苓术二泽汤加减治疗血吸虫性肝硬化合并顽固性腹水临床疗效观察

Observation on the therapeutic effect of Lingzhu Erze decoction for the treatment of obstinate ascites of advanced schistosomiasis cirrhosis

目的观察苓术二泽汤加减治疗晚期血吸虫病肝硬化合并顽固性腹水的临床疗效,为临床治疗提供依据。方法选择2018年1月-2023年12月于石首市人民医院接受治疗的63例血吸虫病肝硬化合并顽固性腹水患者,采用随机数表法将其分为观察组(n=33)和对照组(n=30)。对照组给予保肝、支持、利尿、补充白蛋白及对症治疗,观察组在对照组基础上联合使用苓术二泽汤加减进行治疗。比较两组临床疗效、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素、白蛋白、透明质酸、层粘蛋白、Ⅲ型前胶原、Ⅳ型胶原、腹围、体质量。结果治疗后,观察组总有效率为93.9%(31/33),高于对照组的60.0%(18/30),差异有统计学意义(χ^(2)=10.473,P<0.01)。治疗前两组丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素、白蛋白水平比较,差异均无统计学意义(P均>0.05);治疗后两组丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素水平较治疗前降低(t=12.484、10.054、4.418,P均<0.05),白蛋白水平较治疗前升高(t=3.719,P<0.05),且观察组总胆红素水平低于对照组(t=2.218,P<0.05),差异均有统计学意义。治疗前两组腹围、体质量比较,差异均无统计学意义(P均>0.05);治疗后两组腹围、体质量水平较治疗前降低(t=11.564、9.634,P均<0.01),且观察组腹围、体质量水平低于对照组(t=5.876、4.046,P均<0.01),差异均有统计学意义。治疗前两组透明质酸、层粘蛋白、Ⅲ型前胶原、Ⅳ型胶原水平比较,差异均无统计学意义(P均>0.05);治疗后两组透明质酸、层粘蛋白、Ⅲ型前胶原、Ⅳ型胶原水平较治疗前降低(P均<0.05),且观察组透明质酸、层粘蛋白、Ⅲ型前胶原、Ⅳ型胶原水平低于对照组(t=2.651、2.388、2.332、2.441,P均<0.05),差异均有统计学意义。结论苓术二泽汤加减治疗血吸虫病肝硬化合并顽固性腹水有较好疗效,值得进一步推广应用。

Objective To investigate the clinical effect of the treatment of advanced schistosomiasis cirrhosis with refractory ascites.Methods A total of 63 cases of schistosomiasis cirrhosis with intractable ascites treated from January 2018 to December 2023 were divided into observation group(n=33)and control group(n=30).The control group was given liver protection,support,diuresis,albumin supplementation and symptomatic treatment,and the observation group was treated with combination on the basis of the control group.Compared the clinical efficacy,alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),albumin(ALB)abdominal circumference,body mass,hyaluronic acid(HA),laminin(LN),procollagenⅢ(PC-Ⅲ),collagenⅣ(Ⅳ-C).Results After treatment,the total effective rate of the observation group was 93.9%(31/33),which was higher than 60.0%(18/30)of the control group,and the difference was statistically significant(χ^(2)=10.473,P<0.01).Before treatment,there were no significant differences in the levels of ALT,AST,TBIL,and ALB between the two groups(all P>0.05);after treatment,the levels of ALT,AST,and TBIL in the two groups were lower than those before treatment(t=12.484,10.054,4.418;all P<0.05),and the level of ALB was higher than that before treatment(t=3.719,P<0.05),and the level of TBIL in the observation group was lower than that in the control group(t=2.218,P<0.05),and the differences were statistically significant.There were no significant differences in abdominal circumference and body weight between the two groups before treatment(all P>0.05);after treatment,the abdominal circumference and body weight levels of the two groups decreased compared with those before treatment(t=11.564,9.634;all P<0.01),and the abdominal circumference and body weight levels of the observation group were lower than those of the control group(t=5.876,4.046;all P<0.01),and the differences were statistically significant.There were no significant differences in the levels of HA,LN,PC-Ⅲ,andⅣ-C between the two groups before treatment(all P>0.05);after treatment,the levels of HA,LN,PC-Ⅲ,andⅣ-C in the two groups decreased compared with those before treatment,and the levels of HA,LN,PC-Ⅲ,andⅣ-C in the observation group were lower than those in the control group(t=2.651,2.388,2.332,2.441;all P<0.05),and the differences were statistically significant.Conclusion Lingshu Erze decoction had a good effect in the treatment of schistosomiasis liver cirrhosis combined with refractory ascites,and it is worthy of further promotion and application.