解毒凉血健脾方治疗早中期乙型肝炎相关慢加急性肝衰竭的效果观察

时克; 侯艺鑫; 侯杰; 李玉鑫; 冉崇平; 王宪波

doi:10.3969/j.issn.1001-5256.2021.05.018

解毒凉血健脾方治疗早中期乙型肝炎相关慢加急性肝衰竭的效果观察

DOI: 10.3969/j.issn.1001-5256.2021.05.018

时克^{1, 2},
侯艺鑫¹,
侯杰^{1, 2},
李玉鑫¹,
冉崇平¹,
王宪波^1, ,

1.
首都医科大学附属北京地坛医院中西医结合中心，北京 100015
2.
北京中医药大学第一临床医学院脾胃病科，北京 100700

基金项目:

首都卫生发展科研专项 (2018-1-2172);

北京市科学技术委员会资助 (Z191100006619033);

国家中医药管理局重大疑难疾病中西医临床协作试点项目 (2018-6-4);

国家中医药管理局区域中医诊疗中心 (2019-3-18)

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：时克、侯艺鑫负责资料分析，撰写论文；时克、侯杰、冉崇平参与收集数据；李玉鑫负责修改论文；王宪波指导修改文章并最终定稿。

详细信息

作者简介:
时克(1995—), 女, 主要从事中西医结合肝病研究

侯艺鑫(1984—), 女, 主治医师, 主要从事中西医结合肝病研究

通信作者:
王宪波，wangxianbo638@163.com

二者对本文贡献相同，同为第一作者

中图分类号: R512.62;R575.3
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- 被引次数: 0
出版历程
- 收稿日期: 2020-10-18
- 录用日期: 2020-11-23
- 出版日期: 2021-05-20

Clinical effect of Jiedu Liangxue Jianpi prescription in treatment of patients with hepatitis B virus-associated acute-on-chronic liver failure in early and middle stages

Ke SHI^{1, 2},
Yixin HOU¹,
Jie HOU^{1, 2},
Yuxin LI¹,
Chongping RAN¹,
Xianbo WANG^{1
, ,}

1.
Department of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
2.
Department of Gastroenterology, The First Clinical Medical College of Beijing University of Chinese Medicine, Beijing 100700, China

摘要

摘要: 目的探究解毒凉血健脾方对早中期乙型肝炎慢加急性肝衰竭患者的疗效。方法选取2017年10月—2019年1月在北京地坛医院诊断为早中期乙型肝炎慢加急性肝衰竭患者75例。将患者随机分为中西医结合组36例，对照组39例。对照组予西医治疗，中西医结合组在西医治疗基础上加用解毒凉血健脾方，两组疗程均为8周。观察两组患者的累积有效率，比较治疗前后两组患者肝功能、凝血功能及血常规指标。组间比较采用重复测量资料方差分析，进行一元方差分析或多元方差分析。计数资料两组间比较采用χ²检验。结果治疗第4周，中西医结合组累积有效率比对照组高，差异有统计学意义(77.7% vs 53.8%，χ² =4.734，P＜0.05)。与对照组相比，治疗第1、2周时中西医结合组白蛋白明显升高(P值均＜0.05)；治疗第1周时中西医结合组凝血酶原活动度水平明显升高(P＜0.05)；治疗第3、8周时，中西医结合组中性粒细胞计数、中性粒细胞与淋巴细胞比值均明显下降(P值均＜0.05)。结论解毒凉血健脾方能提高早中期乙型肝炎慢加急性肝衰竭患者的治疗有效率，改善患者肝功能和凝血功能，降低中性粒细胞与淋巴细胞比值。
- 乙型肝炎 /
- 慢加急性肝功能衰竭 /
- 中草药
Abstract: Objective To investigate the clinical effect of Jiedu Liangxue Jianpi prescription in the treatment of patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) in early and middle stages. Methods A total of 75 patients who were diagnosed with HBV-ACLF in early and middle stages in Beijing Ditan Hospital from October 2017 to January 2019 were enrolled and randomly divided into integrated traditional Chinese and Western medicine group with 36 patients and control group with 39 patients. The patients in the control group were given Western medicine treatment, and those in the integrated traditional Chinese and Western medicine group were treated with Jiedu Liangxue Jianpi prescription in addition to Western medicine treatment. The course of treatment was 8 weeks for both groups. Cumulative response rate was observed for both groups, and the two groups were compared in terms of liver function, coagulation function, and routine blood test results before and after treatment. A univariate or multivariate analysis of variance with repeated measures was used for comparison between groups, and the chi-square test was used for comparison of categorical data between two groups. Results At week 4 of treatment, the integrated traditional Chinese and Western medicine group had a significantly higher cumulative response rate than the control group (77.7% vs 53.8%, χ²=4.734, P < 0.05). Compared with the control group, the integrated traditional Chinese and Western medicine group had a significant increase in albumin at weeks 1 and 2 of treatment (all P < 0.05), a significant increase in prothrombin activity at week 1 of treatment (P < 0.05), and significant reductions in neutrophil count and neutrophil-lymphocyte ratio at weeks 3 and 8 of treatment (all P < 0.05). Conclusion Jiedu Liangxue Jianpi prescription can improve the treatment response, liver function, and coagulation function and reduce neutrophil-lymphocyte ratio in patients with HBV-ACLF in early and middle stages.
- Hepatitis B /
- Acute-On-Chronic Liver Failure /
- Drugs, Chinese Herbal

HTML全文

表 1 两组各时间点治疗累积有效率比较

组别	例数	时间	累积有效例数	累积有效率(%)
中西医结合组	36	第1周	13	36.1
		第2周	17	47.2
		第3周	21	58.3
		第4周	28	77.7¹⁾
		第6周	30	83.3
		第8周	30	83.3
对照组	39	第1周	17	43.6
		第2周	18	46.1
		第3周	21	53.8
		第4周	21	53.8
		第6周	29	74.3
		第8周	32	82.1
注：1)与对照组同时间比较，P＜0.05。

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表 2 两组各时间点肝功能的比较

组别	例数	时间	ALT(U/L)	AST(U/L)	TBil(μmol/L)	Alb(g/L)
中西医结合组	36	治疗前	376.40(124.17~859.35)	242.75(93.90~637.95)	250.16±130.59	30.85±4.11
		第1周	123.35(75.15~226.30)¹⁾	107.15(69.95~160.45)¹⁾	285.18±144.54	32.80±6.43¹⁾²⁾
		第2周	47.00(38.55~92.57)¹⁾	83.25(52.45~125.02)¹⁾	252.61±156.21	33.26±3.37¹⁾²⁾
		第3周	40.00(24.95~68.70)¹⁾	79.65(52.70~118.80)¹⁾	203.81±140.91¹⁾	33.72±4.43¹⁾
		第4周	35.00(22.92~63.97) ¹⁾	75.25(49.32~123.72)¹⁾	162.71±134.17¹⁾	33.78±4.52¹⁾
		第6周	33.00(23.10~52.45)¹⁾	56.90(36.97~78.00)¹⁾	124.09±114.15¹⁾	35.33±8.92¹⁾
		第8周	28.16(21.87~45.05)¹⁾	56.00(36.37~85.65)¹⁾	69.05(32.22~122.87)¹⁾	937.30±10.80¹⁾
		F值	5.118	5.057	10.051	3.929
		P值	＜0.001	0.001	0.009	0.001
对照组	39	治疗前	235.60(76.60~1104.10)	233.60(105.60~840.70)	239.39±119.01	30.96±5.74
		第1周	96.40(43.50~275.80)¹⁾	143.60(70.90~230.70)¹⁾	256.71±130.69	31.27±3.98
		第2周	62.30(24.40~96.90)¹⁾	92.00(57.20~137.00)¹⁾	230.23±145.68	31.22±4.01¹⁾
		第3周	36.00(20.30~69.00)¹⁾	75.00(48.80~122.60)¹⁾	203.47±143.74¹⁾	32.02±4.11¹⁾
		第4周	30.00(16.50~58.90)¹⁾	62.60(40.70~124.20)¹⁾	163.78±120.45¹⁾	32.24±4.13¹⁾
		第6周	28.40(15.00~43.60)¹⁾	59.00(37.00~91.10)¹⁾	136.28±110.86¹⁾	33.06±5.21¹⁾
		第8周	23.00(15.10~37.80)¹⁾	47.40(36.00~66.00)¹⁾	113.31±98.33¹⁾	35.28±9.32¹⁾
		F值	5.615	10.593	7.481	2.844
		P值	＜0.001	0.001	0.001	0.011
注: 1)与本组治疗前比较，P＜0.05；2)与对照组同时间比较，P＜0.05。ALT、AST和TBil的数据经正态转换后，进行重复测量资料方差分析。

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表 3 两组各时间点凝血功能及MELD评分比较

组别	例数	时间	PTA(%)	INR	MELD评分
中西医结合组	36	治疗前	34.39±11.19	2.26(1.99~2.89)	33.35±4.74
		第1周	39.80±16.04¹⁾²⁾	2.11(1.75~2.55)¹⁾	32.79±5.56
		第2周	44.47±17.30¹⁾	2.06(1.54~2.46)¹⁾	30.86±5.53¹⁾
		第3周	49.58±20.27¹⁾	1.77(1.40~2.23)¹⁾	29.28±6.15¹⁾
		第4周	52.39±19.75¹⁾	1.76(1.42~2.09)¹⁾	27.59±7.00¹⁾
		第6周	54.69±20.24¹⁾	1.69(1.31~1.89)¹⁾	25.61±6.31¹⁾
		第8周	59.00±20.13¹⁾	1.51(1.30~1.87)¹⁾	16.92±7.34¹⁾
		F值	8.221	9.333	10.285
		P值	＜0.001	＜0.001	＜0.001
对照组	39	治疗前	36.36±9.59	2.20(1.98~2.47)	32.61±3.97
		第1周	36.38±10.82	2.11(1.79~2.49)¹⁾	32.12±4.26
		第2周	42.18±15.46	2.03(1.54~2.38)¹⁾	30.61±5.63¹⁾
		第3周	48.21±18.65¹⁾	1.80(1.32~2.34)¹⁾	30.26±7.95¹⁾
		第4周	49.58±20.76¹⁾	1.85(1.38~2.31)¹⁾	28.18±6.09¹⁾
		第6周	54.72±20.71¹⁾	1.74(1.30~2.07)¹⁾	26.62±6.66¹⁾
		第8周	58.03±24.02¹⁾	1.60(1.28~1.80)¹⁾	17.29±6.01¹⁾
		F值	7.835	5.636	9.230
		P值	＜0.001	＜0.001	＜0.001
注: 1)与本组治疗前比较，P＜0.05。INR的数据经正态转换后，进行重复测量资料方差分析。

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表 4 两组各时间点血常规比较

组别	例数	时间	WBC(×10⁹/L)	Neu (×10⁹/L)	Lym(×10⁹/L)	NLR
中西医结合组	36	治疗前	5.10(3.86~7.57)	3.78(2.22~4.97)	1.48(0.93~1.70)	2.45(1.73~4.55)
		第1周	5.11(3.63~5.41)	3.45(2.20~4.27)¹⁾	1.29(1.05~1.80)	2.07(1.54~3.71)¹⁾
		第2周	4.84(3.97~7.06)¹⁾	2.55(2.00~3.96)¹⁾	1.27(0.89~1.82)	2.01(1.40~2.98)¹⁾
		第3周	3.94(3.04~6.30)¹⁾	1.98(1.54~2.94)¹⁾²⁾	1.27(0.98~2.15)	1.45(1.04~2.20)¹⁾²⁾
		第4周	3.90(2.93~5.80)¹⁾	1.98(1.42~3.09)¹⁾	1.35(0.79~1.99)	1.56(1.20~2.70)¹⁾
		第6周	3.71(2.52~5.64)¹⁾	1.98(1.16~3.00)¹⁾	1.36(0.81~2.18)	1.47(1.02~2.02)¹⁾
		第8周	3.77(2.88~5.80)¹⁾	1.50(1.10~1.90)¹⁾²⁾	1.42(1.16~2.23)	1.03(0.71~1.61)¹⁾²⁾
		F值	10.285	7.754	0.239	9.751
		P值	＜0.001	＜0.001	0.963	＜0.001
对照组	39	治疗前	5.85(4.53~8.30)	3.76(2.56~5.04)	1.30(0.87~1.74)	2.37(1.53~4.46)
		第1周	5.67(4.31~6.92)	3.77(2.47~4.24)	1.25(0.86~1.86)	2.73(1.66~3.91)
		第2周	4.71(4.00~6.12)¹⁾	2.56(1.84~4.00)¹⁾	1.30(0.86~1.71)	2.07(1.23~2.68)¹⁾
		第3周	4.40(3.52~5.53)¹⁾	2.50(1.96~3.92)¹⁾	1.40(0.90~1.88)	1.60(1.23~2.68)¹⁾
		第4周	4.42(3.56~5.60)¹⁾	2.23(1.60~3.46)¹⁾	1.40(0.98~1.97)	1.52(1.17~2.28)¹⁾
		第6周	4.37(3.40~5.40)¹⁾	2.23(1.30~3.06)¹⁾	1.30(0.92~1.96)	1.48(1.06~2.46)¹⁾
		第8周	4.15(3.26~5.00)¹⁾	2.10(1.66~2.80)¹⁾	1.20(0.80~1.78)	1.70(1.29~2.42)¹⁾
		F值	9.230	6.179	0.156	4.170
		P值	＜0.001	＜0.001	0.998	0.001
注: 1)与本组治疗前比较，P＜0.05；2)与对照组同时间比较，P＜0.05。WBC、Neu、Lym、NLR的数据经正态转换后，进行重复测量资料方差分析。

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