本文選題：加味胃苓湯 + 中醫(yī)藥��； 參考：《湖北中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：目的:肝硬化腹水是臨床上常見病及難治病之一,屬于祖國醫(yī)學(xué)“積聚”、“脅痛”、“臌脹”等范疇,臨床上現(xiàn)代醫(yī)學(xué)多以對(duì)癥支持治療為主,療效一般。加味胃苓湯是門九章教授多年來根據(jù)肝病特點(diǎn)及臨床實(shí)踐自擬的治療肝硬化腹水的有效經(jīng)驗(yàn)方。本課題即主要通過臨床觀察和動(dòng)物實(shí)驗(yàn)來進(jìn)一步驗(yàn)證加味胃苓湯的療效,為其治療肝硬化腹水的有效性和科學(xué)性提供相關(guān)的實(shí)驗(yàn)數(shù)據(jù),為加味胃苓湯的開發(fā)應(yīng)用打下堅(jiān)實(shí)的理論基礎(chǔ),為肝硬化腹水的臨床治療提供有益的參考。方法:研究分為實(shí)驗(yàn)研究和臨床研究,包括三個(gè)部分,第一部分運(yùn)用二甲基亞硝胺(DMN)建立肝硬化腹水的大鼠動(dòng)物模型。選用雄性SD大鼠100只,重量在200~250g之間,隨機(jī)選取10只作為正常對(duì)照組,其余90只作為模型組,用來制作肝硬化腹水模型。在熟悉環(huán)境一周后,每次給大鼠腹腔注射1%二甲基亞硝胺(DMN)1ml/kg,每周三天,每天一次,共12周。造模期間,密切關(guān)注大鼠體重,每次注射前稱體重、測腹圍,并與上一次注射前體重、腹圍進(jìn)行對(duì)比,體重明顯下降,甚者下降率在30%以上,暫停腹腔注射。在第12周末進(jìn)行腹腔穿刺觀察有無腹水。為進(jìn)一步判定造模是否成功,對(duì)穿刺有腹水的大鼠和正常對(duì)照組大鼠進(jìn)行解剖以及病理、肝腎功能等方面的比較。第二部分在第一部分造模成功的基礎(chǔ)上與其他藥物比較,探討加味胃苓湯對(duì)肝硬化腹水大鼠模型的治療作用及機(jī)理研究。將第一部分獲得的肝硬化腹水大鼠模型隨機(jī)分成加味胃苓湯高劑量組(A組)、加味胃苓湯低劑量組(B組)、模型組(C組)、速尿+安體舒通組(D組)、扶正化瘀組(E組),每組各8只大鼠。在代謝籠內(nèi)飼養(yǎng)大鼠24小時(shí),留取24小時(shí)尿液,計(jì)算24小時(shí)凈出水量后開始給藥,除模型組給予等容量的生理鹽水灌胃外,加味胃苓湯高劑量組、加味胃苓湯低劑量組給予加味胃苓湯,劑量分別為42.7g/kg體重、6.1g/kg體重,扶正化瘀組給予扶正化瘀膠囊0.075g/kg體重灌服,速尿+安體舒通組給予速尿和安體舒通0.66mg/kg體重灌服。以上各組灌胃液體量均為2ml,每日給藥1次,其濃度及等效劑量按體重折算,共給藥3周。觀察大鼠的一般情況及體重變化,在灌胃的最后一天再次將實(shí)驗(yàn)大鼠飼養(yǎng)于代謝籠內(nèi),再次收集24小時(shí)尿液,計(jì)算24小時(shí)凈出水量。測定門靜脈壓力并檢測大鼠肝功能指標(biāo)及NO、ET-1的含量和肝纖維化標(biāo)志物四項(xiàng)。第三部分觀察加味胃苓湯治療肝硬化腹水的臨床療效,選擇符合肝硬化腹水診斷標(biāo)準(zhǔn)的患者60例,隨機(jī)將其分為治療組和對(duì)照組。對(duì)照組30例,采用常規(guī)西醫(yī)對(duì)癥治療;治療組30例,在常規(guī)西醫(yī)對(duì)癥治療的基礎(chǔ)上配合加味胃苓湯,每日1劑,治療一個(gè)月后。觀察兩組患者治療前后的主要癥狀、體征(包括乏力、納差、腹脹、尿少、黃疸、雙下肢浮腫)、腹圍、體重以及肝功能指標(biāo)、腹部B超檢查指標(biāo)(包括脾厚、門靜脈及脾靜脈寬度)及其有無并發(fā)癥等,同時(shí)監(jiān)測24h尿量變化。結(jié)果:1 12周后,模型組大鼠有51只存活。經(jīng)腹腔穿刺其中48只有腹水,相對(duì)成模率為94.1%。解剖可見造模組的肝臟腫大明顯,表面不平;病理組織學(xué)檢查提示肝硬化以及假小葉形成;門靜脈壓力(Ppv)較正常對(duì)照組明顯升高(p0.01);總膽紅素(TBIL)、丙氨酸氨基轉(zhuǎn)移酶(ALT)、天冬氨酸氨基轉(zhuǎn)移酶(AST)較正常對(duì)照組明顯升高(p0.01);白蛋白(ALB)較正常對(duì)照組明顯降低(p0.05)。2大鼠的一般情況:正常大鼠在整個(gè)實(shí)驗(yàn)期間,體重逐漸增加,毛色光滑潤澤,無異常行為表現(xiàn)。模型組動(dòng)物體重增加緩慢,皮毛光澤度不高,精神倦怠不振,攝食減少,表現(xiàn)為易激惹。各組治療開始后,大鼠進(jìn)食、體重均有所增加,毛色較造模期間光潤,能不同程度地減輕造模藥物對(duì)大鼠的影響。其中,加味胃苓湯高劑量組、加味胃苓湯低劑量組較其它組最顯著的變化就是治療后大便由造模期間的稀溏便轉(zhuǎn)為正常大便。2.1灌胃治療后,經(jīng)解剖,加味胃苓湯高劑量組、加味胃苓湯低劑量組大鼠腹水明顯減少,色淡黃,模型組可見較多腹水,速尿+安體舒通組腹水微量,扶正化瘀組有少量腹水。加味胃苓湯高劑量組、加味胃苓湯低劑量組與模型組比較,差異具有統(tǒng)計(jì)學(xué)意義(p0.05),速尿+安體舒通組與模型組比較,差異具有顯著統(tǒng)計(jì)學(xué)意義(p0.01),而扶正化瘀組與模型組比較,差異不具有統(tǒng)計(jì)學(xué)意義(p0.05);加味胃苓湯高劑量組、加味胃苓湯低劑量組與速尿+安體舒通組比較,差異不具有統(tǒng)計(jì)學(xué)意義(p0.05);與扶正化瘀組比較,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。2.2加味胃苓湯高劑量組、加味胃苓湯低劑量組與速尿+安體舒通組治療后較治療前24小時(shí)凈出水量明顯增加,差異具有顯著統(tǒng)計(jì)學(xué)意義(p0.01);扶正化瘀組治療后較治療前24小時(shí)凈出水量有所增加,前后比較差異不具有統(tǒng)計(jì)學(xué)意義(p0.05)。2.3各治療組門靜脈壓力均有不同程度的降低,與模型組比較差異具有統(tǒng)計(jì)學(xué)意義(p0.05),其中加味胃苓湯高劑量組、加味胃苓湯低劑量組與速尿+安體舒通組比較,差異具有統(tǒng)計(jì)學(xué)意義(p0.05);加味胃苓湯高劑量組與扶正化瘀組比較,差異具有統(tǒng)計(jì)學(xué)意義(p0.05);加味胃苓湯低劑量組與扶正化瘀組比較,差異不具有統(tǒng)計(jì)學(xué)意義(p0.05)。表明加味胃苓湯可以降低大鼠肝硬化腹水門靜脈壓力,其中以加味胃苓湯大劑量組效果最好。2.4加味胃苓湯能明顯減輕大鼠肝組織炎癥與纖維增生的程度,其中尤以加味胃苓湯高劑量組改善最為明顯,其作用與扶正化瘀膠囊組相當(dāng)(p0.05)。2.5治療后,加味胃苓湯高劑量組、加味胃苓湯低劑量組與扶正化瘀組均能不同程度的降低血清丙氨酸氨基轉(zhuǎn)移酶(ALT)、天冬氨酸氨基轉(zhuǎn)移酶(AST)、球蛋白(GLB)和升高白蛋白(ALB)的水平,與模型組比較差異具有顯著統(tǒng)計(jì)學(xué)意義(p0.01);與速尿+安體舒通組比較差異具有統(tǒng)計(jì)學(xué)意義(p0.05);加味胃苓湯高劑量組、加味胃苓湯低劑量組各指標(biāo)分別與扶正化瘀組比較,差異不具有統(tǒng)計(jì)學(xué)意義(p0.05)。2.6治療后,各治療組大鼠NO及ET-1含量均有不同程度的降低,其中加味胃苓湯高劑量組、加味胃苓湯低劑量組與模型組比較差異有統(tǒng)計(jì)學(xué)意義(p0.05),速尿+安體舒通組、扶正化瘀組與模型組比較差異無統(tǒng)計(jì)學(xué)意義(p0.05);加味胃苓湯高劑量組、加味胃苓湯低劑量組與速尿+安體舒通組比較,差異具有統(tǒng)計(jì)學(xué)意義(p0.05);加味胃苓湯高劑量組、加味胃苓湯低劑量組與扶正化瘀組比較,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。2.7治療后,加味胃苓湯高劑量組、加味胃苓湯低劑量組、扶正化瘀組透明質(zhì)酸(HA)、層粘連蛋白(LN)、Ⅲ型前膠原(PCⅢ)及Ⅳ型膠原(CIV)均顯著降低,與模型組比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05或P0.01);速尿+安體舒通組與模型組比較無顯著性差異(p0.05);與扶正化瘀組比較,加味胃苓湯高劑量組、加味胃苓湯低劑量組無顯著性差異(P0.05)。與速尿+安體舒通組比較,加味胃苓湯高劑量組、加味胃苓湯低劑量組具有顯著性差異(p0.01)。3臨床綜合療效及中醫(yī)證候療效:治療1個(gè)月臨床綜合療效比較,治療組顯效率與總有效率分別為23.33%和93.33%,對(duì)照組分別為13.33%和70.0%,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.1兩組患者治療前后主要癥狀、體征改善情況比較,治療組在治療后主要癥狀、及體征改善明顯,與治療前比較差異有顯著統(tǒng)計(jì)學(xué)意義(P0.05);對(duì)照組患者治療后主要癥狀及體征也有改善,與治療前比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。3.2兩組患者肝功能、凝血酶原活動(dòng)度改善比較,治療組治療后ALB、PTA、A/G水平明顯升高,與治療前比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)照組ALB、PTA、A/G水平也有升高,但與治療前比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者AST、ALT、TBIL水平治療后比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05),ALB、PTA、A/G水平治療后比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.3兩組患者體重、腹圍、平均24h尿量比較,兩組患者治療后體重、腹圍與治療前比較降低;與治療前比較,平均24h尿量明顯增多,差異有統(tǒng)計(jì)學(xué)意義(P0.05);對(duì)照組治療前后體重、腹圍差異無統(tǒng)計(jì)學(xué)意義(P0.05),平均24h尿量治療前后差異有統(tǒng)計(jì)學(xué)意義。兩組在治療后體重、腹圍、平均24h尿量比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.4兩組患者腹部B超比較,兩組患者在治療后腹部B超指標(biāo)(包括脾臟厚度、門靜脈及脾靜脈寬度)較治療前有改善,差異有統(tǒng)計(jì)學(xué)意義(P0.05);對(duì)照組脾臟厚度、脾靜脈寬度改善與治療前比不如治療組明顯。兩組患者治療后B超指標(biāo)(包括脾臟厚度、門靜脈及脾靜脈寬度)比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。3.5兩組患者治療后B超腹水量均有所減少,治療組與治療前比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05);對(duì)照組治療后與治療前比較差異不具有統(tǒng)計(jì)學(xué)意義;兩組治療后比較,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),說明治療組消腹水的作用優(yōu)于對(duì)照組。3.6兩組患者治療中并發(fā)癥的發(fā)生率分別是13.33%和23.33%,并發(fā)癥發(fā)生率比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。3.7兩組患者在治療后血、尿、便常規(guī)、一般體格檢查、腎功能、心電圖等指標(biāo)與治療前比較無明顯異常變化;在整個(gè)治療過程及治療結(jié)束后未發(fā)生不良反應(yīng),提示加味胃苓湯治療肝硬化腹水安全有效,并且無明顯毒副作用。結(jié)論:1運(yùn)用二甲基亞硝胺成功建立肝硬化腹水的大鼠模型,為進(jìn)一步研究作準(zhǔn)備。2加味胃苓湯可明顯改變模型大鼠的一般狀況,提高模型大鼠的活力。并具有明顯的消腹水的作用。3加味胃苓湯能明顯增加模型大鼠24小時(shí)凈出水量,有較強(qiáng)的利水作用。4加味胃苓湯能夠降低模型大鼠門靜脈壓力。5加味胃苓湯能夠抑制膠原纖維增生、減輕肝組織炎癥,提示加味胃苓湯有抗纖維化、保肝作用。6加味胃苓湯能夠降低模型大鼠NO及ET-1含量,從而能夠調(diào)整對(duì)肝臟血流的影響,改善門靜脈血流和阻力的影響,這可能是加味胃苓湯能夠降低模型大鼠門靜脈壓力、治療腹水的作用機(jī)制之一。7加味胃苓湯治療肝硬化腹水療效肯定,能夠明顯改善患者的癥狀、體征、以及肝功能等。優(yōu)于單純的西醫(yī)對(duì)照組,并且能夠減少各種并發(fā)癥的發(fā)生,減輕了患者的痛苦,提高了患者的生活質(zhì)量,同時(shí)無不良反應(yīng)發(fā)生,為我們治療肝硬化腹水提供了很好的思路。8加味胃苓湯配合西醫(yī)對(duì)癥治療的中西醫(yī)結(jié)合組在提高患者療效,緩解病人的臨床癥狀,改善其肝功能方面優(yōu)于單純的西醫(yī)對(duì)癥治療組;它可以改善患者臨床癥狀,還可以改善患者肝功能的水平:ALT、AST、ALB、TB、PTA,能夠穩(wěn)定血漿白蛋白水平,改善凝血功能,減輕患者經(jīng)濟(jì)壓力,減少出血等并發(fā)癥,可以給患者獲得更好的遠(yuǎn)期臨床療效。
[Abstract]:Objective: cirrhotic ascites is one of the common and refractory diseases in the clinic. It belongs to the category of "accumulation", "hypochondriac pain", "distension" and so on. In clinical modern medicine, most of the clinical modern medicine is mainly with symptomatic support treatment, and the curative effect is general. The nine chapters of Jiawei Ling Ling decoction are the treatment of liver cirrhosis ascites for many years according to the characteristics of liver disease and clinical practice. This topic is to further verify the curative effect of Jiawei Ling Ling soup through clinical observation and animal experiment, and provide the relevant experimental data for the effectiveness and science of the treatment of liver cirrhosis ascites, and lay a solid theoretical foundation for the development and application of the Jiawei Luling soup, and provide beneficial treatment for the clinical treatment of liver cirrhosis ascites. Methods: the study was divided into experimental and clinical studies, including three parts. The first part used two methylnitrosamine (DMN) to establish the rat model of cirrhotic ascites. 100 male SD rats were selected and 10 were randomly selected as the normal control group, and the other 90 were used as model groups to make liver cirrhosis. After one week of familiar environment, 1% two methylnitrosamine (DMN) 1ml/kg was injected into the abdominal cavity of rats, each Wednesday, once a day, for a total of 12 weeks. During the modeling period, the weight of rats was closely concerned, the weight was measured before each injection, the abdominal circumference was measured, and the weight of the previous injection was compared with the abdominal circumference, the weight decreased significantly and the decline rate was 30%. In order to further determine whether the model was successful, the second part of the first part of the model was compared with other drugs on the basis of the success of the first part of the model and the liver and kidney function. The effect and mechanism of modified Wei Ling Decoction on the rat model of cirrhotic ascites. The first part of the liver cirrhosis ascites rat model was randomly divided into the high dose group (group A) of Jiawei Ling Ling Decoction (group B), the model group (group C), furosemide + ansasong group (group D), the group of Fuzheng Huayu (group E), 8 rats in each group. The rats were kept in the metabolic cage for 24 hours, leaving the urine for 24 hours and calculating the net water content for 24 hours. In addition to the model group, the high dose group of Wei Ling soup was added to the model group and the low dose group of Wei Ling decoction was given with the dosage of 42.7g/kg weight, 6.1g/kg weight, and the group of Fuzheng Huayu group were given the centralizability. Blood stasis capsule 0.075g/kg body weight perfusion, furosemide + anspironolactone group to give furosemide and anacontan 0.66mg/kg weight perfusion. The volume of gastric perfusion in all groups is 2ml, 1 times a day, the concentration and equivalent dose of weight conversion, a total of 3 weeks. Observe the general situation and body weight changes in rats, the last day in the gavage of rats will be experimental rats again. In the metabolic cage, the urine was collected for 24 hours, and the net water content of 24 hours was calculated. The portal pressure was measured and the liver function index of the rats and the content of NO, ET-1 and four markers of liver fibrosis were detected. The third part observed the clinical efficacy of Jiawei lling Decoction in the treatment of cirrhotic ascites, and chose 60 patients with the diagnostic criteria of cirrhosis ascites. The control group was randomly divided into the treatment group and the control group. 30 cases in the control group were treated with conventional western medicine, and 30 cases in the treatment group were combined with Jiawei Wei Ling Decoction on the basis of conventional western medicine treatment, 1 doses a day, and one month after treatment. The main symptoms and signs of the two groups before and after treatment were observed (including fatigue, difference, abdominal distension, urine, jaundice, jaundice, and lower limbs). Edema), abdominal circumference, weight and liver function index, abdominal B-ultrasound examination index (including splenic thickness, portal vein and splenic vein width) and its complications, and monitoring 24h urine volume. Results: after 112 weeks, 51 rats in the model group were alive. 48 of them had ascites through abdominal puncture, and the relative model rate was 94.1%., the liver was dissected. Histopathological examination suggested liver cirrhosis and false lobule formation; portal vein pressure (Ppv) was significantly higher than normal control group (P0.01); total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST) was significantly higher than normal control group (P0.01); albumin (ALB) was more obvious than normal control group. The general condition of reducing (P0.05).2 rats: the body weight increased gradually during the whole experiment, the hair color was smooth and moist, and there was no abnormal behavior. The weight of the model group increased slowly, the skin glossiness was not high, the mental burnout was not vibrant, the feeding reduced, and the irritability. After the treatment of each group, the rats fed, the weight of the rat increased, Mao increased, Mao increased. It can reduce the effect of the light in the model during the process of modeling. Among them, the high dose group of Jiawei Ling Ling decoction, the most significant change of the low dose group of Jiawei Ling Ling Decoction and the other groups is the treatment after the treatment of the dilute stool during the period of the treatment to the normal stool.2.1 after the treatment. The abdominal water of the rats in the low dose group of Wei Ling Ling decoction was significantly reduced and the color was pale yellow. The model group could see more ascites, the ascitic water in the furosemide + analastong group, and a small amount of ascites in the group of Fuzheng Huayu Decoction. The difference of the high dosage group of Jiawei Ling Ling Decoction and the model group was compared with the model group (P0.05), and the ratio of the furosemide + analastong group to the model group was compared. The difference had significant statistical significance (P0.01), but the difference was not statistically significant (P0.05) in the group of Fuzheng Huayu and the model group (P0.05); the difference was not statistically significant (P0.05) in the high dose group of Jiawei Ling Ling Decoction and the low dose group of Jiawei Ling Ling Decoction and the group of furosemide + anolactone (P), and the difference was statistically significant (P 0.05) the high dose group of.2.2 added Wei Ling soup, the low dose group of Jiawei Ling Ling Decoction and the 24 hours after treatment, the net water content of the group was significantly increased, the difference has significant statistical significance (P0.01), and the net amount of water in the group of Fuzheng Huayu group was increased after 24 hours after treatment, and the difference was not statistically significant (p0. 05) the pressure of portal vein in each group of.2.3 was reduced in varying degrees, and the difference was statistically significant (P0.05). The difference was statistically significant (P0.05) in the high dose group of Jiawei Ling Ling decoction, the low dose group of Jiawei Ling Ling Decoction and the group of furosemide + anolactone (P0.05), and the difference between the high dose group and the group of Fuzheng Huayu group was poor. The difference was statistically significant (P0.05); the difference between the low dose group of Jiawei Ling Ling Decoction and the group of Fuzheng Huayu was not statistically significant (P0.05). It showed that Jiawei Ling decoction could reduce the pressure of portal vein in the ascites of the rat liver cirrhosis, and the best effect of the large dosage group of Jiawei Ling Ling Decoction (.2.4 plus Wei Ling Decoction) could obviously reduce the inflammation and inflammation of liver tissue in rats. The degree of fibrous hyperplasia, especially the high dose group of Jiawei Luling soup, was the most obvious. After the treatment of the group of Fuzheng Huayu Capsule (P0.05).2.5, the high dose group of Jiawei Ling Ling decoction, the low dose group of Jiawei Ling Decoction and the group of Fuzheng Huayu could reduce the serum alanine aminotransferase (ALT) and the aminotransferase of aspartic acid in different degrees. The levels of AST, globulin (GLB) and elevated albumin (ALB) were significantly different from those in the model group (P0.01), and the difference was statistically significant (P0.05) compared with the group of furosemide + analosontin (P0.05); the different indexes of the low dose group of Jiawei Ling Ling Decoction and the low dose group of Jiawei Ling Ling Decoction were compared with that of the Fuzheng Huayu group. After P0.05.2.6 treatment, the contents of NO and ET-1 in each group of rats were reduced in varying degrees. There was a significant difference between the high dose group of Jiawei Ling Ling Decoction and the low dose group of Jiawei Ling Ling soup with the model group (P0.05). There was no significant difference between the group of furosemide + analacontan and the group of Fuzheng Huayu and model group (P0.05). The high dose group of Wei Ling decoction, the low dose group of Jiawei Ling Ling Decoction and the group of furosemide + anolactone, the difference has statistical significance (P0.05); the high dose group of Jiawei Ling Ling decoction, the low dose group of Jiawei Ling Ling Decoction and the group of Fuzheng Huayu group, the difference has statistical significance (P0.05) after.2.7 treatment, the high dose group of Jiawei Ling Ling Decoction and the low dose group of Jiawei Luling soup Hyaluronic acid (HA), laminin (LN), type III procollagen (PC III) and type IV collagen (CIV) in the group of Fuzheng Huayu group were significantly lower than those in the model group (P0.05 or P0.01), and there was no significant difference between the model group and the model group (P0.05). There was no significant difference in the low dose group of Wei Ling Decoction (P0.05). Compared with the group of furosemide + anacontan, the high dose group of Jiawei Ling Ling Decoction and the low dose group of Jiawei Ling Ling decoction had significant difference (P0.01) the clinical comprehensive curative effect of.3 and the curative effect of TCM syndrome: the effective and total effective rate of the treatment group was 23.33% and 93.33%, respectively, for the 1 months of clinical treatment. The control group was 13.33% and 70% respectively. The difference between the two groups was statistically significant (P0.05), the main symptoms before and after treatment in the.3.1 two groups, the improvement of physical signs, the major symptoms after treatment, and the improvement of the physical signs were significant (P0.05), and the main symptoms and body after treatment in the control group. The difference was not statistically significant (P0.05) before treatment (P0.05), there was no significant difference in the liver function and prothrombin activity in the.3.2 two groups. The level of ALB, PTA, and A/G in the treatment group was significantly higher than that before treatment (P0.05), and the level of ALB, PTA, and A/G in the control group was also elevated, but there was no statistical difference compared with that before treatment. Learning significance (P0.05); two groups of patients with AST, ALT, TBIL level after treatment, the difference was not statistically significant (P0.05), ALB, PTA, A/G level after treatment compared, the difference was statistically significant (P0.05).3.3 two group of body weight, abdominal circumference, average 24h urine volume, two groups of patients after treatment weight, abdominal circumference and before treatment before treatment, compared with before treatment, average 24h The urine volume was significantly increased, the difference was statistically significant (P0.05). There was no significant difference between the weight and abdominal circumference of the control group before and after treatment (P0.05), and the difference of the average 24h urine volume before and after treatment was statistically significant. The difference of the weight, abdominal circumference and mean 24h urine volume after treatment in the two groups was significant (P0.05) in the two groups of patients with abdominal B ultrasound comparison, and the two groups of patients were compared. After treatment, the index of abdominal B-ultrasound (including the thickness of the spleen, the width of the portal vein and the splenic vein) was better than before the treatment (P0.05); the spleen thickness of the control group and the width of the splenic vein were better than those in the treatment group. The two groups of patients after treatment (including the thickness of the spleen, the width of the portal vein and the splenic vein) were poor after treatment. No statistical significance (P0.05).3.5 two groups of patients with B ultrasonic water volume decreased, the treatment group compared with before treatment was statistically significant (P0.05); the control group after treatment and before treatment, the difference was not statistically significant; the two groups after treatment, the difference was statistically significant (P0.05), indicating the treatment group to eliminate ascites in the treatment group. The incidence of complications in the treatment group of.3.6 two groups was 13.33% and 23.33%, respectively, and there was no significant difference in the incidence of complications (P0.05). There were no significant changes in blood, urine, routine, general physical examination, renal function and electrocardiogram in group.3.7 two. And there is no adverse reaction after the treatment, suggesting that Jiawei Ling soup is safe and effective in the treatment of cirrhotic ascites, and there is no obvious side effect. Conclusion: 1 the rat model of cirrhotic ascites by using two methylnitrosamine can be successfully established, and the general condition of the model rats can be obviously changed by the preparation of.2 added Wei Ling Soup for further study, and the model can be improved. The activity of the rat and the effect of obvious ascites elimination.3 can obviously increase the net water content of the model rats for 24 hours, and the strong water effect of.4 can reduce the pressure of the rat's portal vein, which can reduce the portal pressure of the model rats,.5 and Wei Ling soup can inhibit the proliferation of collagen fiber and reduce the inflammation of the liver tissue. Vitamin.6 and Wei Ling decoction can reduce the content of NO and ET-1 in model rats, thereby adjusting the effect of liver blood flow and improving the portal.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259

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