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中医特色慢病管理在社区慢性乙型肝炎患者中的效果评价
Clinical effect of chronic disease management with traditional Chinese medicine characteristics in community patients with chronic hepatitis B
文章发布日期:2018年07月06日  来源:  作者:萧焕明,张其鹏,施梅姐,等  点击次数:408次  下载次数:63次

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【摘要】:目的观察中医特色慢病管理方案干预社区慢性乙型肝炎(CHB)患者的疗效。方法采用非随机病例对照的研究方法,选取2014年-2016年在广州天河社区就诊的84例CHB患者为研究对象,将其分成中医慢病管理组和对照组,每组42例。中医慢病管理组给予恩替卡韦片(0.5 mg,1次/d,口服)治疗和中医慢病管理;对照组给予恩替卡韦片治疗和常规疾病基础知识教育及服药指导。治疗48周后比较两组患者ALT复常率、HBeAg血清学转换率、HBV DNA阴转率、中医症状积分、生存质量积分等的差异。符合正态分布的计量资料组间比较采用两独立样本t检验,治疗前后的比较采用配对t检验;非正态分布的计量资料采用相对应的非参数检验方法进行分析。计数资料两组间比较采用χ2检验或Fisher确切概率法。结果治疗48周后,中医慢病管理组的临床证候积分明显低于对照组(3.66±1.92 vs 6.42±2.48,t=5.563,P<0.001),且生存质量总分明显高于对照组(550.75±54.24 vs 491.08±54.21,t=-4.888,P<0.001)。中医慢病管理组的48周ALT复常率(80.00% vs 72.22%,χ2=0.590,P=0.443)、HBV DNA阴转率(73.17% vs 68.42%,P>0.05)、HBeAg血清学转换率(29.27% vs 18.42%,P>0.05)均稍高于对照组,但差异均无统计学意义。结论中医特色慢病管理能够改善社区慢性乙型肝炎患者临床症状,提高患者生存质量,同时,对于提高患者抗病毒疗效有一定意义,值得在社区进一步推广应用。
【Abstract】:ObjectiveTo investigate the clinical effect of chronic disease management with traditional Chinese medicine (TCM) characteristics in community patients with chronic hepatitis B (CHB). MethodsA non-randomized case-control study was performed for 84 CHB patients who visited Tianhe Community in Guangzhou from 2014 to 2016. These patients were divided into TCM chronic disease management group and control group, with 42 patients in each group. The patients in the TCM chronic disease management group were given oral entecavir tablets (0.5 mg, once a day) combined with TCM chronic disease management, and those in the control group were given entecavir tablets, education on disease knowledge, and instructions on medication. The two groups were compared in terms of alanine aminotransferase (ALT) normalization rate, HBeAg seroconversion rate, HBV DNA clearance rate, TCM symptom score, and quality-of-life score after 48 weeks of treatment. The two-independent-samples t test was used for comparison of normally distributed continuous data between groups, and the paired t-test was used for comparison before and after treatment; the non-parametric 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, and the Fisher′s exact test was used when more than 20% of the cells have an expected frequency of less than 5. ResultsAfter 48 weeks of treatment, the TCM chronic disease management group had a significantly lower clinical syndrome score and a significantly higher overall quality-of-life score than the control group (clinical syndrome score: 3.66±1.92 vs 6.42±2.48, t=5.563, P<0.001; overall quality-of-life score: 550.75±54.24 vs 491.08±54.21, t=-4.888, P<0.001). Compared with the control group, the TCM chronic disease management group had slightly higher 48-week ALT normalization rate (80.00% vs 72.22%, χ2=0.590, P=0.443), HBV DNA clearance rate (73.17% vs 68.42%, P>0.05), and HBeAg seroconversion rate (29.27% vs 18.42%, P>0.05). ConclusionIn community patients with CHB, chronic disease management with TCM characteristics can improve their clinical symptoms, quality of life, and antiviral outcome and thus holds promise for clinical application in community.
【关键字】:肝炎, 乙型, 慢性; 社区卫生服务; 中医; 疾病管理
【Key words】:hepatitis B, chronic; community health services; Traditional Chinese Medicine; disease management
【引证本文】:XIAO HM, ZHANG QP, SHI MJ, et al. Clinical effect of chronic disease management with traditional Chinese medicine characteristics in community patients with chronic hepatitis B[J]. J Clin Hepatol, 2018, 34(8): 1669-1673. (in Chinese)
萧焕明, 张其鹏, 施梅姐, 等. 中医特色慢病管理在社区慢性乙型肝炎患者中的效果评价[J]. 临床肝胆病杂志, 2018, 34(8): 1669-1673.

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