本文關(guān)鍵詞： 原發(fā)性膽汁性肝硬化 引火補(bǔ)土法 熊去氧膽酸膠囊 療效觀察　出處：《湖北中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:觀察引火補(bǔ)土法聯(lián)合熊去氧膽酸膠囊治療原發(fā)性膽汁性肝硬化(PBC)的臨床療效及安全性,探討本病中醫(yī)證的實(shí)質(zhì),揭示引火補(bǔ)土法作用機(jī)理,為臨床治療PBC提供新的治療思路和方法。方法:采用隨機(jī)對(duì)照臨床試驗(yàn)方法,將2013年5月至2015年10月湖北省中醫(yī)院肝病門診及住院部就診的原發(fā)性膽汁性肝硬化(中醫(yī)證型屬“肝腎不足,火不溫土型”)患者隨機(jī)分為兩組:引火補(bǔ)土法聯(lián)合UDCA治療組、UDCA對(duì)照組,納入統(tǒng)計(jì)分析的共50例。觀察治療1、3個(gè)月后兩組肝功能指標(biāo)、中醫(yī)證候總積分、中醫(yī)證候量化評(píng)分的變化,比較兩組臨床療效。結(jié)果:1總體療效比較:治療1個(gè)月后,治療組與對(duì)照組總有效率分別為57.69%、50.00%,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);治療3個(gè)月后,治療組總有效率為80.77%,對(duì)照組總有效率為62.50%,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2中醫(yī)證候總積分比較:治療1個(gè)月后,治療組患者中醫(yī)證候總積分(7.12±2.11)較治療前(10.32±5.56)有明顯改善,差異有統(tǒng)計(jì)學(xué)意義(P0.05),而對(duì)照組治療前后中醫(yī)證候總積分(治療前為11.34±6.01、治療后為10.23±3.13)差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。治療3個(gè)月后,治療組中醫(yī)證候總積分為2.16±0.11,較治療前明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05);對(duì)照組治療后中醫(yī)證候總積分為5.42±1.18,較治療前明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05);治療后中醫(yī)證候總積分治療組較對(duì)照組明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3中醫(yī)證候量化評(píng)分比較:治療1個(gè)月后,治療組患者脅肋隱痛、腰膝酸軟、黃疸、咽干口燥、骨蒸潮熱、失眠多夢(mèng)、下肢水腫、大便泄瀉等中醫(yī)證候量化評(píng)分較治療前明顯下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05),而對(duì)照組僅脅肋隱痛、黃疸、下肢水腫等中醫(yī)證候量化評(píng)分較治療前下降明顯,差異有統(tǒng)計(jì)學(xué)意義(P0.05),且治療組患者腰膝酸軟、黃疸、咽干口燥、骨蒸潮熱、失眠多夢(mèng)、下肢水腫、大便泄瀉等中醫(yī)證候量化評(píng)分較對(duì)照組明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05);治療3個(gè)月后,治療組各中醫(yī)證候量化較治療前均有明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05),而對(duì)照組仍有骨蒸潮熱、口腔潰瘍、失眠多夢(mèng)、大便泄瀉等中醫(yī)證候量化評(píng)分較治療前無(wú)明顯降低,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),且治療組患者骨蒸潮熱、失眠多夢(mèng)、口腔潰瘍、大便泄瀉等中醫(yī)證候量化評(píng)分較對(duì)照組明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4肝功能指標(biāo)比較:治療1、3個(gè)月后,兩組肝功能指標(biāo)較治療前均明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。治療1個(gè)月后,治療組ALT、AST等肝功能指標(biāo)較對(duì)照組明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05),余肝功能指標(biāo)兩組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。治療3個(gè)月后,治療組ALP、GGT、TBi L等肝功能指標(biāo)較對(duì)照組下降明顯,差異有統(tǒng)計(jì)學(xué)意義(P0.05),余肝功能指標(biāo)兩組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。5安全性觀察:治療組和對(duì)照組治療前后血液分析、尿液分析、糞便常規(guī)、腎功能、心電圖等觀測(cè)指標(biāo)均無(wú)異常變化。結(jié)論:引火補(bǔ)土法聯(lián)合UDCA治療PBC較單純西藥治療具有更好的療效,在消除或緩解臨床癥狀、改善肝功能方面表現(xiàn)出明顯的優(yōu)勢(shì)�！案文I不足,火不溫土”是PBC的重要病機(jī),采用引火補(bǔ)土法指導(dǎo)PBC的臨床治療安全有效,值得臨床進(jìn)一步研究。
[Abstract]:Objective: To observe the fire up indigenous Ursodeoxycholic Acid Capules for the treatment of primary biliary cirrhosis (PBC) clinical efficacy and safety of the essence of TCM syndrome, reveal the mechanism of indigenous fire up, with new ideas and methods for clinical treatment of PBC. Methods: using the method of randomized controlled clinical trials, May 2013 to October 2015 Hubei Provincial Traditional Chinese Medical Hospital outpatient and inpatient treatment of primary biliary cirrhosis (TCM "liver and kidney deficiency, fire temperature and soil type) were randomly divided into two groups: combined treatment of UDCA kindling up indigenous group, UDCA control group, included in the statistical analysis of 50 cases. Observation on the treatment of 1,3 two months after the group index of liver function, total score of TCM syndrome score, TCM syndrome changes, clinical efficacy of two groups were compared. Results: compared with the 1 overall curative effect: after 1 months of treatment, the treatment group and control group total efficiency Were 57.69%, 50%, the difference was not statistically significant (P0.05); after 3 months of treatment, the total efficiency of treatment group was 80.77%, control group total effective rate was 62.50%, the difference was statistically significant (P0.05).2 TCM syndrome total score: 1 months after treatment, the patients in the treatment group TCM syndrome the total score (7.12 + 2.11) than before treatment (10.32 + 5.56) was significantly improved, the difference was statistically significant (P0.05), and the control group before and after treatment of TCM syndrome total score (11.34 + 6.01 before treatment, after treatment was 10.23 + 3.13) there was no statistically significant difference (P0.05) for 3 months. After the treatment of TCM syndrome total score was 2.16 + 0.11, was significantly lower than that before treatment, the difference was statistically significant (P0.05); the control group after treatment of TCM syndrome total score was 5.42 + 1.18, was significantly lower than that before treatment, the difference was statistically significant (P0.05); after treatment, the total score of TCM syndrome the treatment group than the control group significantly reduced Low, the difference was statistically significant (P0.05).3 TCM Syndrome Scale: after 1 months of treatment, patients treated with flank pain, Yaoxisuanruan, jaundice, dry throat, osteopyrexia hot flashes, insomnia, lower extremity edema, diarrhea, TCM syndrome score than before treatment decreased significantly, there are statistically significant difference (P0.05), while the control group only flank pain, jaundice, edema of lower extremity and TCM syndrome score decreased significantly, the difference was statistically significant (P0.05), and the patients in the treatment group Yaoxisuanruan, jaundice, dry throat, osteopyrexia hot flashes, insomnia, lower extremity edema, diarrhea etc. TCM syndrome score significantly lower than the control group, the difference was statistically significant (P0.05); after 3 months of treatment, the treatment group TCM syndrome were lower than before the treatment, the difference was statistically significant (P0.05), while the control group still has the deficiency of hot flushes, oral ulcer Ulcers, insomnia, diarrhea, TCM syndrome score than before treatment significantly decreased, the difference was not statistically significant (P0.05), and the treatment group of patients with deficiency of hot flashes, insomnia, oral ulcers, diarrhea, TCM syndrome score significantly lower than the control group, the difference was statistically significant (P0.05.4) liver function index: 1,3 months after treatment, two groups of indexes of liver function were significantly lower than before treatment, the difference was statistically significant (P0.05). After 1 months of treatment, the treatment group ALT, AST and other indexes of liver function was significantly lower than the control group, the difference was statistically significant (P0.05), no significant residual liver the function index of the difference between the two groups (P0.05). After 3 months of treatment, the treatment group ALP, GGT, TBi, L and other indexes of liver function decreased significantly than the control group, the difference was statistically significant (P0.05), no significant residual liver function index difference between the two groups (P0.05).5 security Observation: treatment group and control group before and after treatment, blood analysis, urine analysis, stool routine, renal function, no abnormal changes in ECG observation index. Conclusion: the combination therapy of UDCA and PBC flash fill method compared with the pure western medicine treatment has better curative effect, to eliminate or alleviate symptoms, improve liver function showed obvious advantages "liver and kidney deficiency, fire and soil temperature is the important pathogenesis of PBC, using fire fill guide PBC treatment method is safe and effective, and is worthy of further study.

【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】：2016
【分類號(hào)】：R259

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