本文選題：慢乙肝 + 肝郁脾虛�。� 參考：《安徽中醫(yī)藥大學》2017年碩士論文

【摘要】：1目的通過對肝樂顆粒聯(lián)合恩替卡韋在肝郁脾虛型慢性乙型肝炎(Chronic Hepatitis B,CHB)臨床治療中作用研究,觀察肝樂顆粒對慢乙肝患者臨床癥狀及實驗室指標的影響,評價肝樂顆粒的安全性及療效,探討肝樂顆粒在慢乙肝治療中的可能作用機制,為中西醫(yī)結合治療慢乙肝提供新的治療策略,為今后中醫(yī)臨床優(yōu)化治療慢乙肝提供更多的選擇和科學依據(jù)。2方法選取60名慢性HBV感染肝郁脾虛證患者,隨機分為對照組與治療組,治療組予恩替卡韋聯(lián)合肝樂顆粒治療,對照組僅予恩替卡韋治療。分別于治療前、治療24w、治療48w后觀察兩組患者中醫(yī)癥狀、肝功能(ALT、AST、GGT、AKP、TBIL、ALB)、HBsAg、HBV DNA、肝纖四項(HA、LN、PⅢNP、CⅣ)及相關安全性指標。評估肝樂顆粒治療慢乙肝的即時療效。3結果3.1兩組治療后均可明顯改善患者總體中醫(yī)證候,且治療48w后明顯優(yōu)于治療24w后(P0.01);兩組對比,治療組對總體中醫(yī)證候改善明顯優(yōu)于對照組(P0.05)。3.2治療組治療24w及48w后在所有癥狀改善均優(yōu)于治療前(P0.05);治療24w后與治療48w后比較,治療48w后在胸脅脹痛、納差、胃脘脹滿、口淡、便溏、噯氣、乳房脹痛改善優(yōu)于治療24w后(P0.05),在善太息、乏力、舌脈方面無可比性,差異無統(tǒng)計學意義(P0.05)。3.3對照組治療24w后,除乳房脹痛外(P0.05),其他癥狀改善優(yōu)于未治療前(P0.05);治療48w后所有癥狀改善均優(yōu)于治療前(P0.05);治療24w后與治療48w后比較,治療48w后除舌脈外(P0.05),其他癥狀改善優(yōu)于治療24w后(P0.05)。3.4兩組治療24w后比較,治療組在善太息、胃脘脹滿、乏力、口淡、便溏改善方面優(yōu)于對照組(P0.05),在胸脅脹痛、納差、噯氣、乳房脹痛、舌脈方面無可比性(P0.05);治療48w后比較,治療組在善太息、胃脘脹滿、乏力、口淡、便溏改善方面優(yōu)于對照組(P0.05),在胸脅脹滿、納差、噯氣、乳房脹痛、舌脈方面無可比性(P0.05)。3.5治療24w及48w后,治療組總有效率明顯優(yōu)于對照組(P0.01)。3.6治療組治療24w及48w后在各個實驗室指標方面改善均明顯優(yōu)于治療前(P0.01);治療24w與治療48w后比較,治療48w后ALB、HBsAg、肝纖四項方面改善優(yōu)于治療24w后(P0.05)。3.7對照組治療24w及48w后在各個實驗室指標方面均明顯優(yōu)于治療前(P0.01);治療24w與治療48w后比較,治療48w后HBsAg、肝纖四項改善優(yōu)于治療24w后(P0.05)。3.8兩組治療24w后比較,治療組在肝纖四項方面改善優(yōu)于對照組(P0.05);治療48w后比較,治療組在肝纖四項及TBIL方面改善優(yōu)于對照組(P0.05)。3.9兩組治療前后安全性指標均在醫(yī)學參考值范圍內波動,治療前后無明顯變化,無統(tǒng)計學意義。4結論4.1在西醫(yī)抗病毒的基礎上聯(lián)合肝樂顆粒治療肝郁脾虛型慢性乙型肝炎療效確切,肝樂顆�？捎行Ц纳苹颊吲R床癥狀及中醫(yī)證候。4.2肝樂顆�？山档突颊逿BIL及肝纖四項指標,但具體作用機制仍需進一步探討。4.3肝樂顆粒臨床應用無明顯不良反應,安全性良好。
[Abstract]:Objective to study the effect of Ganle granule combined with entecavir on the clinical treatment of chronic hepatitis B patients with chronic hepatitis B with liver stagnation and spleen deficiency, and to observe the effect of Ganle granule on the clinical symptoms and laboratory indexes of patients with chronic hepatitis B. To evaluate the safety and efficacy of Ganle granule, to explore the possible mechanism of Ganle granule in the treatment of chronic hepatitis B, and to provide a new therapeutic strategy for the treatment of chronic hepatitis B with integrated Chinese and western medicine. Methods 60 patients with chronic HBV infection with liver stagnation and spleen deficiency syndrome were randomly divided into control group and treatment group. The treatment group was treated with entecavir combined with Ganle granule. The control group was treated only with entecavir. Before treatment, 24 weeks after treatment and 48 weeks after treatment, the TCM symptoms, liver function of the two groups were observed, and the related safety indexes were measured. The liver function of the two groups was compared with that of the control group. The liver function of the two groups was compared with that of the control group. The liver function of the two groups was compared with that of the control group. The liver function of the two groups was compared with that of the control group. The liver function of the two groups was compared with that of the control group. Evaluation of the immediate curative effect of Ganle granule on chronic Hepatitis B results 3.1 after treatment, both groups could obviously improve the overall TCM syndromes of the patients, and after 48 weeks of treatment, it was significantly better than that after 24 weeks of treatment (P 0.01), and the two groups were compared with each other. The improvement of TCM syndromes in the treatment group was obviously better than that in the control group at 24 and 48 weeks after treatment, and after 24 weeks and 48 weeks, the symptoms in the treatment group were better than those in the control group after 24 weeks and 48 weeks respectively, and after 24 weeks and 48 weeks, the symptoms of the treatment group were significantly better than those of the control group, and after 48 weeks of treatment, the symptoms of the treatment group were significantly better than those of the control group. The improvement of loose stools, belching and breast distending pain was better than that of P0.05 after 24 weeks of treatment. The difference was not statistically significant after 24 weeks of treatment in the control group. With the exception of breast distending pain, the improvement of other symptoms was better than that before treatment (P 0.05); after 48 weeks of treatment, all symptoms were improved better than that before treatment (P 0.05); after 24 weeks of treatment, it was compared with that after 48 weeks of treatment. After 48 weeks of treatment, the improvement of other symptoms was better than that of the two groups after 24 weeks of treatment. The treatment group was superior to the control group in terms of good information, full stomach distension, fatigue, light mouth, loose stools, pain in chest and flank, anorexia, belching, and the improvement of loose stools was better than that of the control group in the improvement of P0.05, and the improvement of other symptoms was better than that of the control group after 24 weeks of treatment, and that of the treatment group was better than that of the control group. After 48 weeks of treatment, the treatment group was superior to the control group in terms of good rest, full stomach distension, fatigue, light mouth, loose stool improvement, full chest distention, anorexia, belching, and breast distending pain. After 24 and 48 weeks of treatment, the total effective rate of the treatment group was significantly better than that of the control group after 24 weeks and 48 weeks of treatment, and the improvement of each laboratory index in the treatment group was significantly better than that in the control group at 24 weeks and 48 weeks after treatment, and at 24 weeks after treatment and 48 weeks after treatment, the total effective rate of the treatment group was significantly better than that of the control group. After 48 weeks of treatment, the improvement of four aspects of ALB HBsAg and liver fiber was better than that of 24 weeks after treatment and 48 weeks after treatment. The control group was significantly better than the control group in each laboratory index after 24 weeks and 48 weeks, and 24 weeks after treatment and 48 weeks after treatment, the improvement of liver fiber was significantly better than that of 24 weeks after treatment and 48 weeks after treatment. After 48 weeks of treatment, the four improvements of HBsAg and liver fiber were better than those of the two groups after 24 weeks of treatment (P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, respectively), and the improvement of liver fibrils in the treatment group was better than that in the control group, and after 48 weeks, the improvement was better in the treatment group. The improvement of liver fiber and TBIL in the treatment group was better than that in the control group (P 0.05N. 3.9). The safety indexes of the two groups fluctuated within the medical reference value before and after treatment, but there was no obvious change before and after treatment. Conclusion 4.1 on the basis of western medicine antiviral therapy combined with Ganle granule is effective in the treatment of chronic hepatitis B with liver stagnation and spleen deficiency. Ganle granule can effectively improve the clinical symptoms of patients and TCM syndromes .4.2 Ganle granule can reduce the TBIL and liver fiber four indexes, but the specific mechanism still need to further explore the clinical application of .4.3 Ganle granule no obvious adverse reactions, good safety.
【學位授予單位】：安徽中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R512.62

【相似文獻】

相關期刊論文 前10條

1 王改梅;肝樂寧治療慢性乙型肝炎及肝硬化療效觀察[J];甘肅中醫(yī)學院學報;1997年04期

2 李誠秀,李玲,羅俊,楊文秀,張小蕾,黃能慧,程明亮;漢丹肝樂的毒性研究[J];貴陽醫(yī)學院學報;1999年02期

3 喻洪偉,張春梅;酒肝樂治療酒精性肝病療效觀察[J];遼寧中醫(yī)雜志;2003年04期

4 余海峰,林明增,陳霄峰,洪榮標;肝樂寧治療肝硬變近期療效分析[J];臨床薈萃;1998年24期

5 劉志軍;;脂肝樂降血脂20例臨床觀察[J];北方藥學;2012年03期

6 苗芊,馬洪波,金瑞;鑫肝樂治療慢性乙型肝炎的近期療效觀察[J];北京中醫(yī)藥大學學報(中醫(yī)臨床版);2003年01期

7 唐樹林;脂肝樂治療脂肪肝100例[J];遼寧中醫(yī)雜志;1997年04期

8 羅天永,吳君,劉琴,梁躍東,張影影;漢丹肝樂治療慢性活動性肝炎肝纖維化分析[J];貴陽醫(yī)學院學報;1999年02期

9 吳君;陸蔭英;程明亮;丁一生;;漢丹肝樂對免疫性肝纖維化模型大鼠轉化生長因子-β_1的影響[J];中國中西醫(yī)結合雜志;2002年S1期

10 曹軍;楊靜;陳雷;楊志福;王磊;李華;崔佳;文愛東;;肝樂舒顆粒的質量標準研究[J];中國藥師;2012年08期

相關會議論文 前10條

1 付榮泉;程明亮;;漢丹肝樂對豬血清免疫性肝纖維化肝中氧化及抗氧化的影響[A];第十二次全國中西醫(yī)結合肝病學術會議論文匯編[C];2003年

2 吳君;王一凡;閆超;劉芙蓉;;復方中藥漢丹肝樂對砷暴露大鼠肝臟損傷的保護作用[A];全國第2屆中西醫(yī)結合傳染病學術會議暨國家中醫(yī)藥管理局第1屆傳染病協(xié)作組會議論文匯編[C];2008年

3 吳君;羅天永;梁耀東;;復方中藥漢丹肝樂抗肝纖維化的臨床觀察[A];第一次全國中西醫(yī)結合傳染病學術會議論文匯編[C];2006年

4 王鑫;李勇;;十寶消ve方治療慢性乙型肝炎后肝硬化(肝郁脾虛型)的臨床觀察研究[A];中華中醫(yī)藥學會脾胃病分會第二十四次全國脾胃病學術交流會論文匯編[C];2012年

5 陳志偉;邵雅斐;;60例肝郁脾虛型亞健康疲勞狀態(tài)患者的可視化診斷[A];中華中醫(yī)藥學會亞健康分會換屆選舉暨“‘治未病’及亞健康防治論壇”論文集[C];2008年

6 陳志偉;邵雅斐;;肝郁脾虛型亞健康疲勞狀態(tài)患者的可視化診斷[A];第三屆中和亞健康論壇暨2009·亞健康產(chǎn)業(yè)展覽會論文集[C];2009年

7 胡愛榮;丁一生;程明亮;;漢丹肝樂對免疫性肝纖維化大鼠HSCs增殖、活化及凋亡的影響[A];第十二次全國中西醫(yī)結合肝病學術會議論文匯編[C];2003年

8 甘愛萍;;腸瀉安對肝郁脾虛型慢性腹瀉臨床觀察[A];中華中醫(yī)藥學會第二十二屆全國脾胃病學術交流會暨2010年脾胃病診療新進展學習班論文匯編[C];2010年

9 李躍華;相田園;張?zhí)m鳳;金京南;張占強;楊京;;抑郁癥患者肝郁氣滯及肝郁脾虛型HAMD抑郁量表結構因素分析[A];中國中西醫(yī)結合學會養(yǎng)生學與康復醫(yī)學專業(yè)委員會委員會議暨第七次學術研討會論文集[C];2011年

10 李躍華;相田園;張?zhí)m鳳;金京南;張占強;楊京;;抑郁癥患者肝郁氣滯及肝郁脾虛型HAMD抑郁量表結構因素分析[A];第六次全國中西醫(yī)結合養(yǎng)生學與康復醫(yī)學學術研討會論文集[C];2009年

相關重要報紙文章 前10條

1 田佳;苗藥宜肝樂通過重點科技推廣項目認證[N];人民日報海外版;2004年

2 山西省平遙縣中醫(yī)院 王金亮;乳房脹痛非獨肝郁[N];中國中醫(yī)藥報;2013年

3 鐘燕宇 韓萍 張雅靜北京小湯山醫(yī)院;中醫(yī)調治肝郁脾虛型亞健康[N];中國中醫(yī)藥報;2009年

4 上海中醫(yī)藥大學 胡義揚;乙型肝炎如何預防[N];上海中醫(yī)藥報;2004年

5 宋欣榮;乙型肝炎新藥素比伏在中國獲準上市[N];科技日報;2007年

6 解放軍458醫(yī)院全軍肝病中心主任醫(yī)師 劉樹人;乙型肝炎化驗單怎樣看[N];廣東科技報;2008年

7 ;乙型肝炎的消毒處理[N];保健時報;2005年

8 陳黎明;乙型肝炎[N];家庭醫(yī)生報;2006年

9 鄭靈巧;慢性乙型肝炎仍難治愈[N];健康報;2008年

10 ;中西醫(yī)結合治療慢性乙型肝炎療效好[N];中國中醫(yī)藥報;2005年

相關博士學位論文 前10條

1 付義;女性肝郁患者心身狀態(tài)初探及暢郁方藥效作用實驗研究[D];北京中醫(yī)藥大學;2005年

2 曾斌芳;脂肪性肝病病證、用方用藥及其臨床的一體化研究[D];新疆醫(yī)科大學;2009年

3 趙晶;中醫(yī)辨證治療抑郁癥腎虛肝郁型和肝郁脾虛型的臨床研究[D];北京中醫(yī)藥大學;2008年

4 郇述玲;慢加急性乙型肝炎肝衰竭和慢性乙型肝炎患者IL-33和ST2測定的臨床價值[D];山東大學;2015年

5 程紅球;慢性乙型肝炎中醫(yī)證型對拉米夫定抗病毒的療效評價及機制研究[D];湖北中醫(yī)藥大學;2015年

6 王珍麗;慢性乙型肝炎與慢加急性乙型肝炎肝衰竭患者TACE甲基化狀態(tài)的研究[D];山東大學;2015年

7 范玉琛;免疫負調控分子TIPE2在慢性HBV感染患者中的表達及臨床意義[D];山東大學;2015年

8 朱艷玲;IFNα治療慢性乙型肝炎無應答患者USP18的表達及調控研究[D];重慶醫(yī)科大學;2012年

9 張華;江蘇省乙型肝炎疾病負擔與防治策略評價研究[D];東南大學;2015年

10 楊鉑;基于中醫(yī)傳承輔助系統(tǒng)的慢性乙型肝炎活血化瘀方藥研究[D];山東中醫(yī)藥大學;2016年

相關碩士學位論文 前10條

1 程德美;肝樂顆粒聯(lián)合西藥治療慢性乙型肝炎（肝郁脾虛型）臨床療效觀察[D];安徽中醫(yī)藥大學;2017年

2 沈銀河;失眠癥肝郁類證中醫(yī)證型分布及其臨床特點研究[D];福建中醫(yī)藥大學;2015年

3 成亞亞;柴芍調肝方治療肝郁脾虛型腸易激綜合征臨床研究[D];河北醫(yī)科大學;2015年

4 柳江;針刺治療肝郁脾虛型慢性泄瀉(腸易激綜合征)的臨床研究[D];長春中醫(yī)藥大學;2015年

5 李西云;刺絡放血配以針刺治療肝郁脾虛型失眠的臨床研究[D];成都中醫(yī)藥大學;2015年

6 郝春花;加減逍遙湯治療耳鳴（肝郁脾虛型）的臨床觀察[D];黑龍江中醫(yī)藥大學;2016年

7 陳昀;愈潰湯治療肝郁脾虛型消化性潰瘍的臨床療效觀察[D];山東中醫(yī)藥大學;2015年

8 周澤鵬;五行音樂輔助治療腹瀉型腸易激綜合征的療效評價研究[D];廣州中醫(yī)藥大學;2016年

9 梁巧文;基于5-HT信號系統(tǒng)枳芍散對肝郁脾虛型IBS的作用機理研究[D];廣州中醫(yī)藥大學;2016年

10 王忱;解郁止瀉方治療緩解期慢性潰瘍性結腸炎的療效觀察[D];黑龍江中醫(yī)藥大學;2016年

，

本文編號：1800077