本文選題：酒精性肝病　切入點(diǎn)：肝膽濕熱　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：盡管目前現(xiàn)代醫(yī)學(xué)對酒精性肝病的病因、發(fā)病機(jī)理、診斷、治療等方面都已經(jīng)取得諸多進(jìn)展,但臨床如何最大限度的控制酒精性肝病的發(fā)生率?如何截斷或扭轉(zhuǎn)酒精性肝病病情的不斷進(jìn)展?如何防控酒精性肝硬化各種嚴(yán)重并發(fā)癥進(jìn)而延長其生存期?甚至如何采用更為低廉或方便的藥物治療手段等等,都是當(dāng)今酒精肝病研究領(lǐng)域值得關(guān)注的重點(diǎn)問題。前期,我們依據(jù)中醫(yī)理論,結(jié)合臨床觀察發(fā)現(xiàn)各型酒精性肝病以肝膽濕熱為基本病機(jī)的臨床特點(diǎn),研制出"自擬清肝方"作為院內(nèi)制劑常規(guī)治療各型酒精性肝病,取得良好的臨床效果,本課題對該方進(jìn)行初步臨床療效評價。目的:觀察自擬清肝方治療肝膽濕熱型酒精性肝病患者的臨床療效。方法:全部患者均來自徐州市傳染病醫(yī)院肝病科門診,并符合納入標(biāo)準(zhǔn)的80例的肝膽濕熱型酒精性肝病患者,采用隨機(jī)對照分組法,分成治療組和對照組,各40例。治療組采用自擬清肝方(茵陳25g、梔子10g、葛根15g,枳i子15g、虎杖10g、金錢草15g、郁金10g、茯苓10g、澤瀉10g、柴胡6g)煎劑200ml/次,日2次口服,日服一劑。對照組采用多烯磷脂酰膽堿膠囊,每次456mg,每日3次口服,兩組療程均為4周。觀察指標(biāo):兩組治療前后中醫(yī)癥候積分的變化,檢測并記錄肝功能、消化系超聲的變化。結(jié)果:(1)治療組顯效率為92.5%,總有效率為97.5%;對照組顯效率為87.5%,總有效率為95%。兩組間總療效差異無統(tǒng)計學(xué)意義,P0.05。(2)比較治療組治療前后、對照組治療前后的指標(biāo)變化情況,兩組病例的ALT、AST、TBIL、GGT在水平方向上進(jìn)行比較,P0.05,有統(tǒng)計學(xué)差異。所以,治療組在改善肝功能方面要優(yōu)于對照組。(3)在改善脅肋脹痛、身目發(fā)黃、尿黃等證候積分方面,治療組明顯優(yōu)于對照組,兩組比較有統(tǒng)計學(xué)意義(P0.05);在惡心、嘔吐、厭油、大便秘結(jié)等證候積分方面,無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:(1)理論研究初步揭示了酒精性肝病不同階段的病機(jī)特點(diǎn),并提出肝膽濕熱是酒精肝病的基本病理因素,清化肝膽濕熱法是基本治法。(2)自擬清肝方治療酒精性肝病的總體療效優(yōu)于多烯磷脂酰膠囊對照組;(3)自擬清肝方能夠有效減輕酒精性肝病患者的脅肋脹痛、身目發(fā)黃、尿黃等主要癥狀;(4)自擬清肝方能改善酒精性肝病肝功能,包括有效降低血清總膽紅素、谷丙轉(zhuǎn)氨酶、谷草轉(zhuǎn)氨酶、谷氨酰轉(zhuǎn)肽酶等水平;(5)自擬清肝方對于改善酒精性肝病患者肝臟超聲腫脹及肝損傷的征象也有一定作用;(6)自擬清肝方在治療過程中無明顯不良反應(yīng)的發(fā)生。
[Abstract]:Although many advances have been made in the etiology, pathogenesis, diagnosis and treatment of alcoholic liver disease in modern medicine, how to control the incidence of alcoholic liver disease in clinic?How to cut off or reverse the progress of alcoholic liver disease?How to prevent and control various serious complications of alcoholic cirrhosis and prolong their survival?Even how to use cheaper or more convenient drug treatment is a key issue in the research field of alcoholic liver disease.In the early stage, according to the theory of traditional Chinese medicine and clinical observation, we found that various types of alcoholic liver diseases were characterized by dampness and heat of liver and gallbladder as the basic pathogenesis, and we developed "self-made Qinggan recipe" as a routine treatment for various types of alcoholic liver diseases.Good clinical effect has been obtained.Objective: to observe the clinical effect of Qinggan prescription in treating alcoholic liver disease of damp-heat type of liver and gallbladder.Methods: all the patients were from the Department of Hepatology, Xuzhou Infectious Disease Hospital, and 80 patients with alcoholic liver disease of damp-heat type of liver and gallbladder were divided into treatment group and control group with 40 cases each.The treatment group was treated with 200ml/ decoction (Yinchen 25g, Gardenia 10g, Pueraria lobata 15g, Trifoliate trifoliata 15g, Polygonum cuspidatum 10g, Poria cocos 10g, Radix Alismatis 10g, Chaihu 6g).The control group was treated with polyenylphosphatidylcholine capsule, 456mg / time, 3 times a day. The course of treatment in both groups was 4 weeks.Observation measures: changes of TCM symptom score, liver function and digestive system ultrasonic changes were detected and recorded before and after treatment in the two groups.Results the effective rate of the treatment group was 92.5 and the total effective rate was 97.5.The control group was 87.5and the total effective rate was 950.Results the effective rate of the treatment group was 92.5 and the total effective rate was 97.5.There was no significant difference in the total curative effect between the two groups (P 0.05). The changes of the indexes before and after treatment in the treatment group and in the control group were compared. The two groups were compared in the horizontal direction between the two groups (P 0.05).Therefore, the treatment group is superior to the control group in improving liver function.) in terms of improving symptoms such as pain in the ribs, yellowness of the body and eyes, and yellowish urine, the treatment group is obviously superior to the control group. The two groups have statistical significance in improving liver function. In terms of nausea, vomiting, and oil weariness, the treatment group is obviously superior to the control group.Big constipation knot and other syndromes integral, there is no statistical significance (P 0.05).Conclusion the theoretical study reveals the pathogenesis of alcoholic liver disease at different stages, and points out that dampness and heat of liver and gallbladder are the basic pathological factors of alcoholic liver disease.Qinghua liver-gallbladder damp-heat method is the basic treatment method. 2) the overall curative effect of self-made Qinggan recipe for alcoholic liver disease is better than that for the control group of polyenylphosphatidyl capsule (Phosphatidyl capsule). The self-made Qinggan recipe can effectively alleviate the pain of flank swelling and yellowness of body and eyes in patients with alcoholic liver disease.Qinggan prescription can improve liver function of alcoholic liver disease, including reducing serum total bilirubin, alanine aminotransferase, alanine aminotransferase, and alanine aminotransferase.Glutamyl transpeptidase et al.) the self-made Qinggan prescription has a certain effect on improving the signs of liver ultrasonic swelling and liver injury in patients with alcoholic liver disease. 6) the self-formulated Qinggan recipe has no obvious adverse reactions during the treatment.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R259

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