中药治疗慢性肝炎和慢性重型肝炎疗效评价

An Appraisal of the Therapeutic Effectiveness of Traditional Chinese Medicines in the Treatment of Severe Chronic Viral Hepatitis B

目的 :探讨中药在治疗慢性乙型病毒性肝炎重度、重型肝炎的疗效 ,评价临床意义。方法 :14 8例肝炎患者中 ,其中重度慢性乙肝患者 65例 ,分为常规治疗不加中药组 2 9例和常规治疗加中药治疗组 3 6例 ;重型肝炎患者 3 2例 ,治疗组 18例患者为入院前进行汤剂治疗 >1周 ,对照组 14例为入院前未进行中药治疗 ,两组均用中药治疗。重型肝炎恢复期 5 1例为 2 0 0 0年 3月～ 2 0 0 2年 6月出院病例 ,分成中药治疗组 2 7例 ,对照组 2 4例不用中药治疗。慢性乙肝中草药治疗 ,主要以茵陈蒿汤加味 ,有茵陈、栀子、大黄、龙胆草、柴胡、田基黄等。当地进行中草药治疗重型肝炎的组方也是在此基础上 ,加黄芩、黄柏、虎杖、白花蛇舌草、山豆根、当归、党参等 ,多于 15种中草药。重型肝炎恢复期血清总胆红素(T BiL)、转氨酶完全正常后 ,应用制鳖甲、炮穿山甲、莪术、三七、血竭、当归、党参、鸡内金、山豆根等 ,粉碎后过 80目筛 ,制蜜丸 ,3g ,po ,bid ,服 2周停 1周 ,2个月为 1个疗程。检测T BiL、凝血酶活动度 (PTA)、透明质酸 (HA)、层粘蛋白 (LN)、Ⅲ型胶原 (PCⅢ )、Ⅳ型胶原水平 (Ⅳ C) ,进行比较分析。结果 :治疗组与对照组各类比较 ,统计学均差异有显著性 (P <0 .0 5 )。结论

Objective:TO appraise the therapeutic effectiveness of traditional Chinese medicines in the treatment of severe chronic viral hepatitis B. Methods:148 patients with severe chronic viral hepatitis B served as the subject of the study. Among these, 65 patients suffered from severe chronic viral hepatitis B, 29 cases of which received only conventional therapy while the other 36 were subjected to treatment with traditional Chinese medicines on the basis of the conventional therapy. 32 patients suffered from severe viral hepatitis B associated with hepatic failure. Of these, 18 patients had received decoction treatment longer than one week before admission, while the other 14 had not been treated with traditional Chinese medicines prior to admission. All these 32 patients were subjected to treatment with traditional Chinese medicines. The remaining 51 patients in the restoration stage of severe hepatitis associated with hepatic failure were discharged from our hospital from March 2000 to June 2002. Of these, 27 patients were treated with traditional Chinese medicines while the other 24 were not. For the treatment of chronic viral hepatitis B, the major traditional Chinese medicine was Oriental Wormwood Decoction modified by adding Capejasmine, rhubarb, elephantopus scaber, bupleurum root, Japanese St. Johns wort etc.. Traditional Chinese medicines prescribed for the treatment of severe viral hepatitis B in the localities were shown to have the same basis as ours, modified by adding scutellaria root, phellodendron bark, giant knotweed rhizome, oldenlandia, subprostrate sophorca root, Chinese angelica root, pilose asiabell root etc., totalling more than 15 traditional Chinese medicines. For patients in the convalescent stage of severe hepatitis with serum total bilirubin and aminotransferases completely restored to normal levels, 3 g of honeyed pills containing fresh water turtle shell, pangolin scales, zedoary, notoginseng, dragon's blood, Chinese angelica root, pilose asiabell root, chicken's gizzard membane, subprostrate sophora root etc., were given to each of them PO, b.i.d. for 2 consecutive weeks followed by a break of one week. The course of treatment lasted 2 months. Levels of serum total bilirubin, plasma thromboplastin antecedent, hyaluronic acid, laminin, type Ⅲ collagen and type Ⅳcollagen were monitored and compared with those assayed before the treatment. Results:Apparently better therapeutic effectiveness was demonstrated in patients treated with traditional Chinese medicines than in those who were not ( P <0.05). Conclusion:Traditional Chinese medicines were shown to lower the levels of serum total bilirubin in patients with severe chronic viral hepatitis B. Striking amelioration of serum indices of liver fibrosis was also noted in patients in the restoration stage of severe hepatitis associated with hepatic failure as a result of the treatment with traditional Chinese medicines. However, components of traditional Chinese medicines may aggravate injuries of liver cells in the treatment of acute liver failure.