本文選題：慢性乙型病毒性肝炎　切入點(diǎn)：龍柴方　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：研究目的:探討龍柴方治療慢性乙肝的臨床療效,為中西醫(yī)聯(lián)合治療慢性乙型肝炎提供新的治療方法。研究方法:選取符合本研究納入標(biāo)準(zhǔn)的慢乙肝患者60人,遵循隨機(jī)分配的原理分為治療組和對(duì)照組,每組各30人。以24周為總療程,治療組予中藥湯劑龍柴方和恩替卡韋分散片口服,對(duì)照組單用恩替卡韋分散片,觀察兩組患者治療前及治療后相關(guān)臨床癥狀、體征、肝功能指標(biāo)、乙肝病毒標(biāo)志物及乙肝病毒載量的變化,參照相關(guān)療效評(píng)定標(biāo)準(zhǔn),應(yīng)用SPSS 20.0統(tǒng)計(jì)軟件,統(tǒng)計(jì)分析臨床療效。研究結(jié)果:1.臨床癥狀:治療12周時(shí),治療組中醫(yī)癥狀積分為15.53±6.20,與治療前相比較下降了 6.90±3.49;對(duì)照組為17.47±6.77較前下降了 4.90±2.72。兩組均有臨床癥狀改善,差異顯著,有統(tǒng)計(jì)學(xué)意義(P0.05)。治療24周時(shí),治療組中醫(yī)癥狀積分為8.73±5.79,與治療前相比較下降了 13.70±4.92;對(duì)照組中醫(yī)癥狀積分為13.40±7.23,與治療前相比較下降了 9.03±4.58,兩組比較差異顯著(P0.01)。說(shuō)明治療組與對(duì)照組的治療方案均能有效的改善臨床癥狀體征,且治療組在改善臨床癥狀方面的效果要優(yōu)于對(duì)照組,尤其是在改善脅肋疼痛、倦怠乏力、大便稀溏、舌苔黃膩、口干口苦癥狀方面,其優(yōu)越性隨療程的延長(zhǎng)更加顯著。2.肝功能:治療組與對(duì)照組在丙氨酸轉(zhuǎn)氨酶、谷草轉(zhuǎn)氨酶、谷氨酰轉(zhuǎn)肽酶、總膽紅素、結(jié)合膽紅素等方面較治療前均有明顯改善,說(shuō)明治療組和對(duì)照組均能很好的改善患者肝功能指標(biāo)。治療組在降低丙氨酸轉(zhuǎn)氨酶和谷草轉(zhuǎn)氨酶方面與對(duì)照組比較有意義,說(shuō)明治療組在降低丙氨酸轉(zhuǎn)氨酶和谷草轉(zhuǎn)氨酶兩組酶方面要優(yōu)于對(duì)照組。3.乙型肝炎病毒e抗原:治療組25例HBeAg陽(yáng)性患者,24周治療后18人仍呈陽(yáng)性,轉(zhuǎn)陰7例,陰轉(zhuǎn)率28%;對(duì)照組24例HBeAg陽(yáng)性患者,24周治療后19人仍呈陽(yáng)性,轉(zhuǎn)陰5例,陰轉(zhuǎn)率20.8%。兩組數(shù)據(jù)比較無(wú)統(tǒng)計(jì)學(xué)意義(P=0.74)。4.病毒載量應(yīng)答:治療24周時(shí),治療組HBVDNA總應(yīng)答數(shù)19例,總應(yīng)答率63.30%;對(duì)照組HBV DNA總應(yīng)答數(shù)17例,總應(yīng)答率56.70%,兩組間比較P=0.80,差異無(wú)統(tǒng)計(jì)學(xué)意義。治療組HBVDNA完全應(yīng)答數(shù)8例,完全應(yīng)答率26.67%,部分應(yīng)答數(shù)11例,部分應(yīng)答率36.67%,無(wú)應(yīng)答數(shù)11例,無(wú)應(yīng)答率36.67%;對(duì)照組HBVDNA完全應(yīng)答數(shù)為6例,完全應(yīng)答率為20%,部分應(yīng)答數(shù)為11例,部分應(yīng)答率為36.67%,無(wú)應(yīng)答數(shù)為13例,無(wú)應(yīng)答率43.30%。兩組數(shù)據(jù)間比較P=0.80,差異無(wú)統(tǒng)計(jì)學(xué)意義。5.安全性方面:治療組與對(duì)照組在24周的療程中未發(fā)生與藥物有關(guān)的明顯的不良反應(yīng)。血常規(guī)、尿常規(guī)、腎功能等各項(xiàng)安全性指標(biāo)未出現(xiàn)異常。研究結(jié)論:1.用龍柴方聯(lián)合恩替卡韋治療慢性乙型病毒性肝炎肝郁脾虛,濕熱瘀阻型證,有較好的臨床效果。對(duì)患者的臨床癥狀、肝功能等實(shí)驗(yàn)室指標(biāo)有一定的改善作用,且療效優(yōu)于單用恩替卡韋治療。2.龍柴方組方新穎合理,治療效果顯著,預(yù)計(jì)在臨床應(yīng)用方面有廣闊的前景,值得推廣。
[Abstract]:Objective: to explore the clinical efficacy of Longchaifang in the treatment of chronic hepatitis B, and to provide a new method for the treatment of chronic hepatitis B by combining traditional Chinese and western medicine. According to the principle of random distribution, the treatment group and the control group were divided into treatment group and control group with 30 persons in each group. The treatment group was treated with Longchai decoction and entecavir dispersible tablets for 24 weeks, while the control group was only treated with entecavir dispersible tablets. The changes of clinical symptoms, signs, liver function indexes, hepatitis B virus markers and hepatitis B virus load were observed before and after treatment in the two groups. SPSS 20.0 statistical software was used to evaluate the efficacy of the two groups. The clinical symptom score of the treatment group was 15.53 鹵6.20, which decreased by 6.90 鹵3.49 compared with that before treatment, and that of the control group was 17.47 鹵6.77 and 4.90 鹵2.72.The clinical symptoms were improved in both groups. There was statistical significance (P 0.05). After 24 weeks of treatment, The score of TCM symptom in the treatment group was 8.73 鹵5.79, which decreased by 13.70 鹵4.92 compared with that before treatment, and that in the control group was 13.40 鹵7.23, which was 9.03 鹵4.58 compared with that before treatment. The difference between the two groups was significant (P 0.01). Can effectively improve clinical symptoms and signs, The effect of treatment group in improving clinical symptoms was better than that in control group, especially in improving rib pain, fatigue, loose stool, yellow and greasy tongue coating, dry mouth and bitter symptoms. Liver function: alanine aminotransferase, glutamic oxaloacetic transaminase, glutamyl transpeptidase, total bilirubin and conjugated bilirubin were significantly improved in treatment group and control group. It shows that both the treatment group and the control group can improve the liver function index of the patients. The treatment group has significance in reducing alanine aminotransferase and alanine aminotransferase compared with the control group. The results showed that the treatment group was superior to the control group in reducing alanine aminotransferase and alanine aminotransferase. 3. Hepatitis B virus e antigen: in the treatment group, 18 patients were still positive after 24 weeks of treatment with HBeAg positive, 7 patients turned negative. In the control group, 19 patients were still positive after 24 weeks of treatment, 5 patients turned negative, and the negative conversion rate was 20.8. there was no significant difference between the two groups. The viral load response: after 24 weeks of treatment, the total response of HBVDNA was 19 cases in the treatment group. The total response rate was 63.30% in the control group, 17 cases in the control group and 56.70% in the control group. There was no significant difference between the two groups in the total number of HBVDNA responses (8 cases), the complete response rate (26.67%), the partial response rate (11 cases), the partial response rate (36.67) and the non-response rate (11 cases). In the control group, there were 6 cases of complete response of HBVDNA, 20 cases of complete response, 11 cases of partial response, 36.67% of partial response and 13 cases of non-response. The non-response rate was 43.30.The difference between the two groups was not statistically significant. 5. Safety: there were no significant adverse reactions related to drugs in the treatment group and the control group during the 24-week course of treatment. Conclusion: 1. Using Longchaifang combined with entecavir in the treatment of chronic viral hepatitis B with liver stagnation and spleen deficiency, damp-heat stagnation, has a good clinical effect. The laboratory indexes such as liver function can be improved, and the curative effect is better than that of enticavir alone. The prescription of Longchaifang is novel and reasonable, and the therapeutic effect is remarkable. It is expected to have a broad prospect in clinical application and is worth popularizing.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R512.62

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