解毒通络法治疗失代偿期肝炎后肝硬化的临床疗效观察

Treatment of decompensated cirrhosis by therapy of resolving toxin and dredging collaterals

目的观察解毒通络法治疗失代偿期肝炎后肝硬化的临床疗效,探讨其作用机制。方法取符合西医肝炎后肝硬化诊断标准同时符合湿热内蕴证、瘀血阻络证中医证候标准的患者作为观察对象,随机分为治疗组和对照组各30例。对照组以西医对症治疗为主,治疗组在对照组治疗基础上给予软肝缩脾汤(以解毒通络法拟定)加减治疗,4周为1个疗程。观察中医证候积分、肝功能、凝血酶原活动度及肝纤4项等变化。结果治疗组的中医证候积分、肝功Child分级、肝纤4项较治疗前有明显好转,与对照组比较均有显著性差异(P﹤0.05)。结论解毒通络法治疗失代偿期肝炎后肝硬化,在中医证候、肝功Child分级、抗肝纤维化方面均优于对照组,作用机制可能是保护肝细胞、抑制肝内炎症反应、抗肝纤维化、降低门静脉压力等,对肝炎后肝硬化有较好的治疗作用。

Objective To observe the curative effect of the therapy of resolving toxin and dredging collaterals on decompensated cirrhosis and investigate the mechanism. Method The patients with decompensated cirrhosis accorded with Western diagnostic standard of cirrhosis and TCM syndrome of internal accumulating of damp-heat and blood stasis obstructing collaterals were chosen as the observation objects and divided randomly into the treatment group and control group （each n=30）. The control group was treated with Western medicine and the treatment group, with Ruangansuopi Decoction （made up according to the therapy of resolving toxin and dredging collaterals） besides Western therapy. One treatment course was for 4 weeks. The changes of TCM syndrome integrals, liver function, prothrombin activity and 4 indexes of liver fibrosis were observed. Result In the treatment group TCM syndrome integrals, Child grade of liver function and 4 indexes of liver fibrosis were improved than before the treatment, which was significantlg different to those in the control group （P〈0.05）. Conclusion The therapy of resolving toxin and dredging collaterals has a better curative effect on decompensated cirrhosis in TCM syndromes, Child grade of liver function and liver fibrosis than the control therapy. The mechanism may be related to that it can protect the liver cells, inhibit liver inflammatory reaction, resist liver fibrosis and induce the portal venous pressure.