软肝利水汤加减联合腹水超滤浓缩回输治疗乙型肝炎肝硬化腹水患者对其血清LPS、ET-1及NO影响

Effects of Ruangan Lishui Decoction and Ultrafiltration Concentration of Ascites on Serum LPS,ET-1 and NO in Patients with Hepatitis B Cirrhosis Ascites

目的:探讨软肝利水汤加减联合腹水超滤浓缩回输治疗乙型肝炎肝硬化腹水患者对其血清LPS、ET-1及NO的影响。方法:选取2017年1月-2018年12月在我院治疗的乙型肝炎难治性腹水患者160例根据随机数字表法分为试验组和对照组,每组80例。试验组给予腹水超滤浓缩回输治疗联合软肝利水汤,对照组仅仅给予腹水超滤浓缩回输治疗。观察患者腹水、腹围、体质量、24 h尿量和临床症状的变化,并进行疗效评定,检测治疗前后患者血清中TBiL、ALT、AST、ALB、PA、LPS、ET-1、NO水平,观察不良反应的发生情况。结果:试验组临床缓解33例,有效21例,显效16例,无效10例;对照组临床缓解18例,有效20例,显效26例,无效16例,差异有统计学意义(P<0.05)。治疗前两组患者体质量、腹围、24 h尿量差异无统计学意义(P>0.05),经治疗后体质量、腹围减小,24 h尿量增加,实验组变化程度大于对照组,差异用统计学意义(P<0.05)。治疗前两组患者TBiL、ALT、AST、ALB、PA等肝功能指标差异无统计学意义(P>0.05),经治疗后,两组患者TBiL、ALT、AST下降,ALB、PA升高,试验组变化程度大于对照组(P<0.05)。治疗前两组患者血清LPS、ET-1、NO差异无统计学意义(P>0.05),经治疗后两组患者LPS、ET-1、NO均下降,试验组小于对照组,差异有统计学意义(P<0.05)。试验组发生腹泻2例,便秘3例,腹腔感染3例,不良反应发生率10.00%;对照组发生腹泻3例,便秘1例,腹腔感染1例,不良反应发生率6.25%,两组患者不良反应不同,但无统计学意义(P>0.05)。结论:软肝利水汤联合腹水超滤浓缩回输治疗利尿消肿、减少腹水、减轻体质量、减小腹围,缓解患者临床症状,改善患者肝功能受损,降低血清LPS、ET-1、NO,不良反应少,安全性高。

Objective:To investigate the effects of Ruangan Lishui Decoction plus ascites ultrafiltration concentration and reinfusion on serum LPS,ET-1 and NO in patients with ascites due to hepatitis B cirrhosis. Methods:160 patients with refractory ascites of hepatitis B treated in our hospital from January 2017 to December 2018 were divided into experimental group and control group according to sentence random number table,80 cases in each group. The experimental group was treated with ascites ultrafiltration concentration and reinfusion combined with Ruangan Lishui Decoction,while the control group was only treated with ascites ultrafiltration concentration and reinfusion. The changes of ascites,abdominal circumference,body weight,24-hour urine volume and clinical symptoms were observed,and the curative effect was evaluated. The levels of TBiL,ALT,AST,ALB,PA,LPS,ET-1 and NO in serum of patients before and after treatment were detected,and the occurrence of adverse reactions was observed. Results:There were 33 cases of clinical remission,21 cases of effective,16 cases of marked effect and 10 cases of ineffective in the experimental group,and 18 cases of clinical remission,20 cases of effective,26 cases of marked effect and 16 cases of ineffective in the control group(P<0.05). There was no significant difference in body weight,abdominal circumference and 24-hour urine volume between the two groups before treatment(P>0.05). After treatment,the body weight and abdominal circumference decreased and 24-hour urine volume increased. The degree of change in the experimental group was greater than that in the control group,and the difference was statistically significant(P<0.05). Before treatment,there was no significant difference in TBiL,ALT,AST,ALB,PA and other liver function indexes between the two groups(P>0.05). After treatment,TBiL,ALT,AST decreased and ALB and PA increased in the two groups. The degree of change in the experimental group was greater than that in the control group(P<0.05). There was no significant difference in serum LPS,ET-1 and NO between the two groups before treatment(P>0.05). After treatment,the levels of LPS,ET-1 and NO in the two groups decreased,while those in the experimental group were lower than those in the control group(P<0.05). There were 2 cases of diarrhea,3 cases of constipation,3 cases of abdominal infection,and the incidence of adverse reactions was 10.00%. In the control group,there were 3 cases of diarrhea,1 case of constipation and 1 case of abdominal infection. The incidence of adverse reactions was 6.25%. The adverse reactions of the two groups were different,but there was no statistical significance(P>0.05). Conclusion:Ruangan Lishui Decoction combined with ascites ultrafiltration concentration and reinfusion can treat diuresis and edema,reduce ascites,weight,abdominal circumference,alleviate clinical symptoms,improve liver function,reduce serum LPS,ET-1 and NO,with fewer adverse reactions and high safety.