茵陈升白汤联合西药治疗重型慢乙肝随机平行对照研究

Yin Chen Shen Consomme Combined Western Medicine Treatment of Severe Chronic Hepatitis b and Fibroscan Observation Random Parallel Control Study

[目的]观察茵陈升白汤联合西药治疗重型慢乙肝疗效。[方法]使用随机平行对照方法，将60例门诊及住院患者按抛硬币法随机分为两组。对照组30例美洛西林舒巴坦钠，2．25g／次，2次／d。复方甘草酸苷粉针，160mg/次，1次／d，静注。多烯磷酯酰胆碱，475mgD＆，1次／d，静注。还原型谷胱甘肽，1．2g／次，1次／d。门冬氨酸钾镁，30mL／次，1次／d，静注。熊去氧胆酸片，90mg／次，3次／d。水飞蓟宾片，70mg／次，3次／d。维生素K1及短程速尿静推（NS20ml＋速尿40mgiv，qd×7d）。治疗组30例茵陈升白汤（茵陈、白花蛇舌草、田基王、土茯苓、白背叶根各30g，三棱、莪术各10g，生大黄后下、车前子各20g，金钱草30～50g，泽泻、白术各15g，后期加用田七粉冲服5g）。1剂／d，水煎120mL，早晚口服。西药治疗同对照组。连续治疗45d为1疗程。观测临床症状、肝功能（TBIL、DBIL、ALT、AST、ALB、GLB）、黄疸下降速度及时间、Fibroscan肝扫描、PTA、脾脏厚度变化、不良反应。治疗1疗程（45d），判定疗效。[结果]治疗组显效24例，有效4例，无效2例，总有效率93．33％。对照组显效14例，有效12例，无效4例，总有效率86．67％。治疗组疗效优于对照组（P〈0．05）。TBIL和PTA两组均有改善（P〈0．01），治疗组改善优于对照组（P〈0．01）。Fibroscan两组均有改善（P〈0．01），治疗组改善优于对照组（P〈0．01）。B超两组均有改善（P〈0．05），治疗组改善优于对照组（P〈0．05）。并发症治疗组优于对照组（P〈0．01）0[结论]茵陈升白汤联合西药治疗重型慢乙肝效果显著，值得推广。

[ Objective ] To observe the Yin Chen shen consomme combined western medicine treatment of severe chronic hepatitis b and Fibroscan observation. [ Methods ] Using random parallel control method, 60 cases of outpatient and hospitalized patients were randomly divided into two groups according to flip a coin method. The control group 30 cases of mezlocillin sodium with shu ba, 2.25 g/time, 2 times/d. Compound glycyrrhizin glucoside booster injection, 160 mg/times, 1/d, the static note. Polyene phosphatide acyl choline, 475 mg/times, 1/d, the static note. Reduced glutathione, 1.2 g/time, 1/d. Nmda potassium magnesium, 30 ml/second, 1/d, the static note. Bear to oxygen cholic acid, 90 rag/time, 3 times/d. Bean milk thistle, 70 mg/time, 3 times/d. Vitamin K1 and short-range furosemide static thrust （ NS2Oml＋40 mg furosemide iv, qd x 7d ） .Treatment group 30 cases of Yin Chen shen consomme （ Yinchen, Baihuasheshecao, Tianjiwang, Tufuling, Baibeiyegen each 30g, Sanleng, E＇ zhu each 10g, Shengdahuang, Cheqianzi each 20g, Jinqiancao 30 - 50g, Zexie, Baizhu each 15g, late add with panax notoginseng Tianqifen 5g ） . 1/d, boiling water 120 mL, oral sooner or later. Western medicine treatment with the control group. Continuous treatment of 45d 1 course of treatment. Observation of clinical symptoms, liver function （ ALT, AST, TBIL, DBIL, propagated, GLB ）, decreased jaundice, Fibroscan liver scanning speed and time, PTA, spleen thickness change, adverse reactions. Treatment as a course （ 45d ）, to determine efficacy. [ Results ] The treatment group 24 cases were markedly effective, effective 4 cases, 2 had no effect, the total effective rate was 93.33%. Control group 14 cases had marked effect, 12 cases effective, 4 had no effect, the total effective rate was 86.67%. The treatment groupcurative effect is better than that of control group （ P〈0.05 ） . TBIL and PTA in the two groups were improved （P〈0.01）, the treatment group is better than that of control group （P〈0.01） . Fibroscan two groups have improved （ P〈0.01 ）, the treatment group improved better than that of control group （ P〈0.01 ） . Ultrasound in the two groups were improved （ P〈0.05 ）, the treatment group is better than that of control group （ P〈0.05 ） . Complications in the treatment group is better than that of control group （ P〈0.01 ） . [ Conclusion ] Yin Chen shen consomme combined western medicine treatment of severe chronic hepatitis b and Fibrosean observation effect is remarkable, is worth promoting.