本文選題：柔肝化纖顆粒 + 骨髓間充質干細胞移植　； 參考：《廣西中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:本研究重點探討柔肝化纖顆粒聯(lián)合骨髓間充質干細胞治療乙肝肝硬化肝腎陰虛證的臨床療效及安全性,以期為中醫(yī)藥干預骨髓間充質干細胞移植治療乙肝肝硬化提供臨床依據(jù)。方法:采用隨機分組的方法,選取符合納入標準的乙肝肝硬化肝腎陰虛證患者90例。隨機分為2組,各45例,對照組予常規(guī)內科綜合治療及自體骨髓間充質干細胞移植,治療組在對照組的基礎上給予柔肝化纖顆粒治療。觀察兩組在治療后4周、12周、24周、48周肝功能(ALT、AST、TBIL、ALB)和凝血功能指標變化以及治療前后肝臟MRI-DWI的ADC值的變化。結果:(1)治療組41例,總有效率90.24%,對照組42例,總有效率為71.43%,兩組比較有明顯差異(P0.05),柔肝化纖顆�？梢蕴岣吖撬栝g充質干細胞移植治療乙肝肝硬化(肝腎陰虛證)的臨床療效,改善患者臨床癥狀。(2)在改善肝臟功能方面:在治療后第4周,治療組ALT、AST指標下降較對照組明顯,差異具有統(tǒng)計學意義(P0.05);在治療后第12周、24周、48周,治療組患者在改善ALT、AST、TBIL、ALB指標方面優(yōu)于對照組,差異有統(tǒng)計學意義(P0.05或P0.01)。在治療第24周、48周后,治療組在改善凝血功能方面較對照組明顯,差異具有統(tǒng)計學意義(P0.05),提示柔肝化纖顆粒可以改善骨髓間充質干細胞移植患者的肝臟功能。(3)在延緩肝纖維化進展方面:兩組治療后ADC值與治療前相比均有所上升,差異具有統(tǒng)計學意義(P0.01)。在治療后第48周復查MRI-DWI,治療組的ADC值上升至1.38±0.02(×10㧟3mm2/s),對照組ADC值上升至1.37±0.01(×10㧟3mm2/s),差異具有統(tǒng)計學意義(P0.05)。提示骨髓間質干細胞移植可以延緩乙肝肝硬化患者肝纖維化進程,柔肝化纖顆�？梢赃M一步提高其移植治療效果。(4)安全性:兩組的移植患者在術中及術后均未發(fā)生嚴重不良反應及細胞移植的并發(fā)癥,提示柔肝化纖顆粒聯(lián)合骨髓間質干細胞移植安全可靠。結論:(1)測量的ADC值與肝功能常規(guī)檢查的標志物有一定關聯(lián)性,肝臟功能改善時,ADC值會隨之升高。(2)骨髓間質充干細胞移植可以改善患者的肝臟功能、延緩肝纖維化進展,柔肝化纖顆�？梢蕴岣咂湟浦仓委熜Ч�。(3)柔肝化纖顆粒聯(lián)合骨髓間充質干細胞治療乙肝肝硬化肝腎陰虛證患者較安全,無明顯不良反應。
[Abstract]:Objective: This study focuses on the clinical efficacy and safety of the combination of soft liver and chemical fiber particles combined with bone marrow mesenchymal stem cells in the treatment of liver and kidney yin deficiency syndrome of hepatitis B liver cirrhosis, in order to provide a clinical basis for the intervention of bone marrow mesenchymal stem cell transplantation in the treatment of hepatitis B cirrhosis. 90 patients with liver kidney yin deficiency syndrome of liver cirrhosis were randomly divided into 2 groups, each 45 cases, the control group was given conventional comprehensive treatment and autologous bone marrow mesenchymal stem cell transplantation, and the treatment group was treated with soft liver chemical Granule on the basis of the control group. The liver function (ALT, AST, TBIL, ALB) and coagulation function indexes were observed at 4 weeks, 12 weeks, 24 weeks and 48 weeks after treatment. Changes and changes in the ADC value of liver MRI-DWI before and after treatment. Results: (1) 41 cases in the treatment group, the total effective rate is 90.24%, the control group 42 cases, the total effective rate is 71.43%, the two groups have obvious difference (P0.05), the soft liver chemical fiber granule can improve the clinical effect of the bone marrow mesenchymal stem cell transplantation for hepatitis B liver cirrhosis (liver kidney yin deficiency syndrome) and improve the patients. Clinical symptoms. (2) in the improvement of liver function: in the fourth week after treatment, the treatment group ALT, AST index decreased significantly than the control group, the difference was statistically significant (P0.05). After twelfth weeks, 24 weeks, 48 weeks after treatment, the treatment group was better than the control group in the improvement of ALT, AST, TBIL, ALB. The difference was statistically significant (P0.05 or P0.01). In the treatment of the first group. 24 weeks, 48 weeks later, the treatment group was better than the control group in improving the coagulation function, the difference was statistically significant (P0.05), suggesting that the soft liver chemical fiber granule could improve the liver function of the patients with bone marrow mesenchymal stem cells transplantation. (3) to delay the progression of liver fibrosis: the value of ADC was higher after treatment than before treatment. Statistical significance (P0.01). The ADC value of the treatment group increased to 1.38 + 0.02 (x 10? 3mm2/s) in the treatment group forty-eighth weeks after treatment. The ADC value of the control group increased to 1.37 + 0.01 (x 10? 3mm2/s), and the difference was statistically significant (P0.05). It suggested that the transplantation of mesenchymal stem cells could delay the process of liver fibrosis in patients with hepatitis B liver cirrhosis, and the soft liver chemical fiber granules could be used. In order to further improve the effect of transplantation treatment. (4) safety: two groups of transplanted patients had no serious adverse reactions and cell transplantation complications during and after operation, suggesting that the combination of Soft Liver chemical fiber particles and bone marrow mesenchymal stem cells transplantation was safe and reliable. Conclusion: (1) the ADC value measured is related to the marker of liver function routine examination. When the liver function is improved, the ADC value will increase. (2) bone marrow mesenchymal stem cell transplantation can improve the liver function of the patients and delay the progress of liver fibrosis. (3) the combination of Soft Liver chemical fiber particles and bone marrow mesenchymal stem cells in the treatment of hepatitis B liver kidney yin deficiency syndrome patients with hepatitis B liver cirrhosis is safer and less clear. Adverse reaction.
【學位授予單位】：廣西中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R512.62;R575.2

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