降疸汤治疗肝炎后残留黄疸的疗效观察

Observation on Curative Effect of Jiangdan Decoction in Treating Residual Jaundice after Hepatitis

目的:探讨经验方降疸汤治疗肝炎后残留黄疸的临床疗效。方法:观察南通大学附属南通第三医院2014年1月—2019年10月住院的慢性重度乙型肝炎、急性甲型病毒性肝炎、急性戊型病毒性肝炎、肝衰竭等恢复期残留黄疸患者57例,其中降疸汤治疗组32例,对照组25例,两组均以水飞蓟宾、还原型谷胱甘肽、甘草酸制剂等作为基础治疗,乙型肝炎配合抗病毒治疗,治疗组在此基础上加用院内协定方降疸汤(赤芍45 g,茵陈30 g,葛根30 g,红花30 g,丹参30 g,柴胡10 g,党参30 g,瓜蒌30 g,白术30 g,海金沙15 g,金钱草15 g,僵蚕10 g),1剂/d,10 d为1个疗程。观察降疸汤治疗前及治疗后2个疗程结束时肝功能相关指标(ALT、TBIL、DBIL、IBIL、GGT、AKP、TBA)的变化情况,判定临床疗效。结果:治疗组显效8例,有效17例,无效7例,总有效率为78.12%(25/32);对照组显效1例,有效3例,无效21例,总有效率为16.00%(4/25),两组总有效率比较,差异有统计学意义(P<0.05)。治疗组治疗后ALT、TBIL、DBIL、IBIL、AKP、TBA指标较治疗前明显下降,差异有统计学意义(P<0.05),对照组上述指标较治疗前也有一定程度下降,差异有统计学意义(P<0.05),但治疗组治疗后上述指标更低,差异有统计学意义(P<0.05),GGT虽有一定程度下降,但差异无统计学意义(P>0.05)。治疗组治疗前后的ALT差值、TBIL差值、DBIL差值、GGT差值、AKP差值、TBA差值较对照组均有不同程度增加,提示治疗组治疗前后肝功能相关指标下降幅度较对照组大,差异具有统计学意义(P<0.05)。结论:降疸汤有加速黄疸消退,促进损伤肝细胞修复及肝功能改善的作用,适合临床推广应用。

Objective:To investigate the clinical effect of Jiangdan Decoction in treatment of residual jaundice after hepatitis.Methods:57 patients with residual jaundice during the recovery period of chronic severe hepatitis B,acute viral hepatitis A,acute viral hepatitis E or liver failure,were assigned into the TCM treatment group(n=32)and the control group(n=25).Both groups were given the basic treatment of silibinin,reduced glutathione and glycyrrhizic acid;hepatitis B was also given antiviral treatment;on which basis,the treatment group was additionally treated with the cipher prescription of Jiangdan Decoction(Chishao 45 g,Yinchen 30 g,Gegen 30 g,Honghua 30 g,Danshen 30 g,Chaihu 10 g,Dangshen 30 g,Gualou 30 g,Baizhu 30 g,Haijinsha 15 g,Jinqiancao 15 g,Jiangchan 10 g),1 dose per day,10 days as a course of treatment.The changes of liver function related indexes(ALT,TBIL,DBIL,IBIL,GGT,AKP and TBA)were observed before and at the end of two courses of treatment in the two groups.Clinical efficacy was compared between the two groups.Results:In the treatment group,there were 8 remarkably effective cases,17 effective cases and 7 ineffective cases,and the total effective rate was 78.12%(25/32);in the control group,there were 1 remarkably effective case,3 effective cases and 21 ineffective cases,and the total effective rate was 16.0%(4/25);the difference in the total effective rate was statistically significant between the two groups(P<0.05).The indicators of ALT,TBIL,DBIL,IBIL,GGT,AKP and TBA decreased significantly after the treatment compared with those before the treatment in the treatment group(P<0.05);the above indicators in the control group also decreased to a certain extent after the treatment compared with those before the treatment,with statistical significance(P<0.05);there were no statistical differences in the above indicators between the two groups before the treatment,and they were comparable,and which were significantly lower in the treatment group than those in the control group after the treatment except GGT(P<0.05),although GGT decreased to some extent in the two groups after the treatment,there was no statistical difference between the two groups(P>0.05).The differences of ALT,TBIL,DBIL,GGT,AKP and TBA between before and after the treatment increased to varying degrees in the treatment group compared with those in the control group,suggesting that the liver function related indexes(ALT,TBIL,DBIL,GGT,AKP and TBA)of the treatment group decreased more than those of the control group after the treatment(P<0.05).Conclusion:Jiangdan Decoction can accelerate the disappearance of jaundice,promote the repair of damaged liver cells and improve the liver function,which is suitable for clinical application.