豨莶二黄汤联合熊去氧胆酸治疗原发性胆汁性肝硬化患者40例临床观察

Clinical Observation on Xixian Erhuang Decoction Combined with Ursodeoxycholic Acid for 40 Cases of Primary Biliary Cirrhosis

目的观察豨莶二黄汤联合熊去氧胆酸治疗原发性胆汁性肝硬化（PBC）的临床疗效。方法将80例PBC患者随机分为治疗组和对照组各40例。对照组给予熊去氧胆酸胶囊13～15 mg/（kg·d）,每日3次;复方甘草酸苷片,每次50mg,每日3次,治疗2周。治疗组在对照组治疗基础上加用豨莶二黄汤治疗,每日1剂,两组疗程均为24周。观察两组治疗后12周及治疗后24周临床疗效、中医证候积分、肝功能指标水平。结果治疗后12周及24周,两组中医证候积分较治疗前均明显降低（P〈0.05或P〈0.01）,治疗组较对照组中医证候积分降低更显著（P〈0.05或P〈0.01）,治疗组临床疗效完全反应率明显高于对照组（P〈0.05或P〈0.01）。两组丙氨酸氨基转移酶（ALT）、门冬氨酸氨基转移酶（AST）、碱性磷酸酶（ALP）、谷氨酰转肽酶（GGT）、总胆红素（TBIL）及总胆汁酸（TBA）值在治疗后12周及24周均较治疗前显著下降（P〈0.05）;治疗后12周及24周治疗组ALT、AST、ALP、GGT、TBIL及TBA均较对照组同时间显著降低（P〈0.01）。治疗后24周,治疗组血清白蛋白（ALB）较治疗前明显上升（P〈0.05）,与对照组同期比较差异有统计学意义（P〈0.01）。结论豨莶二黄汤联合熊去氧胆酸治疗原发性胆汁性肝硬化能明显改善症状及肝功能,优于单用熊去氧胆酸,且远期疗效好。

Objective To observe the therapeutic effect of ursodeoxycholic acid（ UDCA） combined with Xixian Erhuang Decoction for primary biliary cirrhosis（ PBC）. Methods Eighty cases of PBC were randomized into the treatment group and control group,with 40 in each. The control group was given 13 to 15 m /g（ kg·d） UDCA Capsules and 50 mg Compound Glycyrrhizin Tablets three times daily for 2 weeks. The treatment group was added with Xixian Erhuang Decoction one dose daily. The treatment lasted for 24 weeks. The efficacy,TCM syndrome scores and liver function were observed in both groups after 12-week and 24-week treatment. Results The total TCM syndrome scores in both groups were significantly decreased after 12-week and 24-week treatment（ P〈0. 05 or P〈0. 01）,especially in the treatment group（ P〈0. 05 or P〈0. 01）. The complete response rate in the treatment group was significantly higher than that in the control group（ P〈0. 05 or P〈0. 01）. The levels of alanine aminotransferase（ ALT）,aspartate aminotransferase（ AST）,alkaline phosphatase（ ALP）,gamma-glutamyl transpeptidase（ GGT）,total bilirubin（ TBIL） and total bile acid（ TBA） were significantly decreased in both groups after 12-week and 24-week treatment（ P〈0. 05）,especially in the treatment group（ P〈0. 01）. The albumin level was significantly increased in the treatment group after 24-week treatment（ P〈0. 05）,with a significant difference between groups（ P〈0. 01）. Conclusion The combo therapy of UDCA and Xixian Erhuang Decoction is effective for PBC. It can obviously relieve symptoms and improve liver function with a better long-term effect as compared with single application of UDCA.