中医辨证运用重肝汤剂结合组合型人工肝对早期肝衰竭患者细胞因子水平及转归的影响

Effect of heavy liver decoction combined with combined artificial liver on cytokines levels and prognosis of patients with early liver failure in TCM

目的:探讨中医辨证运用重肝汤剂结合组合型人工肝对早期肝衰竭患者细胞因子水平及转归的影响。方法:2019年5月至2021年5月收治住院的乙型肝炎慢加急性/亚急性肝衰竭并接受人工肝治疗的病例共120例,经随机数字表法分为研究组和对照组,各60例。研究组患者采用重肝汤剂联合组合型人工肝,即半量血浆置换(PE)联合双重血浆分子吸附系统(DPMAS),平均每人治疗2~5(3.46±1.03)次。对照组患者采用单纯PE,平均每人治疗2~5(3.51±0.89)次。比较两组患者治疗前后肝功能指标、INR水平、细胞因子水平及MELD评分变化,收集治疗期间患者不良反应发生情况,并进行为期6个月的跟踪随访,统计两组患者3、6个月存活率,综合分析两组临床疗效差异。结果:研究组患者治疗有效率为95.83%,显著高于对照组(81.25%,P<0.05)。治疗后,两组患者的TBil、Cr、TBA及INR均显著下降(P<0.05),研究组患者改善程度显著优于对照组(P<0.05);两组患者的TNF-α、IL-6、IL-8水平及MELD评分均降低(P<0.05),研究组患者降幅大于对照组(P<0.05);研究组患者不良反应发生率为6.67%,显著低于对照组(20.00%,P<0.05);研究组患者3、6个月存活率分别为85.00%和63.33%,均显著高于对照组的70.00%、45.00%,差异有统计学意义(P<0.05)。结论:中医辨证运用重肝汤剂结合组合型人工肝对早期肝衰竭患者的临床疗效确切,可有效调节患者的细胞因子水平,改善肝功能,不良反应较少,有利于提高患者的早期生存率。

Objective:To explore the dialectical use of heavy liver decoction combined with artificial liver in early stage of liver failure in patients with cytokine levels and outcomes of the impact analysis.Methods:A total of 120 inpatients with acute/subacute hepatitis B liver failure receiving artificial liver treatment from May 2019 to May 2021 in our hospital were prospectively included.They were randomly divided into a study group and a control group,with 60 cases in each one,according to the random number table.The patients in the study group were treated with the heavy liver decoction combined with artificial liver(that is,half-volume plasma exchange PE combined with double plasma molecular adsorption system DPMAS).The average treatment time per person in the study group was two to five(3.46±1.03)times.The control group was treated with simple plasma exchange(PE),and the average treatment time in this group was two to five(3.51±0.89)times per person.The changes of liver function indexes,INR level,cytokine level and MELD score of patients between the two groups before and after treatment were compared.The adverse reactions of patients during the treatment period were collected and followed up for six months.The survival rates of patients in the two groups at three and six months were counted and the differences in clinical efficacy between the two groups were comprehensively analyzed.Results:(1)The effective rate of 95.83%in the research group was significantly higher than 81.25%in the control group(χ^(2)=4.094,P<0.05).(2)After treatment,TBil,Cr,TBA and INR of patients in the two groups were significantly decreased(P<0.05).The improvement degree in the research group was significantly better than that in the control group(P<0.05).(3)After treatment,the levels of TNF-α,IL-6,IL-8 and MELD scores of the two groups were decreased P<0.05).The decrease in the research group was greater than that in the control group(P<0.05).(4)The incidence rate of adverse reactions in the treatment group was6.67%,which was significantly lower than that in the control group(20.00%)(χ^(2)=4.615,P<0.05).(5)The three-month and six-month survival rates of 85.00%and 63.33%in the research group were significantly higher than 70.00%and 45.00%in the control group,respectively,with statistical significance(χ^(2)=15.865,7.673,P<0.05).Conclusion:The dialectical use of heavy liver decoction combined with combined artificial liver in traditional Chinese medicine has reliable clinical effect on patients with early liver failure,and can effectively regulate the levels of cytokines in patients,improve liver function,with less adverse reactions,which is conducive to improving the early survival rate of patients.