辨证分型与保留灌肠联合西药治疗慢性重型肝炎随机平行对照研究

Syndrome Differentiation and Random Parallel Controlled Study on The Treatment of Chronic Severe Hepatitis Combined With Retention Enema

[目的]观察辨证分型与保留灌肠联合西药治疗慢性重型肝炎疗效。[方法]使用随机平行对照方法,将75例住院及门诊患者按按病志号抽签/就诊顺序号方法随机分为两组。对照组26例1甘草酸苷,静滴,1次/d;2谷胱甘肽或N-乙酰半胱氨酸,静滴,1次/d;3促肝细胞生长素,静滴,1次/d。治疗组49例瘀热发黄-凉血活血退黄,赤丹退黄颗粒（赤芍、丹参、葛根、瓜蒌等）,10g/次,3次/d,温开水冲服;如消化道症状较重无法口服给药,温开水100m L溶药30g,1次/d,高位保留灌肠;湿热发黄-清热解毒利湿,复方茵陈方（茵陈30~60g,栀子12g,黄芩6g,大黄10g,炒白术30g,甘草6g）,1剂/d,水煎260m L,早晚口服;气虚瘀黄-益气解毒化瘀,扶正解毒化瘀方（炙黄芪30g,虎杖30~60g,茯苓、地耳草、丹参、益母草各30g,猪苓20g,炒白术30g）,1剂/d,水煎260m L,早晚口服;阳虚瘀黄-温阳健脾退黄,温阳退黄方（茵陈15~30g,白术10g,炮附子3~10g,白蔻仁10g,赤芍50g）,1剂/d,水煎260m L,早晚口服;IMS-100A Plus结肠途径治疗系统温生理盐水5000m L结肠灌洗;生大黄、乌梅各30g,1剂/d,水煎100m L,保留灌肠,3次/周。连续治疗8周为1疗程。观测临床症状、肝功能、中医临床症状量化评分、不良反应。治疗1疗程,随访48周,判定疗效。[结果]治疗组痊愈47例,显效37例,有效10例,无效2例,总有效率95.92%。对照组痊愈19例,显效8例,有效11例,无效7例,总有效率73.08%。治疗组疗效优于对照组（P〈0.05）。肝功能指标两组均有改善（P〈0.05,P〈0.01）,AST、TBIL治疗组改善优于对照组（P〈0.05,P〈0.01）,ALT两组间无明显差异（P〉0.05）。中医临床症状量化评分两组均有改善（P〈0.01）,治疗组改善优于对照组（P〈0.05）。[结论]辨证分型与保留灌肠联合西药治疗慢性重型肝炎,疗效满意,无严重不良反应,值得推广。

[Objective] To observe syndromes and retention enema combined with western medicine in treatment of chronic severe hepatitis patients. [Method] uses random parallel control Method, 75 cases of hospitalized patients and outpatients by Zhi No. ballot by disease / treatment sequence numbers randomly divided into two groups. 26 cases in the control group ① glycyrrhizin, intravenous infusion, 1/d; ② glutathione or N- acetylcysteine infusion, 1/d;③ PHGF, intravenous infusion, 1 times/d. Treated 49 cases of stasis hot yellow - jaundice cooling blood, red Tuihuang particles （red peony, salvia, arrowroot, Melon, etc.）, 10g/time, 3 times/d, warm boiled water; such as gastrointestinal symptoms can not be administered orally heavy, warm water lOOmL dissolved drug 30g, 1 times/d, high retention enema; damp yellow - detoxification dampness, compound capillaries party （Artemisia 30 - 60g, Gardenia 12g, skullcap 6g, rhubarb 10g, fried Atractylodes 30g, licorice 6g）, 1 a/d, decoction 260mL, sooner or later orally; Huang Qi and stasis - Qi Jieduhuayu, Fuzhengjiedu Huayu （Sunburn Astragalus 30g, Polygonum cuspidatum 30 - 60g, Poria, the ear grass, Salvia, motherwort each 30g, Polyporus 20g, fried Atractylodes 30g）, 1 a / d, decoction 260mL, sooner or later oral; Yang stasis yellow -jaundice spleen yang, yang jaundice party （capillaris 15 - 30g, Atractylodes 10g, gun aconite 3 - 10g, white Kou Ren 10g, red peony 50g）, 1 a/d, decoction 260mL, sooner or later orally; IMS-100A Plus colon therapy System warm saline 500OraL colonic irrigation. Rhubarb, plum each 30g, 1 a/d, decoction 100mL, enema, 3 times/ week. 8 weeks of continuous treatment course of treatment. Observation of clinical symptoms, liver function, quantification of TCM clinical symptom scores, adverse reactions. A course of treatment to determine efficacy. Follow-up of 48 weeks, the observed liver function, quantification of TCM clinical symptom score. [Results] The treatment group cured 47 cases, markedly effective in 37 cases, effective 10 cases, invalid 2 cases, the total efficiency of 95.92%. The control group cured 19 cases, markedly effective in 8 cases, effective 11 cases, invalid 7 cases, the total efficiency of 73.08%. The efficacy of the treatment group was better than that of the control group （P〈0.05）. Liver function indexes of two groups were improved （P〈0.05, P〈0.01）, AST, TBIL treatment group is better than control group （P〈0.05, P〈0.01）, ALT no significant difference between the two groups （P〉0.05）. Clinical symptoms quantitative score of two groups were improved （P〈0.01）, the treatment group is better than control group （P〈0.05）. [Conclusion] The syndrome differentiation and treatment of chronic severe hepatitis, combined with retention enema with satisfied effect, no serious adverse reaction, is worth promoting.