本文選題：乙型肝炎 + 肝硬化　； 參考：《大連醫(yī)科大學》2014年碩士論文

【摘要】：目的:乙肝后肝硬化是由于乙肝病毒引起的肝細胞變性壞死,肝組織彌漫性纖維化,以肝細胞增生形成再生結(jié)節(jié),最后形成假小葉為病理特征的慢性肝病。腹水是肝硬化最突出的臨床表現(xiàn),為門靜脈高壓所致,75%以上的失代償期患者有腹水。頑固性腹水是終末期肝硬化的常見并發(fā)癥,不但嚴重影響患者的生活質(zhì)量,而且可以導(dǎo)致感染、上消化道出血、肝昏迷、腎功能衰竭等嚴重的并發(fā)癥,病死率高,目前西醫(yī)尚無有效的方法改善臨床癥狀,控制疾病的進展及復(fù)發(fā)。本研究以中醫(yī)理論為指導(dǎo),應(yīng)用以解氏軟肝利水方為主的中西醫(yī)結(jié)合方法治療乙肝后肝硬化頑固性腹水,觀察及評價臨床療效,探討可能的機制,為乙肝后肝硬化頑固性腹水的治療提供部分理論及實踐依據(jù)。方法:本研究所有病例為大連市第六人民醫(yī)院2013年1月~2014年9月住院的乙肝后肝硬化頑固性腹水患者,按照診斷標準、納入標準及排除標準選取患者65例,經(jīng)知情同意,采用隨機對照研究方法,分為對照組30例,治療組35例。對照組及治療組在治療前臨床參數(shù)無統(tǒng)計學差異。對照組采用西藥抗病毒、護肝、利尿、對癥和支持治療,治療組在抗病毒及一般支持治療基礎(chǔ)上加用解氏軟肝利水方,兩組均治療1月,治療結(jié)束后隨診1個月。觀察兩組治療前后的顯效率、有效率、臨床癥狀改善率、復(fù)發(fā)率,觀測兩組治療前后的肝功能指標(谷丙轉(zhuǎn)氨酶、血清總膽紅素、白蛋白)及腹水量(以患者平臥位超聲下測量腹水深度為標準)的變化,觀測兩組治療前后細胞免疫功能變化。各組間比較采用t檢驗及x2檢驗。探討以解氏軟肝利水方為主的中西醫(yī)結(jié)合治療措施是否優(yōu)于單純西醫(yī)治療乙肝后肝硬化頑固性腹水,為臨床治療提供有益的參考。結(jié)果:1病例入選情況:治療組及對照組均無治療終止及死亡病例,無失訪病例,65例病例均按研究方案完成治療及隨訪。2治療組與對照組比較:顯效率68.3%vs 35.5%(P0.05),有效率85.2%vs64.4%(P0.05),臨床癥狀改善率87.2%vs 54.1%(P0.05),復(fù)發(fā)率12.5%vs 33.4%(P0.05)。上述指標差異有統(tǒng)計學意義,均顯示治療組的療效優(yōu)于對照組。3治療組患者肝功能指標顯示:治療組在黃疸消退及白蛋白升高方面療效優(yōu)于對照組,差異有統(tǒng)計學意義(P0.05)。在谷丙轉(zhuǎn)氨酶降低方面兩組差異無統(tǒng)計學意義(P0.05)。4腹水減少指標:治療組在腹水消退的療效優(yōu)于對照組,差異有統(tǒng)計學意義(P0.05)。5細胞免疫功能指標:治療組白介素-2及干擾素水平明顯升高,與于對照組比較,差異有統(tǒng)計學意義(P0.05)。結(jié)論:解氏軟肝利水方治療乙肝后肝硬化頑固性腹水療效優(yōu)于單純西醫(yī)治療。治療組無因中藥發(fā)生不良反應(yīng),明顯改善患者的癥狀和肝功能,縮短住院時間,節(jié)省住院治療費用,減少復(fù)發(fā),近期及遠期療效均肯定,為乙肝后肝硬化頑固性腹水的臨床治療提供更廣闊的思路和有效的方法。
[Abstract]:Objective: hepatitis B cirrhosis is due to liver cell degeneration and necrosis caused by HBV, diffuse fibrosis of liver tissue, the formation of regenerative nodules from hepatocyte proliferation, and chronic liver disease characterized by false lobule. Ascites is the most prominent clinical manifestation of liver cirrhosis, which is caused by portal hypertension, and more than 75% of the decompensated patients have abdomen. Water. Refractory ascites is a common complication of end-stage liver cirrhosis. It not only seriously affects the quality of life of the patients, but also leads to infection, upper gastrointestinal bleeding, liver coma, renal failure and other serious complications and high mortality. At present, there is no effective method to improve the clinical symptoms and control the progress and recurrence of the disease. The theory of traditional Chinese medicine (TCM) was used as the guidance to treat the refractory ascites of liver cirrhosis after hepatitis B with the method of combining Chinese and Western medicine with the decoction of soft liver and Leishui. The clinical effect was observed and evaluated, and the possible mechanism was discussed. Some theory and practice were provided for the treatment of intractable ascites of hepatitis B after hepatitis B. Methods: all cases in this study were sixth in Dalian. In people's Hospital, 65 patients with HBV refractory ascites hospitalized in September ~2014 January 2013 were selected according to the criteria of diagnosis, and the patients were divided into 30 cases in the control group and 35 in the treatment group by informed consent. There was no statistical difference between the control group and the treatment group before the treatment. The group was treated with western medicine antiviral, liver protection, diuresis, symptomatic and supportive treatment. The treatment group was treated with the anti virus and general support treatment on the basis of the combination of the soft liver and Leishui recipe. The two groups were treated in January and the treatment was followed for 1 months. The effective, effective, clinical symptoms, recurrence rate, and the observation of two groups of treatment were observed before and after the treatment of the two groups. The changes in the liver function index (alanine aminotransferase, serum total bilirubin, albumin) and the amount of ascites were observed in the two groups of patients before and after treatment. The changes of cellular immune function before and after treatment were observed. T test and X2 test were used in each group. No better than the simple western medicine treatment of hepatitis B cirrhosis refractory ascites, for clinical treatment to provide useful reference. Results: 1 cases were selected: the treatment group and the control group had no treatment termination and death cases, no lost cases, 65 cases were completed according to the study scheme and compared with the.2 treatment group and the control group: the effective rate of 68.3%vs 35.5% ( P0.05), the effective rate of 85.2%vs64.4% (P0.05), the improvement rate of clinical symptoms was 87.2%vs 54.1% (P0.05), and the recurrence rate was 12.5%vs 33.4% (P0.05). The difference of the above indexes was statistically significant, all showed that the curative effect of the treatment group was better than that of the control group. The therapeutic effect of the treatment group was better than the control group in the treatment group in the jaundice decline and the increase of albumin. The difference was statistically significant (P0.05). There was no significant difference between the two groups in the reduction of alanine transaminase (P0.05).4 ascites reduction index: the curative effect of the treatment group was better than the control group, and the difference was statistically significant (P0.05).5 cell immune function index: the level of interleukin -2 and interferon in the treatment group was significantly increased, compared with the control group. The difference is statistically significant (P0.05). Conclusion: the curative effect of the decoction of "lihi Ligan Lishui" is better than that of the simple western medicine. The treatment group has no adverse reaction, obviously improves the symptoms and liver function, shortens the hospitalization time, saves the cost of hospitalization and reduces the recurrence, the short-term and long-term effect are affirmative, It provides a broader thinking and effective method for the treatment of refractory ascites after hepatitis B cirrhosis.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R512.62;R575.2

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