茵陈五苓散加味对恶性梗阻性黄疸术后湿热蕴结证患者的减黄护肝作用

Effect of Modified Yinchen Wuling San in Decreasing Jaundice and Protecting Liver After Surgery of Percutaneous Transhepatic Cholangial Drainage

目的：观察茵陈五苓散加味对恶性梗阻性黄疸（MOJ）行经皮肝穿刺胆道引流（PTCD）术后退黄、护肝疗效,并从抗氧化应激和炎症反应方面探讨了其作用机制。方法：将128例MOJ患者,采用SAS软件生成,随机按住院先后顺序分为对照组和观察组各64例。患者均行PTCD术。对照组给予葡醛酸钠注射液,2 mL（0.266 g）/次,静脉注射,2次/d;口服鹅去氧胆酸胶囊,0.25 g/次,3次/d;口服复方联苯双酯颗粒,10 g/次,3次/d。观察组在对照组治疗的基础上给予茵陈五苓散加味内服,1剂/d。两组疗程均治疗28 d。于术前及术后7 d和28 d分别检测比较两组患者的总胆红素（TBIL）,直接胆红素（DBIL）,碱性磷酸酶（ALP）及γ-谷氨酰转移酶（GGT）,总胆汁酸（TBA）,丙氨酸氨基转移酶（ALT）和白蛋白（ALB）等指标;进行治疗前后湿热蕴结证的评分;采用癌症患者生命质量测定量表（EORTC QLQ-C30）和恶性梗阻性黄疸患者特异性条目池（QLQ-MOJ11）,评价患者治疗前后的生活质量;检测治疗前后丙二醛（MDA）,超氧化物歧化酶（SOD）,肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）的水平。结果：观察组临床愈显率为75%,高于对照组的56.25%（χ^2=4.987,P〈0.05）;观察组患者在术后7 d和28 d,TBIL,DBIL,TBA,ALP,GGT和ALT均低于对照组（P〈0.01）,在术后28 d观察组ALB高于对照组（P〈0.01）;观察组湿热蕴结证各症状评分及总积分均低于对照组（P〈0.01）;观察组患者QLQ-BR30量表5个功能领域评分和整体生活质量评分均高于对照组（P〈0.01）;QLQ-BR30量表3个症状领域和QLQ-MOJ11量表的黄疸、瘙痒、消化等三类症状领域及消瘦、发热评分均低于对照组（P〈0.01）;观察组患者血清MDA,IL-6和TNF-α水平均低于对照组（P〈0.01）,SOD水平高于对照组（P〈0.01）。结论：对恶性梗阻性黄疸PTCD术后患者,在常规利胆、降酶、护肝治疗的基础上,采用茵陈五苓散加味,能减轻黄疸,促进肝功能恢复,减轻临床症状,提高患者的生活质量,具有减轻抗氧化应激损伤和炎症损伤的作用。

Objective： To observe the effect of modified Yinchen Wuling San to malignant obstructive jaundice（MOJ） in decreasing jaundice and protecting liver after the surgery of percutaneous transhepatic cholangial drainage（PTCD）,and its mechanism for antioxidant stress and inflammation.Method： One hundred and twentyeight patients with MOJ were divided into control group（64 cases） and observation group（64 cases） by random number table.All of the patients got the surgery of PTCD.Patients in control group got sodium citrate injection for2 mL（0.266 g）/time,2 times/day.Chenodeoxycholic acid capsule for 0.25 g/time,3 times/day.Compound bifendate granules for 10 g/time,3 times/day.In addition to the therapy of control group,patients in observation group got modified Yinchen Wuling San,1 dose/day.A course of treatment was 28 days.Before the surgery,and on the 7 thand 28 thday after the surgery,total bilirubin（TBIL）,direct bilirubin（DBIL）,alkaline phosphatase（ALP）,γ-glutamyl transpeptidase（GGT）,total bile acid（TBA）,alanine aminotransferase（ALT） and albumin（ALB） were detected.Before and after treatment,syndrome of dampness-heat was scored,and the quality of life was evaluated based on scores of European organization for research and treatment scale（EORTC QLQ-C30） and the quality of life questionnaire of malignant obstructie jaundice（QLQ-MOJ11）.And levels of malondialdehyde（MDA）,superoxide dismutase（SOP）,tumor necrosis factor-α（TNF-α） and interleukin-6（IL-6） were detected.Result： The good improvement rate in observation group was 75%,which was higher than 56.25% in control group（χ^2= 4.987,P〈0.05）.On the 7 thand 28 thday after the surgery,levels of TBIL,DBIL,TBA,ALP,GGT and ALT in observation group were lower than those in control group（P〈0.01）.And on the 28 thday after the surgery,level of ALB was higher than that in control group（P〈0.01）.The scores of syndrome of dampness-heat and the total score were all lower than those in control group（P〈0.01）.And scores of the five functional domains of QLQ-BR30 scale,the score of the overall quality of life and level of SOD were all higher than those in control group（P〈0.01）.And scores of the three functional domains（Jaundice,itching and digestion） of QLQ-MOJ11 scale,marasmus and fever were all lower than those in control group（P〈0.01）.And levels of MDA,IL-6 and TNF-α were lower than those in control group（P〈0.01）.Conclusion： For patients with MOJ after surgery of PTCD,in addition to the therapy of increasing choleresis,reducing enzyme and protecting liver,modified Yinchen Wuling San can relieve jaundice and clinical effect,promote recovery of liver function,improve the quality of life,and reduce oxidative stress injury and inflammatory damage,with a better clinical effect than pure western medicine treatment.