本文選題：加味苓桂術(shù)甘顆粒 + 非酒精性單純性脂肪肝　； 參考：《廣西中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:觀察加味苓桂術(shù)甘顆粒治療非酒精性單純性脂肪肝中三個常見中醫(yī)證型的臨床療效,從以方測證的角度探討加味苓桂術(shù)甘顆粒與非酒精性單純性脂肪肝不同證型間的證效關(guān)系;進一步闡明中醫(yī)在臨床應(yīng)用中需辨病辨證相結(jié)合以指導(dǎo)組方遣藥。方法:采集符合納入標(biāo)準(zhǔn)的90例非酒精性單純性脂肪肝患者,痰濕內(nèi)阻證、濕熱內(nèi)蘊證及痰瘀互結(jié)證三個證型,每組各30例。各組均予加味苓桂術(shù)甘顆粒,開水沖服,每日一劑,早晚各一次,同時進行相同的基礎(chǔ)治療方案,連續(xù)治療12周。觀察三組治療前后肝/脾CT值、中醫(yī)證侯評分、體重指數(shù)、甘油三酯(TG)、總膽固醇(TC)等相關(guān)指標(biāo),采用SPSS17.0進行統(tǒng)計分析,評價加味苓桂術(shù)甘顆粒治療非酒精性單純性脂肪肝三個證型間證效關(guān)系。結(jié)果:1、臨床綜合療效比較:痰濕內(nèi)阻證、濕熱內(nèi)蘊證及痰瘀互結(jié)證的臨床綜合療效總有效率分別為67.86%、42.86%、78.57%。組間兩兩比較分析,痰瘀互結(jié)證組與濕熱內(nèi)蘊證組及痰濕內(nèi)阻證組比較,差異均具有統(tǒng)計學(xué)意義(P0.01,P0.05),痰濕內(nèi)阻證組與濕熱內(nèi)蘊證組比較,差異亦具有統(tǒng)計學(xué)意義(P0.05)。2、CT比較:(1)CT療效比較:研究中痰濕內(nèi)阻證總有效率為64.27%;濕熱內(nèi)蘊證組總有效率為57.14%;痰瘀互結(jié)證總有效率為82.14%。組間兩兩比較,痰瘀互結(jié)證組與濕熱內(nèi)蘊證組及痰濕內(nèi)阻證組比較,差異具有統(tǒng)計學(xué)意義(P0.01,P0.05),痰濕內(nèi)阻證組與濕熱內(nèi)蘊證組比較,差異不具有統(tǒng)計學(xué)意義(P0.05)。(2)CT比值變化比較:痰瘀互結(jié)證組治療前后組內(nèi)CT比值比較,差異具有顯著性意義(P0.01),痰濕內(nèi)阻證組及濕熱內(nèi)蘊證組CT比值治療前后組內(nèi)比較,差異均有統(tǒng)計學(xué)意義(P0.05);治療后CT比值組間兩兩比較,痰瘀互結(jié)證與痰濕內(nèi)阻證及濕熱內(nèi)蘊證比較,差異均具有顯著性意義(P0.05),而痰濕內(nèi)阻證與濕熱內(nèi)蘊證比較,差異不具有統(tǒng)計學(xué)意義(P0.05)。3、中醫(yī)癥候比較:痰濕內(nèi)阻證、濕熱內(nèi)蘊證及痰瘀互結(jié)證的中醫(yī)癥候總有效率分別為71.43%、53.57%、82.14%。組間兩兩比較分析,痰瘀互結(jié)證組與濕熱內(nèi)蘊證組及痰濕內(nèi)阻證組比較,差異均具有統(tǒng)計學(xué)意義(P0.01,P0.05),痰濕內(nèi)阻證組與濕熱內(nèi)蘊證組比較,差異不具有統(tǒng)計學(xué)意義(P0.05);三組證型組內(nèi)治療前后的癥候積分比較差異均具有統(tǒng)計學(xué)意義(P0.01);治療前后的中醫(yī)癥候積分差值組間比較,痰瘀互結(jié)證與痰濕內(nèi)阻證及濕熱內(nèi)蘊證比較,差異均具有非常顯著性意義(P0.01),痰濕內(nèi)阻證與濕熱內(nèi)蘊證比較,差異不具有統(tǒng)計學(xué)意義(P0.05)。4、血脂(TC、TG)比較:痰濕內(nèi)阻證、濕熱內(nèi)蘊證及痰瘀互結(jié)證總有效率分別為67.88%、60.71%、85.71%,組間兩兩比較,痰瘀互結(jié)證組與濕熱內(nèi)蘊證組及痰濕內(nèi)阻證組比較,差異均具有統(tǒng)計學(xué)意義(P0.01,P0.05),痰濕內(nèi)阻證組與濕熱內(nèi)蘊證組療效相當(dāng)(P0.05)。三個證型血脂指標(biāo)組內(nèi)治療前后比較,差異均具有統(tǒng)計學(xué)意義(P0.01,P0.05)。5、體重指數(shù)比較:三組證型的體重指數(shù)治療前后比較,差異具有非常顯著性意義(P0.01)。6、安全性檢測:三個證型治療前后進行安全性指標(biāo)檢測,均未發(fā)現(xiàn)異常;三組患者未發(fā)現(xiàn)不良事件和不良反應(yīng)。結(jié)論:1、加味苓桂術(shù)甘顆粒治療非酒精性單純性脂肪肝具有確切的臨床療效,可明顯改善患者的臨床癥狀,降低血脂及體重指數(shù),改善病情程度,延緩疾病進展。2、加味苓桂術(shù)甘顆粒對非酒精性單純性脂肪肝中痰濕內(nèi)阻證、濕熱內(nèi)蘊證及痰瘀互結(jié)證均有明顯的臨床療效,以痰瘀互結(jié)證療效最佳。3、加味苓桂術(shù)甘顆粒治療非酒精性單純性脂肪肝痰濕內(nèi)阻證、濕熱內(nèi)蘊證及痰瘀互結(jié)證患者安全,未發(fā)現(xiàn)藥物不良反應(yīng)。
[Abstract]:Objective: To observe the clinical efficacy of Jiawei Ling Gump granule in the treatment of three common TCM Syndromes of nonalcoholic fatty liver, and to explore the relationship between the different syndromes of different syndromes of Gump granule and nonalcoholic fatty liver, and further clarify the combination of syndrome differentiation and syndrome differentiation in clinical application. Methods: 90 cases of non alcoholic simple fatty liver, phlegm dampness syndrome, damp heat syndrome, phlegm and stasis syndrome were collected and three syndrome types were collected in each group. Each group was given 30 cases in each group. All groups were given Jiawei Luli Gump granules, boiled water, one dose a day, once a day, and the same basic treatment scheme at the same time, and the same basic treatment scheme was carried out simultaneously. After 12 weeks of treatment, the liver / spleen CT value, TCM syndrome score, body mass index, triglyceride (TG), total cholesterol (TC) and other related indexes were observed before and after treatment, and SPSS17.0 was used for statistical analysis to evaluate the relationship between three syndromes of nonalcoholic simple fatty liver with Gump granule in Jiawei Ling Guangxi operation. Results: 1, the clinical comprehensive curative effect was compared: sputum The total effective rate of clinical comprehensive efficacy of damp heat syndrome, damp heat syndrome and phlegm and blood stasis syndrome was 67.86%, 42.86%, 22 comparison between group 78.57%., the difference of phlegm stasis syndrome group and damp heat syndrome group and phlegm damp internal resistance syndrome group, the difference was statistically significant (P0.01, P0.05), and the difference between the phlegm damp internal resistance syndrome group and the damp heat syndrome group was the difference. Also had statistical significance (P0.05).2, CT comparison: (1) CT curative effect comparison: the total effective rate of phlegm dampness syndrome was 64.27%, the total effective rate of damp heat syndrome group was 57.14%, the total effective rate of phlegm and blood stasis syndrome was 22 in 82.14%. group, and the difference between phlegm and blood stasis syndrome group and damp heat internal syndrome group and phlegm damp internal resistance syndrome group was statistically significant (P 0.01, P0.05), compared with the damp heat syndrome group, the difference was not statistically significant (P0.05). (2) the comparison of the ratio of CT: the difference of the ratio of CT in the group of phlegm and stasis syndrome group before and after treatment was significant (P0.01). The difference was statistically significant between the group of phlegm damp internal resistance and the CT ratio in the damp heat syndrome group before and after the treatment. Significance (P0.05), after the treatment of CT ratio between the 22 groups, phlegm stasis syndrome and phlegm damp internal resistance syndrome and damp heat syndrome, the difference has significant significance (P0.05), but the difference of phlegm damp internal resistance and damp heat syndrome is not statistically significant (P0.05).3, the syndrome of TCM syndrome: phlegm damp internal resistance syndrome, damp heat internal syndrome and phlegm stasis syndrome The total effective rate of TCM syndrome was 71.43%, 53.57%, 22 comparison between group 82.14%., the difference of phlegm and blood stasis syndrome group and damp heat syndrome group and phlegm damp internal resistance syndrome group, the difference was statistically significant (P0.01, P0.05), and the difference of phlegm damp internal resistance syndrome group and damp heat syndrome group was not statistically significant (P0.05); the treatment group was treated with the internal treatment in the group of syndrome types. The difference of syndrome scores before and after treatment was statistically significant (P0.01); before and after treatment, the difference of TCM syndrome score difference between groups, phlegm stasis syndrome and phlegm damp internal resistance syndrome and damp heat syndrome were significantly different (P0.01), and the difference between phlegm damp internal resistance syndrome and damp heat syndrome was not statistically significant (P0.05) .4, blood lipid (TC, TG) comparison: the total effective rate of phlegm damp internal resistance syndrome, damp heat internal syndrome and phlegm stasis syndrome was 67.88%, 60.71%, 85.71% respectively, and 22 compared with the group of damp heat internal syndrome and phlegm damp internal resistance syndrome group (P0.01, P0.05), and the curative effect of phlegm damp internal resistance syndrome group and damp heat syndrome group was equivalent (P0. 05). Compared before and after treatment, the difference was statistically significant (P0.01, P0.05).5, and the body mass index (BMI) was compared before and after treatment. The difference between the three groups was very significant (P0.01).6, and the safety was detected before and after the treatment of three syndrome types; three The group patients had no adverse events and adverse reactions. Conclusions: 1, Jiawei Luli Gump granule has definite clinical efficacy in the treatment of nonalcoholic fatty liver. It can obviously improve the clinical symptoms, reduce the blood lipid and body mass index, improve the degree of the disease, delay the.2 of the disease, and add the Gump granule to nonalcoholic simple fat. The syndrome of phlegm damp internal resistance in the fatty liver, damp heat internal syndrome and phlegm and stasis syndrome have obvious clinical curative effect. The best.3 for the syndrome of phlegm and blood stasis syndrome, the treatment of non alcoholic simple fatty liver phlegm dampness syndrome, damp heat syndrome and phlegm stasis syndrome were safe and no adverse drug reaction was found.

【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259

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