發(fā)布時(shí)間：2018-05-03 05:06

  本文選題：敗黃肝寧合劑 + 思美泰��； 參考：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的通過隨機(jī)對(duì)照研究,觀察敗黃肝寧合劑聯(lián)合思美泰治療乙肝肝硬化黃疸(濕熱瘀阻型)的臨床療效及應(yīng)用安全性。方法1.分組方法:將90例在武漢市中西醫(yī)結(jié)合醫(yī)院消化科門診及肝病門診就診,診斷為乙型肝炎后肝硬化黃疸(濕熱瘀阻型)并符合入組標(biāo)準(zhǔn)的患者,根據(jù)隨機(jī)分配原則分成三組,分為中西藥聯(lián)合組(敗黃肝寧合劑+思美泰組)、西藥組(思美泰組)和中藥組(敗黃肝寧合劑組),每組各30例。2.治療方案:三組均用基礎(chǔ)治療(保肝藥物用還原型谷胱甘肽;并常規(guī)予以恩替卡韋抗病毒治療,必要時(shí)輸注血漿或白蛋白等對(duì)癥支持治療)。中西藥聯(lián)合組在基礎(chǔ)治療的同時(shí)給予口服思美泰片(丁二磺酸腺苷蛋氨酸腸溶片,每次500mg,每天兩次)和敗黃肝寧合劑(組成:茵陳、梔子、大黃、龍膽草、赤芍、敗醬草、白茅根、金錢草、北柴胡、厚樸、山楂、神曲、炙甘草。每次50ml,每日兩次)。西藥組在基礎(chǔ)治療上加思美泰口服(每次500mg,每天兩次)治療。中藥組在基礎(chǔ)治療上加本院自制中藥復(fù)方制劑敗黃肝寧合劑(每次50ml,每日兩次)進(jìn)行治療。三組療程均為4周。3.觀察指標(biāo):觀察三組治療前后主要中醫(yī)癥候變化,肝功能指標(biāo)變化(包括TBIL、TBA、ALT、AST、γ-GT、ALP,主要為TBIL、γ-GT),安全性指標(biāo)變化,并根據(jù)相應(yīng)療效評(píng)價(jià)標(biāo)準(zhǔn),作出療效評(píng)價(jià)。同時(shí)觀察三組治療過程中的不良反應(yīng)。4.統(tǒng)計(jì)方法:使用SPSS 17.0統(tǒng)計(jì)學(xué)軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,記錄所有數(shù)據(jù)。計(jì)量資料均以(?x±s)表示,組間比較采用單因素方差分析,組內(nèi)治療前后比較采用配對(duì)t檢驗(yàn);計(jì)數(shù)資料以例數(shù)或百分比(%)表示,采用χ~2檢驗(yàn),等級(jí)資料采用H檢驗(yàn),兩兩比較用Nemenyi檢驗(yàn)。以p0.05為差異具有統(tǒng)計(jì)學(xué)意義,p0.05為無統(tǒng)計(jì)學(xué)意義。結(jié)果1.綜合療效評(píng)價(jià):中西藥聯(lián)合組總有效率為89.3%,西藥組總有效率為46.7%,中藥組總有效率為48.3%。組間比較,西藥組與中藥組總有效率差異無統(tǒng)計(jì)學(xué)意義(p0.05)。中西藥聯(lián)合組總有效率優(yōu)于中藥組及西藥組,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。2.肝功能指標(biāo)變化:經(jīng)過4周治療,三組在治療后肝功能指標(biāo)(tbil、alt、ast、tba、γ-gt、alp)均有明顯改善,與治療前相比差異具有統(tǒng)計(jì)學(xué)意義(p0.05);療程結(jié)束后,西藥組與中藥組肝功能指標(biāo)差異無統(tǒng)計(jì)學(xué)意義(p0.05),而中西藥聯(lián)合組肝功能指標(biāo)明顯低于西藥組和中藥組,且差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。3.各單項(xiàng)中醫(yī)癥狀評(píng)分比較:三組治療后單項(xiàng)癥狀均有改善,與治療前相比差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。對(duì)治療后三組結(jié)果比較,中西藥聯(lián)合組各癥狀評(píng)分較中藥組和西藥組低,且差異均有統(tǒng)計(jì)學(xué)意義(p0.05),中藥組各癥狀評(píng)分與西藥組比較,身目黃染、小便黃赤、惡心嘔吐、倦怠乏力的癥狀評(píng)分無差異(p0.05),而脘腹脹悶、脅肋疼痛、食欲不振、口干口苦的癥狀評(píng)分在中藥組更低,且差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。4.治療前后中醫(yī)癥候總積分比較:治療前三組癥候總積分差異無統(tǒng)計(jì)學(xué)意義(p0.05),三組在治療后積分均有所下降且差異具有統(tǒng)計(jì)學(xué)意義(p0.05),中西藥聯(lián)合組癥候總積分明顯低于中藥組及西藥組且差異具有統(tǒng)計(jì)學(xué)意義(p0.05),中藥組癥候總積分較西藥組低且差異有統(tǒng)計(jì)學(xué)意義(p0.05)。5.安全性觀察:各組患者生命體征平穩(wěn),血尿糞三大常規(guī)、腎功能、凝血功能、電解質(zhì)、肝膽彩超等均未出現(xiàn)明顯變化,2例病例出現(xiàn)輕微腹瀉,停藥后好轉(zhuǎn),其它病例均未出現(xiàn)明顯的不良反應(yīng)及副作用。結(jié)論:敗黃肝寧合劑聯(lián)合思美泰治療肝硬化黃疸(濕熱瘀阻型),在退黃、促進(jìn)肝功能恢復(fù)、改善中醫(yī)癥候等方面均取得了良好的效果,且療效明顯優(yōu)于單用西藥及單用中藥,說明敗黃肝寧合劑和思美泰具有協(xié)同治療作用,且安全性高。
[Abstract]:Objective To observe the clinical efficacy and safety of the treatment of hepatitis B liver cirrhosis jaundice (damp heat stasis type) in the treatment of liver cirrhosis and jaundice (damp heat stasis type) in the treatment of hepatitis B cirrhosis by a randomized controlled study. Methods 1. groups of methods: 90 cases were diagnosed as jaundice of liver cirrhosis after hepatitis B (damp heat stasis) in the outpatient and liver disease out-patient of Wuhan integrated traditional Chinese and Western medicine. The patients were divided into three groups according to the principle of random distribution. They were divided into three groups according to the principle of random distribution, which were divided into two groups: the combination group of Chinese and Western Medicine (Huang Ganning mixture + Si), the western medicine group (MATTEL group) and the Chinese Medicine group (the group of the Huang Gan Ning Mixture), each group had 30 cases of.2. treatment: the three groups were treated with the basic treatment for the liver and the glutathione. At the same time, the combination group of Chinese and Western medicine combined with oral MATTEL tablets (adenosine methionine methionine enteric coated tablets two, each time 500mg, two times a day) and Huang Gan Ning Mixture (composition: Artemisia capillaris, gardenia, rhubarb, gentian, Radix Paeoniae, Rhizoma Paeoniae, Rhizoma Alba root). Strychna, bupleurum, haw, hawthorn, Crataegus, Divine Comedy and licorice. Every time 50ml, two times a day). The western medicine group was treated with Garth MATTEL (500mg every time, every day) on basic treatment. The Chinese medicine group was treated by the Chinese medicine group in the basic treatment. The Chinese medicine compound preparation was treated by the compound preparation of Chinese herbal medicine (50ml each time, two times a day). The three courses were all 4 weeks.3. view. Inspection index: the changes of the main TCM syndrome before and after treatment were observed, and the changes of liver function indexes (including TBIL, TBA, ALT, AST, -GT, ALP, TBIL, gamma -GT), the changes of the safety indexes, and the evaluation of the curative effect according to the evaluation criteria of the corresponding curative effect. Meanwhile, the statistical methods of adverse reactions in the three groups were observed: using SPSS 17 statistics. The data were statistically analyzed and all the data were recorded. The measurement data were expressed as (? X + s). The single factor variance analysis was used in the group. The paired t test was used before and after the treatment in the group. The count data were represented by the number or percentage (%), using the chi square ~2 test, the H test for the grade data, and the Nemenyi test in 22. P0.05 was used as the test. The difference was statistically significant, P0.05 was not statistically significant. Results 1. comprehensive efficacy evaluation: the total effective rate of Chinese and Western medicine combined group was 89.3%, the total effective rate of Western medicine group was 46.7%, the total effective rate of the Chinese medicine group was compared with the 48.3%. group, the total effective difference between the western medicine group and the Chinese medicine group was not statistically significant (P0.05). The total effective rate of the combination group of Chinese and Western medicine group was better than that of the middle and Western medicine group. The difference had statistical significance (P0.05).2. liver function index changes: after 4 weeks treatment, the liver function indexes (TBIL, alt, AST, TBA, gamma -gt, ALP) after treatment were significantly improved after treatment, and the difference was statistically significant compared with that before treatment (P0.05). There was no statistical difference between the western medicine group and the traditional Chinese medicine group after the course of treatment. Significance (P0.05), while the liver function index of the Chinese and Western medicine group was significantly lower than that of the western medicine group and the traditional Chinese medicine group, and the difference had statistical significance (P0.05) the symptom score of each single Chinese medicine in.3.: the three groups improved after the treatment, and the difference was statistically significant compared with that before the treatment (P0.05). The comparison of the results of the three groups after the treatment, the combination of Chinese and Western medicine. The symptoms score of the group was lower than that of the traditional Chinese medicine group and the western medicine group (P0.05). The symptoms score of the Chinese medicine group and the western medicine group were compared with the western medicine group. The symptoms score of the body and eye yellow dye, the nausea and yellow red, the nausea and vomiting, the fatigue and fatigue were not different (P0.05), but the abdominal distension and stuffiness, the rib pain, the loss of appetite, and the symptom score of the dry mouth were lower in the Chinese medicine group. And the difference was statistically significant (P0.05) before and after.4. treatment: the total score of TCM syndrome was not statistically significant before and after treatment (P0.05). The scores of the three groups were decreased and the difference was statistically significant (P0.05) after treatment (P0.05). The total score of the syndrome in the combination group of Chinese and Western medicine was significantly lower than that of the traditional Chinese medicine group and the western medicine group. Statistical significance (P0.05), the total score of TCM syndrome was lower than that of the western medicine group and the difference was statistically significant (P0.05).5. safety observation: the life signs of the patients in each group were stable, the three major routine of blood urine, kidney function, coagulation function, electrolyte, liver and bile color ultrasound were not obvious changes, 2 cases had mild diarrhea, after withdrawal, other diseases, other diseases. No obvious adverse reactions and side effects were found in all cases. Conclusion: yhuang Gan Ning Mixture Combined with thinking MATTEL in the treatment of liver cirrhosis jaundice (damp heat stasis type) has achieved good results in retreating yellow, promoting liver function recovery and improving TCM syndrome, and the curative effect is obviously better than single use of Western medicine and single use of traditional Chinese medicine. Thailand has a synergistic effect and has high safety.

【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R512.62;R575.2

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