疏肝消石汤治疗胆石症肝郁气滞证

Shugan Xiaoshi Decoction in Treatment of Cholelithiasis with Liver Depressionand Qi Stagnation Syndrome

目的:探讨疏肝消石汤治疗胆石症肝郁气滞证的临床疗效及其对血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、核因子-κB(nuclear factor-kappa B,NF-κB)、白细胞介素-6(interleukin-6,IL-6)水平的影响。方法:按照随机数字表法将100例胆石症肝郁气滞证患者随机分成两组。对照组给予熊去氧胆酸片,观察组在对照组治疗基础上给予疏肝消石汤,两组均治疗12周。比较两组患者中医肝郁气滞证证候积分、临床症状缓解时间、胆囊容积、胆囊壁厚度、血清炎症因子(TNF-α、NF-κB、IL-6)变化,并比较两组治疗总有效率及药物安全性。结果:(1)治疗后,两组患者右胁胀痛、食欲不振、急躁易怒、胸闷嗳气积分均显著降低;观察组右胁胀痛积分为(0.75±0.17)分、食欲不振积分为(0.73±0.16)分、急躁易怒积分为(0.70±0.13)分、胸闷嗳气积分为(0.60±0.08)分,均低于同期对照组(P<0.05)。(2)治疗后,观察组患者右上腹疼痛缓解时间为(17.62±2.35)d、恶心呕吐缓解时间为(15.66±2.07)d、食欲不振缓解时间为(15.60±2.09)d、腹胀缓解时间为(16.62±2.30)d,均低于同期对照组(P<0.05)。(3)治疗后,两组患者胆囊容积、胆囊壁厚度均显著低于治疗前;观察组胆囊容积为(20.04±2.08)cm 3、胆囊壁厚度为(1.95±0.18)mm,均低于同期对照组(P<0.05)。(4)治疗后,两组患者TNF-α、NF-κB、IL-6水平均显著低于治疗前;观察组TNF-α水平为(15.15±3.32)ng·L^(-1)、NF-κB水平为(9.53±1.87)μg·L^(-1)、IL-6水平为(16.02±2.72)ng·L^(-1),均低于同期对照组(P<0.05)。(5)观察组有效率为94.0%(47/50),对照组有效率为80.0%(40/50),两组有效率比较,差异有统计学意义(P<0.05)。(6)两组均未发生因服用药物引起的不良反应。结论:疏肝消石汤联合常规西药治疗肝郁气滞型胆石症临床疗效显著,能够显著缓解患者临床症状,抑制炎症反应,改善胆囊收缩功能,促进患者康复。

Objective:To investigate the clinical efficacy of Shugan Xiaoshi Decoction in treating cholelithiasis and its effect on the levels of serum tumor necrosis factor-α(TNF-α),nuclear factor kappa-B(NF-κB)and interleukin-6(IL-6)in treatment of cholelithiasis.Methods:One hundred patients with cholelithiasis(Liver depression and Qi stagnation syndrome)were divided into two groups according to the randomized numerical table method.The control group was given ursodeoxycholic acid tablets,and the observation group was given Shugan Xiaoshi Decoction on basis of the treatment in the control group.Both groups were treated for 12 weeks.The TCM liver depression and qi stagnation syndrome score,clinical symptom relief time,gallbladder volume,gallbladder wall thickness,serum inflammatory factors(TNF-α,NF-κB,IL-6),and the total effective rate of treatment and drug safety between the two groups were compared.Results:(1)After treatment,the points of right hypochondriac distension,loss of appetite,irritability and chest tightness and belching were significantly reduced in both groups;the points of distending pain in right rib,loss of appetite,irritability and chest tightness as well as belching in the observation group were(0.75±0.17),(0.73±0.16),(0.70±0.13)and(0.60±0.08)respectively,which were significantly lower than those in the control group(P<0.05).(2)After treatment,the time for patients in the observation group in relieving right upper abdominal pain was(17.62±2.35)d,the time for nausea and vomiting to be relieved was(15.66±2.07)d,the time for loss of appetite to be relieved was(15.60±2.09)d,and the time for abdominal distension to be relieved was(16.62±2.30)d,which were significantly lower than those in the control group during the same period(P<0.05).(3)After treatment,the gallbladder volume and gallbladder wall thickness of both groups were significantly lower than those before treatment;the gallbladder volume of the observation group was(20.04±2.08)cm3,and the thickness of the gallbladder wall was(1.95±0.18)mm,which were significantly lower than those of the control group during the same period(P<0.05).(4)After treatment,the levels of TNF-α,NF-κB,and IL-6 were significantly lower than those before treatment in both groups;the levels of TNF-αin the observation group were(15.15±3.32)ng·L^(-1),NF-κB(9.53±1.87)μg·L^(-1),and IL-6(16.02±2.72)ng·L^(-1),which were significantly lower than those in the control group during the same period(P<0.05).(5)The effective rate of the observation group was 94.0%(47/50),and the effective rate of the control group was 80.0%(40/50).The difference between the efficiency of the two groups was statistically significant(P<0.05).(6)No adverse reactions caused by taking drugs occurred in both groups.Conclusion:Shugan Xiaoshi Decoction combined with conventional western medicine is effective in treating cholelithiasis with Liver depression and Qi stagnation syndrome,which can significantly alleviate the clinical symptoms of patients,inhibit the inflammatory reaction,improve the contraction function of the gallbladder,and promote the recovery of patients.