消胀方联合拉米夫定治疗84例乙型肝炎肝硬化代偿期的临床疗效观察

基金项目:国家科技部“十一五”支撑计划项目(No.2006BAI08B02-04);国家自然科学基金项目(No.81072792);国家科技重大专项基金项目(No.2008ZX10005-006);上海高校创新团队建设项目(第一期);上海市教育委员会重点学科资助项目(第5期J50307);上海市教育委员会E研究院建设计划项目(No.03008);上海市科委优秀学科带头人项目(No.10XD1404100)

作者	单位
周振华	上海中医药大学附属曙光医院肝病科上海市中医临床重点实验室
周碧霞	上海中医药大学附属曙光医院肝病科上海市中医临床重点实验室
孙学华	上海中医药大学附属曙光医院肝病科上海市中医临床重点实验室
李曼	上海中医药大学附属曙光医院肝病科上海市中医临床重点实验室
黄凌鹰	上海中医药大学附属曙光医院肝病科上海市中医临床重点实验室
高月求	上海中医药大学附属曙光医院肝病科上海市中医临床重点实验室

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中文摘要:

目的评价消胀方治疗乙型肝炎肝硬化代偿期患者的临床疗效。方法 84例乙型肝炎肝硬化代偿期患者按前瞻性队列研究方法分为治疗组与对照组。治疗组在拉米夫定抗病毒基础上以消胀方(由太子参、白术、陈皮、白茅根、泽泻、泽兰、鳖甲、牡蛎、鸡内金、大腹皮组成),每日1剂,水煎分2次口服;对照组在拉米夫定抗病毒基础上治以扶正化瘀胶囊(主要由丹参、桃仁、绞股蓝、冬虫夏草、五味子组成),每次5粒,每日3次,餐前30min口服,疗程均为12个月。观察并比较治疗前后两组患者的中医证候积分、慢性肝病疾病特异性量表(CLDQ)评分、肝功能、乙肝病毒DNA(HBVDNA),同时对所有患者进行治疗前后B超检查,记录门静脉内径(MPV)、脾静脉内径(SPV)、脾脏长度及厚度的变化。结果治疗后两组患者中医证候积分、CLDQ评分较治疗前均明显降低(P<0.01),且治疗组积分较对照组亦明显减少(P<0.05,P<0.01);两组患者Child-Pugh分级治疗后均明显下降(P<0.01),但组间比较差异无统计学意义;两组患者肝功能较治疗前均明显改善(P<0.01),且治疗组改善较对照组明显(P<0.01);B超结果显示,治疗组患者MPV、SPV、脾长度、脾厚度均有明显降低(P<0.01),对照组仅脾厚度有明显降低(P<0.01);两组患者HBVDNA较治疗前均明显降低(P<0.01),且治疗组降低较为明显(P<0.01)。结论消胀方联合拉米夫定可改善乙型肝炎肝硬化代偿期患者的肝功能、HBVDNA,降低患者的中医证候积分及CLDQ积分,在一定程度上改善患者肝功能Child-Pugh分级,具有较好的疗效。

英文摘要:

Objective To assess the clinical efficacy of Xiaozhang Recipe(XR) in treatment of chronic viral hepatitis B patients with compensated liver cirrhosis.Methods Based on the anti-viral effects of lamivudine,84 chronic viral hepatitis B patients with compensated liver cirrhosis were randomly assigned to the treatment group and the control group.Patients in the treatment group were treated with XR(consisting of heterophylla falsestarwort root,large head atractylodes rhizome,tangerine peel,green tangerine peel,water-plantain tuber,bugleweed herb,turtle shell,oyster shell,chicken’s gizzard-skin endothelium,areca peel,decocted,one dose daily,twice daily).Patients in the control group took Fuzheng Huayu Capsule(consisting of red sage root,walnut seed,gynostemma pentaphyllum,aweto,magnoliavine fruit;five pills each time,three times daily,30 min before meals).The therapeutic course for all was 12 months.The changes of the Chinese medicine symptom scores,chronic liver disease questionnaire(CLDQ),the liver function,hepatitis B virus deoxyribonucleic acid(HBV DNA) were compared between before and after treatment in the two groups.Meanwhile,B ultrasound was performed on all patients.Changes of the inner diameter of the portal vein and the splenic vein,the length and the thickness of the spleen were recorded.Results After treatment the Chinese medicine symptom scores and CLDQ obviously decreased in the two groups(P<0.01).Besides,the score in the treatment group decreased more obviously than that in the control group(P<0.05,P<0.01).The Child-Pugh scores obviously decreased in the two groups(P<0.01).However,the comparison between the two groups did not show any statistical significance(P>0.05).The liver function of of the two groups were improved when compared with before treatment(P<0.01),and the treatment group was superior to the control group(P<0.01).The B ultrasound results showed MPV,SPV,the length and the thickness of the spleen obviously decreased in the treatment group(P<0.01).Only the thickness of the spleen obviously decreased in the control group(P<0.01).The HBV DNA obviously decreased in the two groups(P<0.01),more obviously shown in the treatment group(P<0.01).Conclusions XR in combination of lamivudine could improve the liver function of chronic viral hepatitis B patients with compensated liver cirrhosis and HBV DNA,lower their Chinese medicine symptom scores and CLDQ scores,improve their Child-Pugh classification to some extent.It showed favorable effects.

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