中西医结合治疗肝硬化轻微肝性脑病临床疗效观察

Curative Effect of Integrated Traditional Chinese and Western Medicine on Patients with Liver Cirrhosis and Mild Hepatic Encephalopathy

目的探讨分析桃仁承气汤加味联合乳果糖治疗肝硬化轻微肝性脑病患者疗效及对患者认知功能、血氨及肠道屏障功能的影响。方法选择2017年3月—2019年3月医院收治的肝硬化轻微肝性脑病患者97例,随机分为观察组50例,对照组47例,对照组在常规治疗基础上给予乳果糖治疗,观察组在对照组基础上给予桃仁承气汤加味。比较两组患者血氨水平变化、肝功能指标变化、认知功能变化、肠道屏障功能变化以及不良反应。结果治疗后两组患者血氨水平较治疗前显著降低(P<0.05),且治疗后观察组患者血氨水平显著低于对照组(P<0.05)。治疗后两组患者ALT、AST以及Child-Pugh评分均较治疗前显著降低(P<0.05),且治疗后观察组患者ALT、AST以及Child-Pugh评分显著低于对照组(P<0.05)。治疗后两组患者MMSE评分较治疗前显著升高(P<0.05),且治疗后观察组患者MMSE评分显著高于对照组(P<0.05)。治疗后两组患者内毒素、DAO、TNF-α水平均较治疗前显著降低(P<0.05),且治疗后观察组患者内毒素、DAO、TNF-α水平显著低于对照组(P<0.05)。结论桃仁承气汤加味联合乳果糖治疗肝硬化肝性脑病,可有效改善患者肝功能及认知功能,其作用与降低患者血氨水平、改善患者肠黏膜屏障功能有关,治疗安全性高,值得临床推广。

Objective To explore the effect of Modified Taoren Chengqi Decoction(桃仁承气汤加味)combined with lactulose on cognitive function,blood ammonia and intestinal barrier function in patients with hepatic encephalopathy due to cirrhosis.Methods From March 2017 to March 2019,97 patients with mild hepatic encephalopathy due to cirrhosis were randomly divided into observation group(50 cases)and control group(47 cases).The control group was treated with lactulose on the basis of routine treatment,and the observation group was treated with Modified Taoren Chengqi Decoction on the basis of control group.The changes of blood ammonia level,liver function index,cognitive function,intestinal barrier function and adverse reactions were compared between the two groups.Results After treatment,the blood ammonia level of the two groups was significantly lower than that before treatment(P<0.05),and the blood ammonia level of the observation group was significantly lower than that of the control group(P<0.05).After treatment,the levels of ALT and AST and Child-Pugh scores in the two groups were significantly lower than those before treatment(P<0.05),and the levels of ALT and AST and Child-Pugh scores in the observation group were significantly lower than those in the control group(P<0.05).After treatment,the MMSE score of the two groups was significantly higher than that before treatment(P<0.05),and the MMSE score of the observation group was significantly higher than that of the control group(P<0.05).After treatment,the levels of endotoxin,DAO and TNF-α in the two groups were significantly lower than those before treatment(P<0.05),and the levels of endotoxin,DAO and TNF-α in the observation group were significantly lower than those in the control group(P<0.05).Conclusion Modified Taoren Chengqi Decoction combined with lactulose can effectively improve the liver function and cognitive function of patients with hepatic encephalopathy due to cirrhosis.Its effect is related to the reduction of blood ammonia level and the improvement of intestinal mucosal barrier function of patients.The treatment is safe and worthy of clinical promotion.