本文選題：HBV相關(guān) + 疏肝健脾��； 參考：《山東中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：目的:以中藥疏肝健脾、活血解毒法聯(lián)合飲食調(diào)節(jié),觀察其改善HBV相關(guān)慢性肝病代謝異常的臨床療效,探討HBV相關(guān)慢性肝病患者代謝異常營養(yǎng)需求,為HBV相關(guān)慢性肝病患者提供準(zhǔn)確的飲食指導(dǎo)。方法:本課題將符合納入標(biāo)準(zhǔn)的180例分成三組,劃分為對照組、中藥組和中藥聯(lián)合飲食調(diào)節(jié)組,進(jìn)行臨床資料采集,全部納入患者均予常規(guī)內(nèi)科治療,對照組予常規(guī)內(nèi)科治療和常規(guī)飲食,中藥組予疏肝健脾、活血解毒法中藥復(fù)方制劑,中藥聯(lián)合飲食調(diào)節(jié)組組予疏肝健脾、活血解毒法中藥復(fù)方制劑聯(lián)合飲食調(diào)節(jié)。對所有患者進(jìn)行連續(xù)4個(gè)周次的各項(xiàng)數(shù)據(jù)的采集,通過系統(tǒng)的臨床資料包括人體測量學(xué)、血清學(xué)和生活質(zhì)量等方面的采集,總結(jié)出中藥疏肝健脾、活血解毒法聯(lián)合飲食調(diào)節(jié)HBV相關(guān)慢性肝病營養(yǎng)代謝異常的臨床療效,以完成三組患者營養(yǎng)代謝異常的臨床研究。結(jié)果:疏肝健脾、活血解毒法聯(lián)合飲食調(diào)節(jié)有效的改善了HBV相關(guān)慢性肝病營養(yǎng)代謝異常。從營養(yǎng)代謝指標(biāo)來看,在人體測量學(xué)方面表現(xiàn)為消瘦、低重、肌蛋白消耗的患者,對照組患者出現(xiàn)加重的情況,而中藥組和中藥聯(lián)合飲食調(diào)節(jié)組消瘦、低重、肌蛋白消耗患者逐漸得到緩解,并且中藥聯(lián)合飲食調(diào)節(jié)組的療效要高于中藥組;對脂代謝異�；颊�,從統(tǒng)計(jì)結(jié)果可以看出對照組患者脂代謝異常未得到改善,而是加重,中藥組和中藥聯(lián)合飲食調(diào)節(jié)組改善血脂效果明顯,并且中藥聯(lián)合飲食調(diào)節(jié)組的療效要高于中藥組。在糖代謝方面,從統(tǒng)計(jì)結(jié)果可以看到,對照組是呈現(xiàn)加重趨勢的,中藥組的血糖均數(shù)水平呈現(xiàn)下降趨勢,在第四周時(shí)血糖均值接近正常,中藥聯(lián)合飲食調(diào)節(jié)組的血糖均數(shù)水平下降趨勢更明顯,在第四周時(shí)血糖均值呈現(xiàn)為正常。慢性肝病量表積分方面,通過4周的觀察,對照組的得分呈現(xiàn)升高的趨勢,對照組和中藥聯(lián)合飲食調(diào)節(jié)組均表現(xiàn)為降低趨勢,并且中藥聯(lián)合飲食調(diào)節(jié)組降低趨勢更明顯;在疲勞自評量表方面,對照組的疲勞自評量表得分逐漸升高,疲勞狀況加重,在中藥組和中藥聯(lián)合飲食調(diào)節(jié)組疲勞狀態(tài)得到減輕,中藥聯(lián)合飲食調(diào)節(jié)組更明顯;在中醫(yī)癥狀積分方面,對照組四周的積分逐漸升高,中藥組合中藥聯(lián)合飲食調(diào)節(jié)組逐漸降低。從肝臟炎性指標(biāo)顯示看,對照組ALT、AST、ALP、GGT、TB治療后較治療前升高,特別是第四周升至最高;中藥組和中藥聯(lián)合飲食調(diào)節(jié)組ALT、AST、ALP、GGT、TB治療后均有不同程度的降低,并且中藥聯(lián)合飲食調(diào)節(jié)組降低更顯著。從肝臟合成指標(biāo)可以看出,HBV相關(guān)慢性肝病合并蛋白代謝異常者,主要表現(xiàn)為蛋白質(zhì)的合成功能下降,包括各種血清蛋白,諸如白蛋白、前白蛋白、視黃醇結(jié)合蛋白,對照組中肝臟合成功能指標(biāo)下降明顯,第四周時(shí)各種蛋白指標(biāo)顯著低中藥組和中藥聯(lián)合飲食調(diào)節(jié)組;中藥組和中藥聯(lián)合飲食調(diào)節(jié)組各項(xiàng)肝功能合成指標(biāo)均升高,并且在第四周時(shí)中藥聯(lián)合飲食調(diào)節(jié)組顯著高于中藥組。結(jié)論:疏肝健脾、活血解毒法中藥復(fù)方聯(lián)合飲食調(diào)節(jié)臨床療效顯著,有效的改善HBV相關(guān)慢性肝病患者三大營養(yǎng)物質(zhì)代謝,提高肝臟調(diào)節(jié)糖代謝紊亂、脂質(zhì)代謝異常的能力,促進(jìn)肝臟的合成功能,修復(fù)肝臟炎癥,改善臨床癥狀體征和血清學(xué)指標(biāo),提高生活質(zhì)量。
[Abstract]:Objective: To observe the clinical curative effect of improving the metabolic abnormality of HBV related chronic liver diseases with the combination of traditional Chinese medicine and liver invigorating the spleen and activating blood and detoxifying method, to explore the metabolic abnormal nutritional requirements of the patients with HBV related chronic liver disease, and to provide accurate dietary guidance for the patients with HBV related chronic liver disease. Methods: the subject will be divided into 180 cases in accordance with the standard of three. Group, divided into control group, traditional Chinese medicine group and Chinese medicine combined diet control group, all the patients were collected, all the patients were given conventional medical treatment, the control group was given conventional medical treatment and routine diet, the Chinese medicine group was given the liver and spleen, the method of activating blood and detoxifying the Chinese medicine compound preparation, and the combination diet regulation group of the Chinese medicine group was given to the liver and spleen strengthening and the method of activating blood and detoxifying the spleen. The data of all the patients were collected for 4 consecutive weeks. Through the collection of systematic clinical data including anthropometry, serology and quality of life, we summed up the presence of traditional Chinese medicine to regulate the liver and invigorate the spleen, and to regulate the nutrition and metabolism of HBV related chronic liver diseases with the combined diet of activating blood and detoxifying. The clinical study of three groups of patients with abnormality of nutritional metabolism was completed. Results: the abnormal metabolism of HBV related chronic liver diseases was effectively improved by regulating the liver and invigorating the spleen, activating blood and detoxifying methods combined with dietary regulation. From the point of the index of nutrition metabolism, the patients with weight loss, low weight, muscle protein consumption and the control group appeared in the anthropometry. Aggravation of the situation, but the Chinese medicine group and the combination of traditional Chinese medicine diet control group of thin, low weight, muscle protein consumption patients gradually relieved, and the effect of Chinese medicine combined diet regulation group is higher than the traditional Chinese medicine group; for patients with abnormal lipid metabolism, it can be seen from the statistical results that the abnormal lipid metabolism in the control group is not improved, but it is aggravated, Chinese medicine group and the middle of the Chinese medicine group. The effect of medicine combined with diet regulation group was obvious, and the effect of Chinese medicine combined diet regulation group was higher than that of the traditional Chinese medicine group. In the aspect of sugar metabolism, it can be seen from the statistical results that the control group showed the tendency of aggravation, the level of blood sugar average of the Chinese medicine group showed a downward trend, the mean blood sugar was close to normal in the fourth week, and the combined diet of Chinese medicine was used. The decreasing trend of blood glucose level in the control group was more obvious. The mean blood sugar was normal at the fourth week. The score of the chronic liver disease scale was higher than that of the control group and the combination diet control group of the control group and the traditional Chinese medicine group by 4 weeks of observation. Obviously, the fatigue self rating scale of the control group increased gradually, the fatigue condition was aggravated, the fatigue state of the traditional Chinese medicine group and the Chinese traditional Chinese medicine combined diet control group were relieved, and the combination of traditional Chinese medicine diet regulation group was more obvious. The diet control group gradually decreased. From the liver inflammatory index, the control group ALT, AST, ALP, GGT, TB were higher than before the treatment, especially fourth weeks to the highest. The traditional Chinese medicine group and the combination of traditional Chinese medicine diet control group ALT, AST, ALP, GGT, TB were reduced to a different degree after treatment, and the combination of traditional Chinese medicine diet control group decreased more significantly. From liver combination. It can be seen that the HBV related chronic liver disease associated with abnormal protein metabolism is mainly manifested in the decrease of protein synthesis function, including all kinds of serum albumin, such as albumin, prealbumin, retinol binding protein, and the decrease of liver synthetic function in the control group, and the various protein indexes in the fourth week are significantly lower in Chinese medicine and traditional Chinese medicine. The combination diet regulation group, Chinese medicine group and the combination of traditional Chinese medicine diet regulation group increased the liver function synthesis index, and in the fourth week, the Chinese medicine combined diet regulation group was significantly higher than the traditional Chinese medicine group. Conclusion: the clinical effect of regulating the liver and invigorating the spleen, activating blood and detoxifying the traditional Chinese medicine compound diet is significant, effectively improving the HBV related chronic liver disease patients three The metabolism of large nutrients can improve the liver regulation of glucose metabolism disorder, the ability of abnormal lipid metabolism, promote liver synthesis, repair liver inflammation, improve clinical symptoms, signs and serological indexes, and improve the quality of life.

【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R259

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 占國清;李芳;譚華炳;;終末期肝病患者的營養(yǎng)支持[J];湖北醫(yī)藥學(xué)院學(xué)報(bào);2014年01期

2 金愛華;楊華升;;慢性肝病營養(yǎng)評估研究進(jìn)展[J];中西醫(yī)結(jié)合肝病雜志;2013年05期

3 蔡頌文;李偉;張?jiān)氯A;張玉蘭;沈穎;陸婷;韓婷;;營養(yǎng)風(fēng)險(xiǎn)篩查NRS2002的臨床應(yīng)用觀察[J];氨基酸和生物資源;2013年01期

4 陶英;廖琴;;鼓脹病(肝硬化腹水)的中醫(yī)辨證施護(hù)[J];內(nèi)蒙古中醫(yī)藥;2012年16期

5 齊玉梅;;肝功能障礙營養(yǎng)治療[J];中國實(shí)用內(nèi)科雜志;2011年03期

6 吳玉輝;;燕麥的功效及對小麥粉灰分的影響[J];糧食加工;2011年01期

7 張變萍;;肝硬化病人的飲食護(hù)理[J];全科護(hù)理;2008年28期

8 李勇;;乙型病毒性肝炎中醫(yī)研究思路與方法[J];山東中醫(yī)雜志;2008年02期

9 李勇;;病毒性肝炎的中醫(yī)思維理念與思考[J];世界中醫(yī)藥;2008年01期

10 于淑清;孟慶華;李玉賢;馮巖梅;倪明美;王金環(huán);王欣;;慢性肝炎和肝炎后肝硬化患者能量代謝的研究[J];中華全科醫(yī)師雜志;2007年10期

，

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