【摘要】：目的：觀察柔肝健脾清化法治療乙肝肝硬化肝脾兩虛,濕熱瘀結(jié)證的臨床療效。通過收集臨床病例,比較治療前后癥狀及體征、血清指標、腹部B超等變化情況,驗證本法在治療乙肝肝硬化肝脾兩虛,濕熱瘀結(jié)證的有效性,規(guī)范化評估本法在治療中的優(yōu)勢點,繼而發(fā)掘中醫(yī)藥聯(lián)合西藥治療的優(yōu)勢面,提高患者的生存質(zhì)量,為中醫(yī)藥治療乙肝肝硬化提供臨床參考。方法：采取簡單隨機對照原則,將收集的63例乙肝肝硬化患者分成治療組38例,對照組25例。對照組給予抗病毒或基礎(chǔ)對癥治療,治療組在對照組的基礎(chǔ)上加用以柔肝健脾清化為治療大法的湯劑；觀察治療前、治療后3個月、6個月時肝生化指標、肝纖三項、凝血指標、腫瘤指標等實驗室指標變化,肝脾B超變化,以及治療前后臨床癥狀、體征的變化。采用SPSS17.0對收集的數(shù)據(jù)進行統(tǒng)計與分析。結(jié)果：癥狀及體征的影響：治療組和對照組都可減輕患者乏力、脅痛、納差、口干口苦、腹水的表現(xiàn),結(jié)果具有統(tǒng)計學(xué)意義(P0.01)；兩組對比治療效果時,治療組更能改善患者的乏力、腹脹、脅痛、納差、口干口苦及腹水(P＜0.01),身目黃染及肝脾腫大(P0.05)具有統(tǒng)計學(xué)意義。肝生化功能的影響：治療組和對照組均可以降低患者ALT、AST、 ALP (P0.01),治療組在降低ALT水平(P0.01), AST、TBIL水平(P0.05)優(yōu)于對照組；相比對照組,治療組可以提高肝硬化患者ALB和pALB水平(P0.01)；對于肝纖維化三項指標,兩組治療后均有下降(P0.05),在降低PC III與IV-C方面,治療組要優(yōu)于對照組(P0.05)；在改善凝血指標方面,治療組可縮短PT,提高PTA與PLT(P0.01),對照組僅可有效縮短PT(P0.05),治療組比對照組更能改善PT與PLT(P0.05)；比較腫瘤指標,兩組均可降低AFP水平(P0.05)而且治療組優(yōu)于對照組(P0.01)。肝脾B超的影響：兩組對于改善肝右葉斜徑、門靜脈內(nèi)徑無統(tǒng)計學(xué)意義(P0.05),治療組可縮短脾靜脈內(nèi)徑(P0.05),效果優(yōu)于對照組(P0.05)�？傆行实脑u估：治療組總有效率89.47%,對照組總有效率72.00%,兩組對比有差異(P＜0.05),說明治療組治療效果優(yōu)于對照組。結(jié)論：治療組和對照組都可以有效治療乙肝肝硬化,在改善癥狀及體征、肝生化指標、肝纖三項、凝血指標、AFP及腹部B超各方面,治療組要優(yōu)于對照組。說明柔肝健脾清化法聯(lián)合西藥治療可以更好地改善肝纖維化,保護肝細胞,減輕臨床癥狀,療效肯定。
[Abstract]:Objective: to observe the clinical effect of the treatment of liver and spleen deficiency and damp-heat stasis syndrome in liver cirrhosis. By collecting clinical cases and comparing the changes of symptoms and signs, serum indexes, abdominal B ultrasound before and after treatment, the effectiveness of this method in the treatment of liver and spleen deficiency and damp-heat stasis syndrome of hepatitis B cirrhosis was verified. Standardized evaluation of the advantages of this method in the treatment, and then explore the advantages of traditional Chinese medicine combined with western medicine treatment, improve the quality of life of patients, and provide a clinical reference for the treatment of liver cirrhosis with traditional Chinese medicine. Methods: 63 patients with hepatitis B cirrhosis were divided into treatment group (n = 38) and control group (n = 25). The control group was treated with anti-virus or basic symptomatic therapy, and the treatment group was treated with the decoction of treating dafa on the basis of the control group. Before treatment, 3 months after treatment, 6 months after treatment, the changes of biochemical indexes of liver, three items of liver fiber, coagulation index, tumor index and other laboratory indexes, changes of B-ultrasound in liver and spleen, and changes of clinical symptoms and signs before and after treatment were observed. SPSS17.0 was used to analyze the collected data. Results: the effects of symptoms and signs: both the treatment group and the control group could alleviate the symptoms of fatigue, hypochondria, anorexia, dry mouth and bitter mouth, ascites, the results were statistically significant (P0.01). Compared with the treatment effect, the treatment group can improve the patient's fatigue, abdominal distension, hypochondria, anorexia, dry mouth and bitter mouth and ascites (P < 0.01), yellow stain of body and eyes and hepatosplenomegaly (P0.05). The effect of liver biochemical function: the treatment group and the control group can reduce the ALT,AST, ALP (P0.01), the treatment group in reducing the level of ALT (P0.01), AST,TBIL level (P0.05) is better than the control group; Compared with the control group, the treatment group could increase the levels of ALB and pALB in patients with liver cirrhosis (P0.01). For the three indexes of hepatic fibrosis, the two groups were decreased after treatment (P0.05), in terms of reducing PC III and IV-C, the treatment group was better than the control group (P0.05); In improving coagulation index, the treatment group can shorten PT, to increase PTA and PLT (P0.01), the control group can only shorten PT (P0.05), the treatment group can improve PT and PLT (P0.05); Compared with tumor index, both groups could decrease AFP level (P0.05) and the treatment group was superior to the control group (P0.01). The effect of liver and spleen B ultrasound: two groups for improving the right lobe oblique diameter, portal vein diameter has no statistical significance (P0.05), the treatment group can shorten the splenic vein diameter (P0.05), the effect is better than the control group (P0.05). Evaluation of total effective rate: the total effective rate of the treatment group was 89.47 and that of the control group was 72.00. There was a difference between the two groups (P < 0.05), which indicated that the therapeutic effect of the treatment group was better than that of the control group. Conclusion: both the treatment group and the control group can effectively treat hepatitis B cirrhosis. The treatment group is superior to the control group in improving symptoms and signs, liver biochemical index, liver fibrin three, coagulation index, AFP and abdominal B ultrasound. It is concluded that the combination of the method of strengthening liver and strengthening spleen with western medicine can improve liver fibrosis, protect liver cells, alleviate clinical symptoms and have definite curative effect.
【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】：2016
【分類號】：R259

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