加味赤石脂禹余粮汤对脾肾阳虚证肝硬化腹水患者的影响及疗效分析

Effect and Efficacy Analysis of Modified Chishizhi Yuyuliang Tang in Patients with Cirrhosis Ascites( Spleen-Kidney-Yang Deficiency)

目的:探讨加味赤石脂禹余粮汤治疗肝硬化腹水脾肾阳虚证的临床疗效及对腹水中葡萄糖(GLU)和乳酸脱氢酶(LDH)水平以及血清腹水白蛋白梯度(SAAG)的影响。方法:共选入脾肾阳虚证肝硬化腹水患者104例,随机按照入院先后顺序分为对照组和治疗组各52例。两组均参照《肝硬化腹水的中西医结合诊疗共识意见》标准给予限钠、护肝和利尿治疗;对照组给予恩替卡韦片口服,0.5 mg/次,1次/d。治疗组在对照组用药的基础上给予加味赤石脂禹余粮汤治疗,1剂/d,常规水煎煮,分早晚2次内服。两组患者均治疗4周。比较两组患者治疗前后中医临床症状评分;采取B超检测两组患者门静脉与脾静脉主干宽度和腹水深度;检测两组患者腹水中LDH和GLU水平;比较两组患者治疗前后SAAG。结果:治疗组治疗后中医临床症状评分均明显低于对照组(P<0.01);治疗组临床总有效率为88.46%,对照组为67.31%,治疗组高于对照组(P<0.05);治疗组治疗后门静脉与脾静脉主干宽度和腹水深度均明显低于对照组(P<0.05,P<0.01);治疗后治疗组患者腹水LDH和GLU水平以及SAAG均明显低于对照组,比较差异均有统计学意义(P<0.01)。结论:加味赤石脂禹余粮汤联合恩替卡韦片治疗肝硬化腹水脾肾阳虚证可明显改善患者中医临床症状,改善肝硬化门静脉高压,提高腹水临床治疗效果,可降低患者腹水中LDH和GLU水平以及SAAG。

Objective： To investigate the clinical efficacy of Modified Chishizhi Yuyuliang Tang for cirrhosis ascites of spleen-kidney-yang deficiency and its effect on glucose（ GLU） and lactate dehydrogenase（ LDH） levels in ascitic fluid and serum-ascites albumin gradient（ SAAG）. Method： One hundred and four patients with cirrhosis ascites of spleen-kidney-yang deficiency were randomly divided into control group（ 52 cases）and treatment group（ 52 cases） with digital table method. By referring to the treatment methods in ‘A Consensus Opinion on The Diagnosis and Treatment of Cirrhosis Ascites in The Traditional Chinese and Western Medicine＇,patients of both groups were treated with therapy of sodium restriction,liver protection and diuresis. Patients of control group were treated with entecavir tablets（ 0. 5 mg / time,qd） by orally taking. Patients of treatment group were also treated with Modified Chishizhi Yuyuliang Tang based on the treatment in control group（ 1 dose / d in form of water decoction,bid）. The treatment course was 4 weeks for both groups. The traditional Chinese medicine（ TCM） symptom scores in both groups were compared before and after treatment. The width of the trunk of vena portae and vena lienalis and the depth of ascites were detected by B ultrasound. LDH and GLU levels in ascites were detected for both groups. Levels of SAAG were compared in two groups before and after treatment. Result：The TCM symptom scores in treatment group were significantly lower than those in control group after treatment（ P〈 0. 01）. The total efficacy of treatment group was 88. 46%,significantly higher than 67. 31% in control group,with statistically significant difference（ P〈 0. 05）. Compared with control group,the width of the trunk of vena portae and vena lienalis and the depth of ascites were significantly lower in treatment group after treatment（ P 〈 0. 05,P 〈 0. 01）. Levels of LDH,GLU in ascites and SAAG were significantly lower in the treatment group than those in control group after treatment,with statistically significant differences（ P〈 0. 01）. Conclusion：Modified Chishizhi Yuyuliang Tang combined with entecavir for cirrhosis ascites of spleen-kidney-yang deficiency could evidently improve the TCM symptoms,cirrhotic portal hypertension,clinical therapeutic effects of ascitic fluid and reduce levels of LDH,GLU in ascites and SAAG level.