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抗肝纤维化中成药预防酒精性肝病相关肾功能减退的疗效评价
Effect of anti-liver fibrosis Chinese patent drugs in preventing renal hypofunction associated with alcoholic liver disease
文章发布日期:2020年08月22日  来源:  作者:孟培培,刘尧,周梅月,等  点击次数:599次  下载次数:42次

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【摘要】:目的 探讨抗肝纤维化中成药对于酒精性肝病(ALD)相关肾功能减退的影响。方法 回顾性收集首都医科大学附属北京地坛医院2008年8月1日-2016年3月1日收治的ALD住院患者592例,根据应用扶正化瘀胶囊、安络化纤丸或复方鳖甲软肝片是否≥180累计日剂量分为中药组及对照组,对入组患者进行1∶1倾向评分匹配,得到两组患者各187例,记录病史、饮酒量、血常规、肝肾功能、凝血机制和腹部影像学等结果。符合正态分布的计量资料两组间比较采用t检验,非正态分布采用Mann-Whitney U检验,计数资料两组间比较采用χ2检验,Kalplan-Merier法比较两组患者肾功能减退累积发生率。结果 两组患者年龄、饮酒量、合并高血压、糖尿病比例、基线AST、估算肾小球滤过率(eGFR)、尿酸、凝血酶原时间均无显著性差异(P值均>0.05),随访时间36(23~54)个月。尿酸(HR=1.003,95%CI:1.001~1.005,P=0.001)、凝血酶原时间(HR=1.103,95%CI:1.034~1.177,P=0.003)和红细胞体积分布宽度(HR=1.024,95%CI:1.011~1.038,P<0.001)是ALD发生肾功能减退的独立危险因素,抗肝纤维化中成药(HR=0.170,95%CI=0.053~0.552,P=0.003)是发生肾功能减退的独立保护因素,中药组肾功能减退发生率明显低于对照组(16.6% vs 32.1%,χ2=10.263,P=0.001)。对中药组患者的亚组分析中,累计应用中药治疗>24个月时效果最佳(HR=0.210,95%CI:0.084~0.525,P=0.001)。中药组肾功能减退发生时间明显晚于对照组(36个月vs 24个月,Z=-2.652,P=0.008)。结论 抗肝纤维化中成药可以降低ALD患者肾功能减退发生率,延缓肾功能减退发生时间。
【Abstract】:Objective To investigate the effect of anti-liver fibrosis Chinese patent drugs on renal hypofunction associated with alcoholic liver disease (ALD). Methods A retrospective analysis was performed for 592 patients with ALD who were admitted to Beijing Ditan Hospital, Capital Medical University, from August 1, 2008 to March 1, 2016, and according to whether they were treated with Fuzheng Huayu capsules, Anluo Huaxian pills, or Fufang Biejia Ruangan tablets for ≥180 cumulative defined daily doses, they were divided into Chinese medicine group and control group. After propensity score matching at a ratio of 1∶1, two groups were obtained with 187 patients in each group. Related data were recorded, including medical history, drinking amount, routine blood test results, liver and renal function, coagulation, and abdominal imaging findings. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups; the Kaplan-Meier method was used to compare the cumulative incidence rate of renal hypofunction between two groups. Results There were no significant differences between the two groups in age, drinking amount, proportion of patients with hypertension or diabetes, baseline aspartate aminotransferase, estimated glomerular filtration rate, uric acid, and prothrombin time, and the patients were followed up for 36 months (range 23-54 months). Uric acid (hazard ratio [HR]=1.003, 95% confidence interval [CI]: 1.001-1.005, P=0.001), prothrombin time (HR=1.103, 95%CI: 1.034-1.177, P=0.003), and red cell volume distribution width (HR=1.024, 95%CI: 1.011-1.038, P<0.001) were independent risk factors for renal hypofunction in patients with ALD, and anti-liver fibrosis Chinese patent drug was an independent protective factor against renal hypofunction (HR=0.170, 95%CI: 0.053-0.552, P=0.003). The Chinese medicine group had a significantly lower incidence rate of renal hypofunction than the control group (16.6% vs 32.1%, χ2=10.263, P=0.001). The subgroup analysis of the patients in the Chinese medicine group showed that Chinese medicine treatment for >24 months had the best effect (HR=0.210, 95%CI: 0.084-0.525, P=0.001). Compared with the control group, the Chinese medicine group had a significantly longer time to the onset of renal hypofunction (36 months vs 24 months, Z=-2.652, P=0.008). Conclusion Anti-liver fibrosis Chinese patent drugs can reduce the incidence rate and delay the onset of renal hypofunction in patients with ALD.
【关键字】:肝疾病,酒精性; 肾功能不全; 中成药
【Key words】:liver diseases,alcoholic; renal insufficiency; CHINESE PATENT DRUGS
【引证本文】:MENG PP, LIU Y, ZHOU MY, et al. Effect of anti-liver fibrosis Chinese patent drugs in preventing renal hypofunction associated with alcoholic liver disease[J]. J Clin Hepatol, 2020, 36(9): 2030-2034. (in Chinese)
孟培培, 刘尧, 周梅月, 等. 抗肝纤维化中成药预防酒精性肝病相关肾功能减退的疗效评价[J]. 临床肝胆病杂志, 2020, 36(9): 2030-2034.

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