以脾统血理论为指导的归脾汤治疗乙肝后肝硬化门脉高压症的效果及机制分析

Effects and Mechanism of Guipi Decoction Guided by Spleen Controlling Blood Therapy in Treatment of Cirrhotic Portal Hypertension after Chronic Hepatitis B

目的研究以脾统血理论为指导的归脾汤治疗慢性乙型肝炎(CHB)后肝硬化门脉高压症(PHT)的效果及机制。方法选取2017年2月—2019年2月该院收治的PHT患者76例并采用随机数字表法均分为两组和38例,均给予抗病毒、护肝及降酶等常规治疗,观察组在此基础上采用归脾汤治疗,对照组则给予普萘洛尔口服,疗程均为3个月,比较两组有效率、中医证侯积分、肝功能、肝纤维化指标及门静脉压力。结果观察组治疗效果明显优于对照组(P<0.05),两组有效率分别为89.47%(34/38)和71.05%(27/38)(P<0.05)。治疗后,两组中医证候积分均明显降低(P<0.05),且观察组中医证候积分低于对照组,两组ALT、AST、ALB、TBIL及CHE均明显降低(P<0.05),且观察组ALT、AST、ALB及CHE低于对照组;两组HA、PCⅢ、CⅣ及LN均明显降低(P<0.05),且观察组HA、PCⅢ、CⅣ及LN低于对照组;两组Dpv、Dsv及Qpv均明显降低(P<0.05),Spv明显升高(P<0.05),且观察组Dpv、Dsv及Qpv低于对照组,Spv高于对照组;差异均有统计学意义(P<0.05)。结论在脾统血理论基础上应用归脾汤治疗CHB后肝硬化PHT可有效改善患者症状和肝功能,延缓肝纤维化进展并降低门静脉压力,疗效较单纯西医治疗具有明显优势。

Objective To study the effects and mechanism of Guipi Decoction guided by spleen controlling blood therapy in the treatment of cirrhotic portal hypertension(PHT) after chronic hepatitis B(CHB).Methods Seventy-six patients with PHT admitted to our hospital from February 2017 to February 2019 were selected and divided into two groups according to the random number table method,with 38 cases in each group.All patients were given anti-virus,liver protection and enzyme-lowering therapy.On this basis,the observation group was given Guipi Decoctionand the control group was given propranolol orally,and both groups were treated for 3 months.The effective rate,TCM syndromes scores,liver function,liver fibrosis indexes and portal venous pressure were compared between the two groups.Results The therapeutic effect in the observation group was significantly better than that in the control group(P<0.05),and the effective rates in the two groups were 89.47%(34/38) and 71.05%(27/38),respectively(P<0.05).After treatment,the scores of TCM syndromes in the two groups were significantly decreased(P<0.05),and the scores of TCM syndromes in the observation group were lower than those in the control group.The levels of ALT,AST,ALB,TBIL and CHE in the two groups were significantly decreased(P<0.05),and the levels of ALT,AST,ALB and CHE in the observation group were lower than those in the control group.The levels of HA,PCIII,CIV and LN in the two groups were significantly decreased(P<0.05),and the levels of HA,PCIII,CIV and LN in the observation group were lower than those in the control group.The levels of Dpv,Dsv and Qpv were significantly decreased in the two groups(P<0.05) while the level of Spv was significantly increased(P<0.05),and the levels of Dpv,Dsv and Qpv in the observation group were lower than those in the control group while the level of Spv was higher than that in the control group(P<0.05).Conclusion Based on spleen controlling blood therapy,Guipi Decoction for cirrhotic PHT after CHB can effectively improve the symptoms and liver function of patients,delay the progression of liver fibrosis and reduce portal venous pressure.Its efficacy has obvious advantages compared with that of simple western medicine.