本文選題：益氣養(yǎng)肝方劑 + 茵梔黃顆粒�。� 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:在干擾素聯(lián)合利巴韋林抗丙型肝炎病毒治療的基礎(chǔ)上,以茵梔黃顆粒沖劑作對照,觀察益氣養(yǎng)肝方劑干預(yù)干擾素聯(lián)合利巴韋林抗病毒治療不良反應(yīng)的臨床療效。方法:收集2014年9月至2015年12月期間就診于吉林大學(xué)第二醫(yī)院肝膽胰內(nèi)科經(jīng)門診收入院并應(yīng)用干擾素聯(lián)合利巴韋林系統(tǒng)治療的丙型病毒性肝炎患者40例,隨機(jī)分為益氣養(yǎng)肝方劑聯(lián)合治療實(shí)驗(yàn)組及茵梔黃顆粒沖劑聯(lián)合治療對照組,每組各20例;在給予聚乙二醇干擾素α-2a(商品名:派羅欣,上海羅氏制藥有限公司生產(chǎn))180ug,皮下注射,每周1次,利巴韋林(四川美大康藥業(yè)股份有限公司生產(chǎn))1000mg/次,1次/日的同時,實(shí)驗(yàn)組20例丙型肝炎患者給予益氣養(yǎng)肝方制劑150 ml/次,3次/日,對照組20例患者給予茵梔黃顆粒沖劑3g/次,3次/日。每個療程持續(xù)12周。分別于治療前及治療1周、2周、4周觀察記錄發(fā)熱、乏力、肌肉關(guān)節(jié)酸痛、頭痛、失眠等不良反應(yīng)及血常規(guī)的變化情況;于治療4周、12周、24周檢查并記錄患者HCV-RNA變化情況;于治療前及治療2周、4周、8周檢查并記錄肝功能(ALT、AST、TBIL、ALB)變化情況;于治療前及治療4周、8周、12周檢測肝臟瞬時彈性成像(肝硬度值,單位為KPA)變化情況。結(jié)果:1.治療前后不良反應(yīng)復(fù)常情況根據(jù)臨床觀察,在治療1周時益氣養(yǎng)肝方劑聯(lián)合治療實(shí)驗(yàn)組在發(fā)熱、肌肉關(guān)節(jié)酸痛、頭痛方面的緩解率分別為63.2%、60.0%、50.0%,明顯優(yōu)于茵梔黃顆粒沖劑聯(lián)合治療對照組30.0%、21.4%、13.3%的緩解率,且差異有統(tǒng)計(jì)學(xué)意義(P0.05);在治療2周時實(shí)驗(yàn)組在發(fā)熱、乏力、肌肉關(guān)節(jié)酸痛、頭痛、失眠方面的緩解率分別為89.5%、82.4%、86.7%、77.8%、72.7%,較對照組50.0%、44.4%、50.0%、40.0%、30.8%的緩解率優(yōu)勢明顯,有統(tǒng)計(jì)學(xué)差異(P0.05);在治療4周時實(shí)驗(yàn)組與對照組在粒細(xì)胞減少方面緩解率分別為84.6%及41.7%,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);在血小板減少方面,兩組在所有治療時間點(diǎn)緩解情況相似(P0.05)。2.治療前后病毒學(xué)應(yīng)答情況根據(jù)臨床觀察,在治療4周、12周及24周時,益氣養(yǎng)肝方劑聯(lián)合治療實(shí)驗(yàn)組的快速病毒學(xué)應(yīng)答(RVR)率、早期病毒學(xué)應(yīng)答(EVR)率及持續(xù)病毒學(xué)應(yīng)答(SVR)率分別為60.0%、85.0%、75.0%,茵梔黃顆粒沖劑聯(lián)合治療對照組RVR率、EVR率及SVR率分別為50.0%、75.0%、70.0%,兩組比較無統(tǒng)計(jì)學(xué)差異(P0.05)。3.治療前后肝臟功能復(fù)常情況根據(jù)臨床觀察,益氣養(yǎng)肝方劑聯(lián)合治療實(shí)驗(yàn)組與茵梔黃顆粒聯(lián)合治療對照組組內(nèi)比較,在第4周及第8周時,兩組患者ALT、AST、TBIL水平下降明顯,差異有統(tǒng)計(jì)學(xué)意義(P0.05);整個治療過程中,兩組治療前后組間比較及治療前后肝功能各指標(biāo)下降幅度(均值)組間比較均無明顯差異(P0.05)。4.治療前后肝硬度值變化情況根據(jù)臨床觀察,益氣養(yǎng)肝方劑聯(lián)合治療實(shí)驗(yàn)組在治療第12周與治療前比較KPA值明顯下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05),對照組在治療第12周與治療前比較KPA值無明顯變化(P0.05);在治療第12周時實(shí)驗(yàn)組KPA值水平降幅(均值)明顯高于對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:益氣養(yǎng)肝方劑干預(yù)干擾素聯(lián)合利巴韋林治療慢性丙型病毒性肝炎患者,可顯著改善患者發(fā)熱、乏力、肌肉關(guān)節(jié)酸痛、粒細(xì)胞減少、頭痛、失眠等不良反應(yīng);具有明顯溶解纖維、改善肝纖維化程度的作用;可作為聚乙二醇干擾素聯(lián)合利巴韋林(PR)方案治療慢性丙型肝炎的輔助治療手段,值得推廣應(yīng)用。
[Abstract]:Objective: on the basis of interferon combined with ribavirin (ribavirin) anti hepatitis C virus, Yinzhi Huang granule was used as control to observe the clinical efficacy of interferon interferon combined with ribavirin for antiviral treatment. Methods: from September 2014 to December 2015, the liver and gallbladder pancreas of the second hospital of Jilin University were collected. 40 patients with viral hepatitis C treated by interferon combined with Leigh Bhave Lin system were randomly divided into the combination therapy group of Yiqi nourishing liver prescription and Yinzhi Huang granule in the control group, with 20 cases in each group, and were given pegylate alpha -2a (commodity name: pomroin, Shanghai Roche Pharmaceuticals. Limited company production) 180ug, subcutaneous injection, 1 times a week, Leigh Bhave Lin (Sichuan Mei Da Kang pharmaceutical Limited by Share Ltd production) 1000mg/ times, 1 times per day, while 20 cases of hepatitis C patients in the experimental group were given 150 ml/ times, 3 times per day, 20 patients in the control group were given Yinzhi Huang granule granules 3g/ times, 3 times per day. Each course lasted 12 weeks. The changes of fever, fatigue, muscle and joint pain, headache, insomnia and other adverse reactions and changes of blood routine were observed before and 1 weeks, 2 weeks and 4 weeks respectively. The changes of HCV-RNA were checked and recorded for 4 weeks, 12 weeks and 24 weeks, and the changes of liver function (ALT, AST, TBIL, ALB) were recorded before and 2 weeks, 4 weeks and 8 weeks before and after treatment. Before and after treatment, 4 weeks, 8 weeks and 12 weeks, the transient elastography of the liver (the value of liver hardness, unit KPA) was detected. Results: 1. of the adverse reactions were observed before and after 1. treatment. In the 1 week treatment, the remission rate of the combined treatment group of Yiqi Yang and liver prescription in the experimental group was 63.2% and 60%, respectively. 50%, obviously better than the Yinzhi yellow granule combined with the combined treatment of 30%, 21.4%, 13.3% remission rate, and the difference was statistically significant (P0.05). During the 2 week treatment, the experimental group was 89.5%, 82.4%, 86.7%, 77.8%, 72.7%, respectively, in fever, fatigue, muscle and joint ache, headache, and insomnia, 50%, 44.4%, 50%, 40%, compared with the control group. The remission rate had a significant difference (P0.05), and the rate of granulocytopenia was 84.6% and 41.7% in the experimental group and the control group at 4 weeks, and the two groups were statistically significant (P0.05). In the thrombocytopenia, the two groups were similar (P0.05) to the virological response before and after the treatment of.2.. According to clinical observation, the rate of rapid virology response (RVR), the rate of early virological response (EVR) and sustained virological response (SVR) were 60%, 85%, and 75% respectively at 4 weeks, 12 and 24 weeks, and the rate of RVR, EVR rate and SVR rate were 50%, 75 respectively in the control group. There was no statistically significant difference (P0.05) between the two groups (P0.05) before and after.3. treatment. According to the clinical observation, the level of ALT, AST, and TBIL in the two groups were significantly decreased in the group of two groups, and the difference was statistically significant (P0.05). During the treatment, there was no significant difference between the two groups before and after treatment and the decrease of the liver function before and after treatment (P0.05). The changes of liver hardness value before and after.4. treatment were observed. The KPA value of the experimental group of Yiqi nourishing liver prescription combined treatment group was significantly lower than that before treatment, and there was a difference between the two groups. There was no significant change in the value of KPA (P0.05) in the control group at twelfth weeks and before treatment (P0.05). The decrease of KPA in the experimental group was significantly higher than that of the control group at the twelfth week of treatment (P0.05). Conclusion: Yiqi Yang liver prescription interferon combined with Leigh Bhave Lin in the treatment of chronic hepatitis C patients It can significantly improve the patient's fever, fatigue, muscle and joint pain, granulocytic reduction, headache, insomnia and other adverse reactions; it can dissolve fiber obviously and improve the degree of liver fibrosis; it can be used as a supplementary treatment for the treatment of chronic hepatitis C with peginterferon combined with Leigh Bhave Lin (PR) scheme.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R512.63

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