应用肝脾相关理论干预慢性重型肝炎肠黏膜屏障功能的研究

Effect of Intervention Therapy Based on Liver-spleen Correlation Theory on Intestinal Mucosal Barrier Function in Patients with Chronic Severe Hepatitis

【目的】观察应用肝脾相关理论干预慢性重型肝炎的临床疗效及探讨其对肠黏膜屏障的保护作用。【方法】选取慢性重型肝炎患者60例,采用简单随机法将患者随机分为对照组(基础治疗+凉血解毒法)30例和观察组(基础治疗+凉血解毒法+健脾益气法)30例,疗程2周,共2个疗程,观察治疗前后症状积分、血清学变化和治疗后总有效率,同时观察2组患者的肠黏膜通透性(血清二胺氧化酶水平、尿中乳果糖/甘露醇排出率)和血浆内毒素水平。【结果】观察组的总有效率(80.0%)优于对照组(66.7%),差异有显著性意义(P<0.05)。2组均可改善临床症状,改善肝功能,升高凝血酶原活动度,且观察组作用优于对照组,差异有显著性意义(P<0.05);2组治疗前内毒素水平、尿中乳果糖/甘露醇排出率比较,差异均无显著性意义(P>0.05),治疗后观察组血浆内毒素水平、尿中乳果糖/甘露醇排出率较治疗前显著降低(P<0.05),且与对照组比较差异有显著性意义(P<0.05)。【结论】应用肝脾相关理论治疗慢性重型肝炎可提高临床疗效,并可改善慢性重型肝炎患者肠黏膜屏障功能,纠正肠源性内毒素血症。

Objective To observe the therapeutic effect of intervention therapy based on liver-spleen correlation theory for chronic severe hepatitis,and to investigate its preventive effect on intestinal mucosal barrier function of the patients with chronic severe hepatitis.Methods Sixty chronic severe hepatitis patients were equally randomized into two groups.The treatment group was given routine basic treatment and Chinese herbal medicine with the actions of cooling blood and removing toxicity,strengthening spleen and replenishing Qi.The control group was given routine basic treatment and Chinese herbal medicine with the actions of cooling blood and removing toxicity.Two weeks constituted one treatment course,and the treatment lasted 2 courses.The scores of symptoms and serological parameters were examined before and after treatment,and the total effective was evaluated after treatment.Meanwhile,the intestinal mucosal permeability parameters of serum diamine oxidase（DAO） and evacuation ratio of urine lactulose and mannitol（L/M） as well as plasma endotoxin level were detected in the two groups.Results The total effective rate was 80.0% in the treatment group,which was superior to 66.7% in the control group,and there were significant differences between the two groups（P0.05）.The clinical symptoms of two groups were relieved to various degrees,liver function was improved,and thrombinogen activity was promoted,the differences being significant between the two groups（P0.05）.The differences of plasma endotoxin level and the ratio of L/M were insignificant between the two group before treatment（P0.05）.After treatment,plasma endotoxin level and the ratio of L/M were decreased in the two groups（P0.05 compared with those before treatment）,and the decrease was obvious in the treatment group（P0.05 compared with that in the control group）.Conclusion Intervention therapy based on liver-spleen correlation theory can increase the therapeutic effect of chronic severe hepatitis patients,and can improve intestinal mucosal barrier function and intestinal endotoxemia of the patients with chronic severe hepatitis.