疏肝利胆汤加味联合熊去氧胆酸治疗原发性胆汁性胆管炎肝胆湿热证的疗效研究

Efficacy Research of Shugan Lidan Decoction(疏肝利胆汤)Combined with Ursodeoxycholic Acid Treating Primary Biliarycholangitis with Syndrome of Damp and Heat in Liver and Gallbladder

目的探讨疏肝利胆汤加味联合熊去氧胆酸治疗原发性胆汁性胆管炎(PBC)肝胆湿热证的疗效。方法纳入2017年10月—2020年9月医院收治的62例PBC肝胆湿热证患者,按随机数字表法分成治疗组与对照组,每组31例。对照组患者采取熊去氧胆酸胶囊治疗;治疗组患者的熊去氧胆酸胶囊干预同对照组,且给予疏肝利胆汤加味内服。两组连续干预12周。比较两组临床疗效、肝功能改善、肝胆湿热证单项症状评分、肝纤维化指标。结果治疗组(93.55%,29/31)的总有效率与对照组(67.74%,21/31)相比显著提高(P<0.05);治疗后,两组血清总胆红素(TBil)、碱性磷酸酶(ALP)、谷氨酰转移酶(GGT)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)水平显著下降,且治疗组上述指标下降更明显(P<0.01);治疗后,两组患者的肝胆湿热证单项症状评分明显降低,且治疗组降低更加明显(P<0.01);治疗后,两组血清透明质酸、Ⅲ型前胶原、层黏连蛋白、Ⅳ型胶原水平显著下降,且治疗组以上指标下降更明显(P<0.01)。结论于常规熊去氧胆酸干预基础上,采取疏肝利胆汤加味治疗PBC肝胆湿热证的疗效更优,有助于患者肝功能、中医证候以及肝纤维化指标的改善。

Objective To investigate the efficacy of Shugan Lidan Decoction(疏肝利胆汤)combined with ursodeoxycholic acid treating primary biliary cholangitis(CGN)with syndrome of damp and heat in liver and gallbladder.Methods Sixty-two PBC patients with syndrome of damp and heat in liver and gallbladder admitted in the hospital from October of 2017 to September of 2020 were enrolled and divided into the treatment group and the control group according to the random number table method with 31 cases in both groups.The control group was treated with ursodeoxycholic acid capsule.Ursodeoxycholic acid capsule intervention in the treatment group was the same as that in the control group and Shugan Lidan Decoction was given for internal administration.The two groups were continuously intervened for 12 weeks.The clinical efficacy,liver function improvement,single symptom score of syndrome of damp and heat in liver and gallbladder and liver fibrosis index were compared between the two groups.Results The total effective rate of the treatment group(93.55%,29/31)was significantly higher than that of the control group(67.74%,21/31)(P<0.05).After treatment,the serum levels of total bilirubin(TBil),alkaline phosphatase(ALP),glutamyltransferase(GGT),aspartate aminotransferase(AST)and alanine aminotransferase(ALT)in the two groups were significantly decreased,and the above indexes in the treatment group were more significantly decreased(P<0.01).After treatment,the single symptom score of syndrome of damp and heat in liver and gallbladder in the two groups were significantly decreased,and the reduction was more obvious in the treatment group(P<0.01).After treatment,the serum levels of hyaluronic acid,type Ⅲ procollagen,laminin and type Ⅳ collagen in the two groups were significantly decreased,and the above indexes in the treatment group were significantly decreased(P<0.01).Conclusion On the basis of ursodeoxycholic acid,Shugan Lidan Decoction has a better curative effect on treating PBC with syndrome of damp and heat in liver and gallbladder,which is helpful to improve the liver function,traditional Chinese medicine syndrome and liver fibrosis index of patients.