肝豆灵汤改善痰瘀互结型Wilson病患者肝脏功能的临床观察

Clinical Efficacy of Gandouling Decoction in Improving Hepatic Function with Phlegm and Blood Stasis Type Wilson’s Disease

目的:观察肝豆灵汤对痰瘀互结型Wilson病患者肝脏功能的临床疗效。方法:将2015年1月至2017年12月安徽中医药大学第一附属医院脑病中心收治的Wilson病痰瘀互结型患者72例,随机分为治疗组和对照组,各36例。两组均予以二巯丙磺酸钠常规治疗,对照组予以口服护肝片,治疗组予以肝豆灵汤口服,治疗共6个疗程。在治疗前后分别进行中医证候疗效、肝脏功能血清酶学[丙氨酸氨基转移酶(ALT)、天门冬氨酸转氨酶(AST)、碱性磷酸酶(AKP)],胆红素代谢指标[总胆红素(TBIL)],血清肝纤维化指标[层黏连蛋白(LN)、透明质酸(HA)、Ⅳ型胶原(CⅣ)、Ⅲ型前胶原肽(PⅢP)],凝血指标[纤维蛋白原(FBG)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)]等相关指标评估。结果:中医证候疗效总有效率治疗组为86.11%(31/36),对照组为63.89%(23/36),治疗组优于对照组(P<0.05);两组治疗后ALT,AST,AKP,TBIL水平均显著改善(P<0.01),其中治疗组优于对照组(P<0.01);两组治疗后肝纤维化指标显著改善(P<0.01),其中治疗组优于对照组(P<0.01);两组治疗后凝血指标均有不同程度改善(P<0.05,P<0.01),其中在降低PT,APTT,TT水平,提高FBG水平等方面优于对照组(P<0.05,P<0.01)。结论:肝豆灵汤能显著改善Wilson病痰瘀互结型患者的肝脏功能,具体表现在改善血清酶学及胆红素指标,逆转肝纤维化,促进凝血因子产生,减轻出血倾向,从而延缓病情进展,提高患者生活质量。

Objective:To observe the clinical efficacy of Gandouling decoction on hepatic function of patients with phlegm and blood stasis type Wilson’s disease.Method:From January 2015 to December 2017,totally 72 cases of phlegm and blood stasis type Wilson’s disease admitted to Encephalopathy Center in the First Affiliated Hospital of Anhui University of Chinese Medicine were randomly divided into treatment group and control group,with 36 cases in each group.Patients in both groups were injected with sodium dimercaptopropane sulfonate for routine treatment.At the same time,patients in control group received Hugan Tablets,and patients in treatment group received Gandouling decoction for a total of 6 treatment courses.Before and after treatment,traditional Chinese medicine(TCM)syndrome effective rate,serum enzyme index[alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(AKP)],bilirubin metabolism index[total bilirubin(TBIL)],liver fibrosis index[laminin(LN),hyaluronic acid(HA),collagen type IV(CⅣ),procollagen typeⅢpeptide(PⅢP)]and blood coagulation index[fibrinogen(FBG),prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)]were observed.Result:TCM syndrome effective rates of treatment group and control group were 86.11%(31/36)and 63.98%(23/36)respectively,with a significant difference between two groups(P<0.05).ALT,AST,AKP,TBIL decreased in two groups after treatment(P<0.01),and the effects of ALT,AST,AKP,TBIL in treatment group were significantly better than those in control group(P<0.01),liver fibrosis index decreased in both groups after treatment(P<0.01),and the effect in treatment group was significantly better than that in control group(P<0.01).Blood coagulation indexes were improved to different degrees in both groups(P<0.05,P<0.01),and there were significant differences between treatment group and control group in decreasing PT,APTT,TT levels(P<0.05,P<0.01)and increasing FBG level(P<0.01).Conclusion:Gandouling decoction can significantly improve hepatic function of patients with phlegm and blood stasis type Wilson’s disease,which is manifested in improving serum enzymes and bilirubin indexes,reversing liver fibrosis,promoting clotting factors and reducing bleeding tendency,in order to delay the progress of the disease and improve the life quality of patients.