中药治疗肝衰竭患者内毒素血症及其检测方法

The study for treating liver failure patients with traditional Chinese medicine and detecting method of their endotoxemia

目的:探讨慢性乙型肝炎(CHB)肝衰竭患者血清内毒素血症水平的检测意义及配合辨证论治中药汤剂口服治疗及大黄乌梅汤灌肠与单纯西药治疗的疗效比较。方法:选择60例CHB肝衰竭患者,包括慢性肝衰竭及慢加急性肝衰竭,随机分为按肝衰竭诊疗规范治疗,单纯西药治疗的对照组和配合辨证论治中药汤剂及大黄乌梅汤灌肠治疗的实验组。采用鲎试剂动态浊度定量检测法检测患者入组0周、4周、8周、12周血清内毒素水平。结果:有效患者血清内毒素水平呈逐渐下降趋势,无效及死亡患者则呈上升趋势,或起始即出现重度内毒素血症。配合辨证论治中药汤剂口服治疗及大黄乌梅汤灌肠可显著降低患者内毒素血症水平,效果优于单纯西药治疗,8周差异有统计学意义(P<0.05)。实验组患者有效率显著高于对照组。结论:肝衰竭状态下,可存在不同程度的内毒素血症,内毒素血症水平可显著影响肝衰竭患者病情预后。辨证论治中药汤剂及大黄乌梅汤灌肠可进一步提高其临床疗效。

Objective：To investigate the value of testing serum endotoxin level in liver failure patients with hepatitis B and compare the efficacy treated by STBDD （ selection of treatment based on differential diagnosis） combined with Dahuang Wumei decoction enema, and simple western medicine treatment. Methods： Sixty patients of hepatitis B liver failure, including chronic liver failure and acute-on-chronic liver failure, were randomly divided into the control group treated by simple western medicine according to the standard of diagnosis, and the experimental group treated by STBDD combined with Dahuang Wumei decoction enema. The serum endotoxin level of patients was detected by LAL dynamic turbidimetric method at 0 week, 4 weeks, 8 weeks, 12 weeks. Results： The serum endotoxin level in the effective patients decreased gradually, while ineffective patients showed ascendant trend, or had severe start endotoxemia- After 8 weeks, the serum endotoxin level of the experimental group was superior to that of the control group, the difference was statistically significant （P〈0.05） . The mortality of the experimental group were significantly lower than the control group. Conclusion： Endotoxin levels in liver failure state can significantly influence the prognosis. STBDD combined with Dahuang Wumei decoction enema may further improve the efficacy.