中西医结合治疗乙型肝炎慢加急性肝功能衰竭临床研究

Clinical Study on Combination of Chinese and Western Medicine Treatment of Hepatitis B Virus-Acute on Chronic Liver Failure

目的:观察茵虎退黄方治疗乙型肝炎慢加急性肝功能衰竭(hepatitis B virus-acute on chronic liver failure,HBV-ACLF)患者的临床疗效。方法:采用随机对照试验设计方案,将符合纳入标准的68例患者随机分为治疗组和对照组,每组34例。对照组采用西医常规疗法:(1)营养支持疗法:血浆白蛋白低于30 g·L-1者,给予同型血浆200 m L、体积分数20%人血白蛋白50 m L(两者交替应用),均每周2次,静脉滴注。(2)保肝治疗:给予复方甘草酸苷注射液100 m L,注射用促肝细胞生长素120μg,分别加入体积分数5%葡萄糖注射液250 m L,静脉滴注,每日1次。(3)抗病毒治疗:恩替卡韦分散片0.5 mg,口服,每日1次。(4)人工肝支持治疗(血浆置换):每次置换新鲜同型血浆2 000 m L,每周1次,若血清总胆红素低于正常高限值10倍,即停止人工肝治疗。(5)并发症防治:合并感染者及时应用抗生素控制感染,积极预防肝性脑病、肝肾综合征及上消化道出血等并发症。治疗组在对照组治疗基础上加用茵虎退黄方(茵陈45 g,虎杖30 g,赤芍30 g,茯苓30 g,猪苓20 g,炒白术20 g,郁金20 g,车前子30 g,玉米须30 g)治疗。腹部胀满甚者加大腹皮30 g,炒莱菔子30 g;纳差者加焦山楂、焦神曲、焦麦芽各20 g,焦谷芽20 g,便秘甚者加麻子仁30 g,生大黄9 g;有齿鼻衄血或皮下瘀斑者,加仙鹤草30 g,三七3 g;有神志异常者加服安宫牛黄丸,每日1丸。以上中药配方颗粒由深圳三九医药贸易有限公司提供。两组患者均以2个月为1个疗程。观察两组患者治疗前后症状体征、血清肝功能指标如总胆红素(serum total bilirubin,TBIL)、谷丙转氨酶(glutamic pyruvic transaminase,ALT)、谷草转氨酶(glutamic-oxalacetic transaminase,AST)、血清白蛋白(blood albumin,ALB)、前白蛋白(prealbumin,PA)等指标改善情况,以及其他生化学指标如凝血酶原活动度(prothrombin activity,PTA)、血氨(blood ammonia,AMON))、内毒素(endotoxin,LPS)、肿瘤坏死因子-α(Tumor necrosis factor alpha,TNF-α)及白细胞介素-6(Interleukin-6,IL-6)水平变化情况。结果:(1)两组患者临床疗效比较:治疗组显效22例,有效6例,无效5例,有效率为85.29%;对照组显效14例,有效7例,无效11例,有效率为67.65%,两组比较,差异有统计学意义(P<0.05);(2)两组实验室指标比较:治疗后两组肝功能及凝血功能指标均较治疗前明显好转,差异有统计学意义(P<0.05);(3)治疗后两组AMON、LPS、TNF-α及IL-6水平均较治疗前明显改善,且治疗组疗效优于对照组,差异有统计学意义(P<0.05);(4)两组患者并发症发生率、人工肝治疗次数及住院治疗时间比较,治疗组均优于对照组,差异有统计学意义(P<0.05)。结论:中西医结合治疗能够提高HBV-ACLF患者生存率,减少并发症的发生及人工肝治疗次数,缩短患者住院治疗时间。其作用机制与降低患血氨、内毒素水平及减少炎性细胞因子(TNF-α、IL-6)释放,从而阻断肝细胞进一步损伤、促进者肝脏功能恢复等因素有关。

Obiective To observe the clinical effect of Yin Hu Tui Huang Fang treatment of hepatitis B virus-acute on chronic liverfailure（HBV-ACLF）. Methods ：68 patients were randomly divided into the treatment group and the control group （n = 34）. The control group received conventional treatment , Nutritional support therapy：serum albumin less than 30g · L - 1 patients, given the same type of plasma 200mE,the volume fraction of 20% Human Albumin 50 mL （two alternate applications） ,2 times a week, intravenous drip. Liver protection treatment ： Compound Glycyrrhizin Injection 100 mL, Hepatocyte Growth - promoting Factor for Injection 120 ixg,separately adding volume fraction 5% , Glucose Injection 250 mL, intravenous drip, 1 time a day. Antiviral treatment ： Entecavir Dispersible Tablets 0.5 rag, oral, 1 time a day. Artificial liver support therapy （ plasma exchange） ： each re- placement of fresh plasma 2000 mL, one time a week, if serum total bilirubin is less than 10 times of the normal high limit, that is, stop artificial liver treatment. Prevention of complications ： timely application of antibiotics to control infection accompanied, pre- vention of hepatic encephalopathy, hepatorenal syndrome and upper gastrointestinal bleeding and other complications, and the treat- ment group based on routine treatment of Western medicine combined with Yin Hu Tui Huang Fang, composition：Yinehen （Capil- lary Artemisia） 45 g, Huzhang （ Polygonum Cuspidatum ） 30 g, Fuling （ Poria Cocos ） 30 g, Zhuling （Grifola） 20 g, Chaobaizhu （ Fried Atractylodes Macrocephala Koidz） 20 g, Yujin （ Radix Curcumae） 20 g, Cheqianzi （ Semen Plantaginis） 30 g, Yumixu （ Stigma of Corn） 30 g. Abdominal fullness obviously addition Dafupi （ Pericarpium Arecae） 30 g, Chaolaifuzi （ Fried Radish Seed） 30g ; anorex- ia plus Jiaoshanzha （ Scorched Hawthorn Fruit） 20 g, Jiaoshenqu （ Medicated Leaven） 20g, Jiaomaiya （ Caramel Malt） 20 g, Jiaoguya （ Rice Sprout） 20 g, serious constipation addition Maziren （ Semen Cannabidis） 30 g, Shengdahuang （ Raw Rhubarb） 9 g; gingival hemorrhage, epistaxis or ecchymosis, plus Xianhecao （ Hairyvein Agrimony ） 30 g, Sanqi （ Pseudo - Ginseng） 3 g. Abnormal mind plus take Angongniuhuang pill, 1 pill per day. Chinese medicine granule provided by Shenzhen 39 Pharmaceutical Trading Compa- ny Limited. Two groups were treated for 2 months for 1 course, two groups were observed before and after treatment in patients with liver function index of symptoms and signs, such as serum total bilirubin （TBIL）, alanine aminotransferase （ALT）, aspartate amin- otransferase （AST）, serum albumin （ALB） ,prealbumin （PA） to improve the situation, and other biochemical indicators such as prothrombin activity （ I：VFA）, blood ammonia （AMON） ）, endotoxin （ LPS）, tumor necrosis factor alpha （TNF-a） and interleukin- 6 （IL-6） level changes. Results ： @In the treatment group,22 cases were markedly effective, 6 cases effective,5 cases ineffective, the efficiency was 85.29% ;in the control group, 14 cases were markedly effective,7 cases effective, 11 cases ineffective,the effi- ciency was 67.65% , and the difference was statistically significant （P 〈 0.05 ）. Two groups of liver function and blood coagula- tion function （PTA） index comparison ： after treatment, the liver function and coagulation function index of the two groups were sig- nificantly improved compared with before treatment, the treatment group was better than the control group（ P 〈 0.05 ）. （·Compari- son of other biochemical indicators ： AMON, LPS, TNF-a and IL-6 levels were significantly improved after treatment in two groups, the treatment group was better than the control group （P 〈 O. 05 ）. @The two groups of patients with complications, artificial liver treatment times and hospitalization time,the treatment group was better than the control group （P 〈 0.05）. Conclusion ： Combina- tion of Chinese and Western medicine can improve the survival rate of HBV-ACLF patients, and reduce the occurrence of compli- cations of artificial liver treatment times, shorten treatment time and reduce hospitalization ; blood ammonia and endotoxin levels and reduce inflammatory cytokines and its mechanism （TNF-a, IL-6） release, thereby blocking the liver cell injury and promote the recovery of liver the function of patients with other factors.