中医药三联疗法治疗脾肾阳虚型肝硬化腹水的临床疗效观察

Clinical effect observation on triple therapy of traditional Chinese medicine for treatment of patients with liver cirrhosis ascites accompanied by yang deficiency of spleen and kidney

目的 观察隔姜灸联合中药腧穴贴敷及参附仙桂汤直肠滴入中医药三联疗法治疗脾肾阳虚型肝硬化腹水的临床疗效.方法 选择河南中医药大学第一附属医院脾胃肝胆病区2014年1月至2018年6月住院肝硬化腹水156例患者,将患者按随机数字表法分为三联组与对照组,每组78例,三联组脱落2例,对照组脱落3例.两组患者均根据病情进行基础治疗,包括限制钠和水摄入、利尿、保肝降酶、补充白蛋白（Alb）.三联组在常规治疗基础治疗上应用隔姜灸联合温阳逐水膏腧穴贴敷及参附仙桂汤直肠滴入;对照组在基础治疗的同时联合参附仙桂颗粒口服.两组均10 d为1个疗程,共2个疗程,随访1个月.观察两组治疗前后腹围、体质量、24 h尿量、超声腹水最大深度、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、总胆红素（TBil）、Alb以及腹胀、乏力、肢体肿胀、尿少等中医症状积分的变化,分析中医药三联疗法治疗脾肾阳虚型肝硬化腹水的临床疗效及安全性.结果 两组治疗后腹围、体质量、超声腹水最大深度、ALT、AST、TBil、Alb、中医症状积分均较治疗前降低,24 h尿量较治疗前明显增加,且三联组腹围、体质量、24 h尿量、超声腹水最大深度、ALT、AST、中医症状积分的变化较对照组更显著〔腹围（cm）：66.8±9.3比86.7±11.4,体质量（kg）：61.3±9.9比69.7±12.4,24 h尿量（mL）：1996.4±402.7比1322.6±342.0,超声腹水最大深度（mm）：28.4±9.2比50.6±11.6,ALT（U/L）：58.4±17.3比84.4±21.6,AST（U/L）：68.8±19.7比96.7±24.4,中医症状积分（分）：5.29±3.70比8.95±3.80,均P〈0.05〕.三联组治疗后TBil低于对照组（μmol/L：29.3±12.4比31.5±12.7）,但两组比较差异无统计学意义（P〉0.05）.两组治疗后Alb均有所升高,但三联组与对照组比较差异无统计学意义（g/L：33.5±8.5比31.3±5.3,P〉0.05）.三联组临床总有效率明显高于对照组〔84.2％（64/76）比64.0％（48/75）〕.两组治疗过程中均未出现严重不良反应,三联组有4例局部皮肤出现轻微发红瘙痒,对症治疗后消褪.结论 隔姜灸联合温阳逐水膏腧穴贴敷及参附仙桂颗粒直肠滴入治疗脾肾阳虚型肝硬化腹水临床疗效好,且不良反应少,值得临床推广应用.

Objective To observe the clinical efficacy of traditional Chinese medicine （TCM） triple therapy including ginger moxihustion, TCM ointment attachment on acupoint and proctoclysis of Shenfuguixian decoction in treatment of liver cirrhosis ascites accompanied by yang deficiency of spleen and kidney syndrome. Methods One hundred and fifty-six in-patients with ascites due to cirrhosis were admitted to the Gastroenterology Ward of the First Affiliated Hospital of Henan University of Chinese Medicine from January 2014 to June 2018. They were divided into a trigeminy group and a control group according to random number table method, 78 cases in each group, 2 patients withdrew in the trigeminy group and 3 patiens in the control group. In line with individual situation of each patient, the basic treatments were given to the patients in both groups, including restriction of sodium and water intake, diuresis, liver protection and enzyme reduction and supplementation of albumin （Alb）. On the basis of conventional therapy, in trigeminy group, the ginger moxihustion was applied, combined with attachment of TCM ointment with the action of warming yang for diuresis on Shu aeupoint and proctoclysis of TCM Shenfuguixian decoction; while in the control group the patients besides the conventional therapy, they received only oral administration of Shenfuguixian granules. The therapeutic course was 10 days in both groups, and all of them took 2 courses and 1 month of follow-up. The changes of levels of abdominal circumference, body mass. 9a-hour urine volume, maximum depth of ascites （by ultrasound examination）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, total bilirubin （TBil）, Alb, TCM symptoms （abdominal distention, fatigue, limb swelling and oliguria） scores were observed in the two groups before and after treatment. Then the curative effect and safety of TCM triple therapy in treatment of liver cirrhosis aseites accompanied by yang deficiency of spleen and kidney were analyzed. Results After treatment, the abdominal circumference, body mass, the maximum depth of ascites （by ultrasound examination）, ALT, AST, TBil, Alb, TCM symptom scores of the two groups were lower significantly, while the 24-hour urine volume of the two groups was higher significantly compared with that before treatment; the degrees of changes in abdominal circumference, body mass, 24-hour urine volume, the maximum depth of ascites, ALT, AST, TCM symptom scores in the triple group were more obvious than those in the control group [abdominal circumference （cm）： 66.8 ± 9.3 vs. 86.7 ± 11.4, body mass （kg）： 61.3 ± 9.9 vs. 69.7±12.4, 24-hour urine volume （mL）： 1 996.4±402.7 vs. 1 322.6±342.0, maximum depth of ascites （ram）：28.4 ± 9.2 vs. 50.6 ± 11.6, ALT （U/L）： 58.4 ± 17.3 vs. 84.4 ± 21.6, AST （U/L）： 68.8± 19.7 vs. 96.7 ± 24.4, TCM symptom scores： 5.29± 3.70 vs. 8.95 ± 3.80, all P 〈 0.05]. After treatment, the TBil level was lower in the triple group than that in the control group （μmol/L： 29.3 ± 12.4 vs. 31.5 ± 12.7）, but there was no statistical significant difference between the two groups （P 〉 0.05）. The Alb levels of the two groups were increased after treatment, but there was no significant difference between the two groups （g/L： 33.5 ± 8.5 vs. 31.3± 5.3, P 〉 0.05）. The total therapeutic effective rate of the triple group was significantly higher than that of the control group [84.2% （64/76） vs. 64.0% （48/75）]. There were no serious adverse reactions in the therapeutic course of the two groups. In the triple group, 4 cases had slight redness and pruritus on the local skin, which disappeared after symptomatic treatment. Conclusions The triple TCM therapy including ginger moxibustion combined with external attachment of TCM ointment at shu acupoint to warm yang for diuresis and proctoelysis of Shenfuguixian decoction has good curative effect on patients with liver cirrhosis ascites accompanied by yang deficiency of spleen and kidney, and only is very mild adverse reaction seen in the therapy, so it is worthy for clinical application.