基于慢性乙型肝炎的中药寒热药性研究

Study on the cold and hot nature of Chinese materia medica on chronic hepatitis B cases

目的:探讨中药寒热药性对慢性乙型肝炎(CHB)患者肝功能的影响差异。方法:对本院采用中药治疗的253例CHB住院病历进行回顾性分析,通过构建CHB肝功能指标的因子结构模型,探索影响CHB疾病进展的关键因素;通过分析寒热方药对以上关键因素指标的改善情况,阐明寒热药性对CHB疗效的影响差异。结果:就肝功能指标而言,影响CHB疾病进展情况的3个方面是:胆汁排泄障碍及胆汁淤积情况、肝脏损害程度、肝脏合成储备功能。寒、热方药均能显著降低患者总胆红素(TBil)、直接胆红素(DBil)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、总胆汁酸(TBA)、乳酸脱氢酶(LDH)、γ-谷氨酰转肽酶(GGT)各指标值(P<0.05,P<0.01),热性方药还能显著升高总蛋白(TP)、白蛋白(ALB)、球蛋白(GLO)(P<0.05)。结论:寒、热方药均能通过降低转氨酶、改善肝脏损害、促进胆汁排泄、减轻胆汁淤积、促进肝脏代谢而表现出对CHB的治疗作用;不同的是热性方药还有升高血清蛋白质的作用。

Objective： To explore the different impact of the cold and hot nature of Chinese materia medica on the liver function of chronic hepatitis B （CHB） patients. Methods： Through the retrospective study on 253 CHB cases of hospitalized patients, the factor structure model based on the liver functional parameters was built and the key points of CHB progression were found. Analyzing the improvements in parameters of the key points acted by cold and hot prescriptions, the different therapeutic effects of the cold and hot nature of Chinese materia medica upon CHB were interpreted. Results： On liver function, there are three aspects to impact on CHB progression： the biliary excretion and cholestasis, the degree of liver damage, liver synthesis and reserve function. Cold and hot prescriptions all decreased obviously the ALT, AST, LDH, TBil, DBil, TBA, GGT, ALP （P〈0.05, P〈0.01）, and Hot prescriptions significantly increased TP, ALB and GLO（P〈0.05）. Conclusion： Cold and hot prescriptions all treated CHB by reducing aminopherases, relieving the damage of liver, promoting the bile excretion, relieving cholestasis and advancing the liver metabolism. But the difference between cold and hot prescriptions was that the Hot prescriptions could heighten the serum protein.