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消胀贴膏治疗肝硬化腹水的效果及其对肾素-血管紧张素-醛固酮系统的影响
Effect of Xiaozhang plaster in treatment of cirrhotic ascites and its influence on the renin-angiotensin-aldosterone system
文章发布日期:2019年06月14日  来源:  作者:李爽,陶艳艳,邢枫,等  点击次数:205次  下载次数:44次

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【摘要】:目的观察消胀贴膏对肝硬化腹水患者的疗效及其对肾素-血管紧张素-醛固酮系统的影响。方法选取2015年3月-2016年3月间上海市宝山区中西医结合医院消化内科住院的肝硬化腹水患者220例,分为常规治疗组60例、消胀贴膏组60例和特利加压素组100例。常规治疗组采用肝硬化腹水常规治疗方案并限制利尿剂用量,消胀贴膏组患者在常规治疗基础上加用消胀贴膏,特利加压素组在常规治疗基础上加用特利加压素。观察疗效指标(腹水最深处深度、24 h尿量、腹围、体质量、Child-Pugh评分)、症状体征(腹胀、饮食、肛门排气、大便等),以及血清肝肾功能、电解质、血常规、凝血功能、门静脉直径、肾小球滤过率、血管活性物质[血浆肾素活性(PRA)、血管紧张素 Ⅱ(Ang Ⅱ)、醛固酮(ALD)]。计量资料多组间比较采用方差分析,进一步两两比较采用LSD-t检验。结果3组间治疗14 d和28 d时的腹水深度、尿量、腹围、Child评分、Ang Ⅱ水平、ALD水平比较差异均有统计学意义(14 d:F值分别为6.566、16.236、10.856、5.727、41.860、20.845;28 d:169.311、67.686、13.521、39.721、159.256、80.400,P值均<005);3组间治疗28 d时体质量、PRA水平比较差异均有统计学意义(F值分别为5.068、0.012,P值均<0.05);3组间腹胀评分、肛门排气评分、肛门排便评分治疗7 d、14 d、28 d时比较差异均有统计学意义(7 d:F值分别为38.311、33.405、33.996;14 d:64414、39.481、52.455;28 d:57.596、23.041、47.576,P值均<0.05)。结论消胀贴膏和特利加压素均可减少肝硬化腹水患者腹水量,而作用特点可能不同。消胀贴膏对肝硬化腹水的疗效优于常规治疗,且能显著改善患者临床症状,其作用机制可能与降低PRA、AngⅡ、ALD水平有关。
【Abstract】:ObjectiveTo investigate the effect of Xiaozhang plaster in the treatment of cirrhotic ascites and its influence on the renin-angiotensin-aldosterone system. MethodsA total of 220 patients with cirrhotic ascites who were hospitalized in Department of Gastroenterology in Shanghai Baoshan Integrated Traditional Chinese and Western Medical Hospital from March 2015 to March 2016 were enrolled and divided into routine treatment group with 60 patients, Xiaozhang plaster group with 60 patients, and terlipressin group with 100 patients. The patients in the routine treatment group received the routine treatment of cirrhotic ascites with a limitation of the dose of diuretics, those in the Xiaozhang plaster group were treated with Xiaozhang plaster in addition to the routine treatment, and those in the terlipressin group were treated with terlipressin in addition to the routine treatment. The three groups were observed in terms of related outcome measures (depth of ascites, 24-hour urine volume, abdominal circumference, body weight, and Child-Pugh score), symptoms and signs (abdominal distension, diet, passage of gas by anus, and defecation), hepatic and renal function, electrolytes, routine blood test results, coagulation function, portal vein diameter, glomerular filtration rate, and vasoactive substances [plasma renin activity (PRA), angiotensin Ⅱ (AngⅡ), and aldosterone (ALD)]. An analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for comparison within each group. ResultsThere were significant differences between the three groups in depth of ascites, urine volume, abdominal circumference, Child-Pugh score, AngⅡ level, and ALD level on days 14 and 28 of treatment (day 14: F=6.566, 16.236, 10.856, 5.727, 41.860, and 20.845, all P<0.05; day 28: F=169.311, 67.686, 13.521, 39.721, 159256, and 80.400, all P<0.05). There were significant differences between the three groups in body weight and PRA level on day 28 of treatment (F=5.068 and 0.012, both P<0.05). There were also significant differences between the three groups in the scores of abdominal distension, passage of gas by anus, and defecation on days 7, 14, and 28 of treatment (day 7: F=38.311, 33.405, and 33.996, all P<0.05; day 14: F=64.414, 39.481, and 52.455, all P<0.05; day 28: F=57.596, 23.041, and 47.576, all P<0.05). ConclusionBoth Xiaozhang plaster and terlipressin can reduce ascites volume in patients with cirrhotic ascites, but they may have different action characteristics. Xiaozhang plaster is superior to terlipressin in the treatment of cirrhotic ascites and can significantly improve clinical symptoms, possibly by reducing the levels of PRA, AngⅡ, and ALD.
【关键字】:肝硬化;腹水;消胀贴膏;肾素-血管紧张素系统
【Key words】:liver cirrhosis;ascites;Xiaozhang Plaster;renin-angiotensin system
【引证本文】:LI S, TAO YY, XING F, et al. Effect of Xiaozhang plaster in treatment of cirrhotic ascites and its influence on the renin-angiotensin-aldosterone system[J]. J Clin Hepatol, 2019, 35(7): 1496-1500. (in Chinese)
李爽, 陶艳艳, 邢枫, 等. 消胀贴膏治疗肝硬化腹水的效果及其对肾素-血管紧张素-醛固酮系统的影响[J]. 临床肝胆病杂志, 2019, 35(7): 1496-1500.

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