLF未见明显优势,但在部分改善指标及降低并发症方面有一定作用。

Objective To observe the therapeutic effect of integrated Traditional Chinese and Western Medicine on HBV-related liver failure. Methods Fifty-one patients with HBV-related chronic liver failure（HBV-CLF） and 52 patients with HBV-related acute on chronic liver failnre（HBV-ACLF） were enrolled in this study. The HBV-CLF patients were divided into control group（n=24） and treatment group（n=27） The HBV-ACLF patients were divided into control group（n=26） and treatment group（n=26）. The patients in control groups received routine liver protection, anti-virus and expectant treatment while those in treatment groups underwent routine liver protection, anti-virus and expectant treatment plus Traditional Chinese Medicine treatment for 4 weeks based on differentiation of their symptoms and signs. Results The effective rate of HBV-CLF was 63.0% and 54.3% respectively in treatment group and control group（P〉0.05）. The prothrombin activity（PTA） and the incidence of hepatic encephalopathy were lower in treatment group than in control group（P〈0.05）. The effective rate of HBV-ACLF was significantly higher in treatment group than in control group（80.8% vs 53.8%, P〈0.05） . The TBil, PTA, CHE and ALB levels and the incidence of ascites and hepatic encephalopathy were significantly lower in treatment group than in control group（P〈0.05）. Conclusion Integrated Traditional Chinese and Western Medicine can improve the therapeutic effect on HBV-ACLF. Although it cannot significantly improve the therapeutic effect on HBV- CLF, it plays a role in improving certain laboratory indications and in reducing complications of HBV-CLF.