柔肝补血中药治疗酒精性肝硬化伴门脉高压性腹水疗效及对内皮素-1、血管内皮生长因子的影响

The curative effect of nouishing liver and enriching blood medicine in alcoholic cirrhosis with portal hypertensive ascites and its influence on endothelin-1 and vascular endothelial growth factor

目的观察柔肝补血中药治疗酒精性肝硬化伴门脉高压性腹水疗效及对内皮素-1(ET-1)、血管内皮生长因子(VEGF)的影响。方法将110例酒精性肝硬化伴门脉高压性腹水患者随机分为2组,对照组55例给予西医常规治疗,观察组55例在此基础上加用柔肝补血中药治疗,观察2组治疗前后体质量差值、腹围差值、24 h尿量差值、中医证候积分、门静脉主干内径、门静脉主干血流速度、脾静脉内径、丙氨酸转氨酶(ALT)、白蛋白(ALB)、总胆红素(TBil)、凝血酶原时间活动度(PTA)、ET-1及VEGF水平变化情况,统计2组近期疗效。结果观察组治疗前后体质量、腹围及24 h尿量差值均显著大于对照组(P均<0.05);2组治疗后腹胀、纳呆、身目黄染、乏力、口燥心烦及舌绛津少积分均显著低于治疗前(P均<0.05),且观察组治疗后各项积分均显著低于对照组(P均<0.05);2组治疗后门静脉主干内径、门静脉主干血流速度、脾静脉内径、ALT、TBil、ET-1及VEGF水平均显著降低(P均<0.05),ALB和PTA水平均显著提高(P均<0.05),且观察组治疗后各项指标改善情况均显著优于对照组(P均<0.05);观察组近期治疗总有效率显著高于对照组(P<0.05)。结论柔肝补血中药治疗酒精性肝硬化伴门脉高压性腹水可有效缓解临床症状,改善肝功能和凝血功能,并有助于调节ET-1和VEGF水平。

Objective It is to observe the curative effect of Chinese herbal medicine of nourishing liver and enriching blood( NLEB) in alcoholic cirrhosis with portal hypertension ascites and its influence on endothelin-1( ET-1) and vascular endothelial growth factor( VEGF). Methods 110 patients with alcoholic cirrhosis with portal hypertension ascites were randomly divided into 2 groups. 55 cases in the control group were given routine treatment of western medicine,55 cases of observation group were treated with traditional Chinese medicine of NLEB on the basis of the treatment of the control group.The changes of body quality,abdominal circumference,24 hour urine volume,TCM syndrome integral,portal vein diameter,portal vein blood flow velocity,splenic vein diameter,alanine aminotransferase( ALT),albumin( ALB),total bilirubin( TBil),prothrombin time activity( PTA),and the levels of VEGF and ET-1 before and after treatment in the 2 groups were observed. The short-term effects of the two groups were compared. Results The difference of body weight,abdominal circumference and 24 h urine volume before and after treatment in the observation group was significantly greater than that of the control group( P < 0. 05). The syndrome integral of abdominal distention,anorexia,jaundice,body fatigue,dry mouth and vexation,purple tongue and less saliva in the 2 groups after treatment were significantly lower( all P < 0. 05),and the scores of the observation group were significantly lower than those of the control group( all P < 0. 05). The internal diameter of the trunk of the portal vein,the blood flow velocity of the portal vein,the internal diameter of the splenic vein,and the levels of ALT,TBil,ET-1 and VEGF were significantly decreased in the 2 groups( all P < 0. 05),the levels of ALB and PTA were significantly increased( all P < 0. 05); the improvement of all indexes after treatment in the observation group was significantly better than those of the control group( all P < 0. 05). The total effective rate of treatment in the observation group was significantly higher than that of the control group( P < 0. 05). Conclusion Traditional Chinese medicine of NLEB in the treatment of alcoholic cirrhosis with portal hyperbaric ascites can effectively relieve the clinical symptoms,and improve the function of liver and blood coagulation,and it helps to adjust ET-1 and VEGF levels.