消黄方治疗慢性乙型肝炎(湿热瘀阻型)轻度黄疸的临床疗效

杨宗国; 陈晓蓉; 陆云飞; 刘成

消黄方治疗慢性乙型肝炎(湿热瘀阻型)轻度黄疸的临床疗效

上海市公共卫生临床中心

基金项目:

中医药防治艾滋病、病毒性肝炎等疾病临床科研一体化技术平台体系构建及应用研究(2009ZX10005-019)；

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中图分类号: R259
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出版历程
- 出版日期: 2012-10-20

Decotion in chronic hepatitis B patients (damp-heat blood stasis syndrome) with low-grade jaundice

Research funding:

摘要

摘要:
目的评价消黄方治疗慢性乙型肝炎（湿热瘀阻型）轻度黄疸的临床疗效。方法慢性乙型肝炎（湿热瘀阻型）轻度黄疸患者68例,随机数字表简单随机分组,消黄方组38例,熊去氧胆酸（UDCA）组30例。两组基础治疗方案为拉米夫定100 mg,每天1次,口服（或替比夫定600 mg,每天1次,口服）;复方甘草酸苷60 ml,每天1次,静滴;还原型谷胱甘肽1.2 g,每天1次,静滴。UDCA组加UDCA 250 mg,每天3次,口服;消黄方组加消黄方100 ml,每天2次,口服。疗程4周。治疗前后观察两组中医证候、肝功能、肝纤维化指标及APRI指数变化。结果（1）与UDCA组相比,消黄方治疗慢性乙型肝炎（湿热瘀阻型）轻度黄疸的有效率略高（89.5%vs76.7%）,但差异无统计学意义（P>0.05）。（2）与治疗前相比,消黄方在改善性乙型肝炎轻度黄疸患者肝功能及血脂水平（ALT、AST、GGT、LDH、TBil、DBil、pre-A、TBA、TC、apo-A、HDL等）方面差异有统计学意义（P<0.01或P<0.05）。与UDCA组相比,消黄方可有效降低TBil、DBil、TBA、TC...
- 消黄方 /
- 肝炎,乙型,慢性 /
- 黄疸 /
- 胆汁淤积,肝内
Abstract:
Objective To evaluate the therapeutic efficacy of Xiaohuang Decotion (XHD) in chronic hepatitis B (CHB) patients (damp-heat blood stasis syndrome) with low-grade jaundice.Methods Sixty-eight CHB patients (damp-heat blood stasis syndrome) with low-grade jaundice were assigned to one of two groups by using a random number table: XHD treatment group (n=38) , and ursodeoxycholic acid (UDCA) treatment group (n=30) .All patients received the same basic therapeutic regimen, which included once daily oral 100 mg lamivudine (or 600 mg telbivudine) , once daily injection of 60 ml compound glycyrrhizin, and once daily injection of 1.2 g reduced glutathione.The patients in the UDCA group received 250 mg of UDCA thrice daily.The patients in the XHD group received 100 ml of XHD twice daily.In all cases, the treatment course was four weeks.Traditional Chinese medicine (TCM) clinical symptoms and signs, liver function, liver fibrosis index, and aspartate aminotransferase (AST) -to-platelet ratio index (APRI) score were evaluated in both groups before and after treatment.Results The XHD group showed a higher improvement in TCM symptoms and signs than the UDCA group (89.5% vs 76.7%) , but the difference was not significant (P>0.05) .The XHD group showed significantly greater improvement in liver function and blood lipid levels (including alanine aminotransferase, AST, gamma-glutamyltransferase, lactate dehydrogenase, total bilirubin (TBil) , direct reaction bilibrubin (DBil) , pre-A, total bile acid (TBA) , total cholesterol (TC) , apolipoprotein a1 (apo-A) , and high density lipoprotein;P<0.01 or P<0.05) .XHD treatment produced a significantly greater reduction in TBil, DBil, TBA and TC levels, and elevation in the apo-A level (vs UDCA, P<0.05) .Both treatments significantly reduced the hyaluronic acid level (vs before treatment, P<0.05) , but only the XHD treatment significantly reduced the type IV collagen level (vs before treatment, P<0.05) .XHD treatment also significantly reduced the APRI index (vs before treatment, P<0.01) to a degree that was significantly greater than that produced by the UDCA treatment (P<0.05) .Conclusion XHD can alleviate the TCM clinical symptoms and signs of chronic hepatitis B (damp-heat blood stasis syndrome) in patients with low-grade jaundice.Moreover, XHD can improve the patient's liver function and liver fibrosis index.XHD treatment achieves a better therapeutic effect than UDCA for intrahepatic cholestasis jaundice.
- Xiaohuang Decotion /
- hepatitis B /
- chronic /
- jaundice

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参考文献(26)

[1]Li YM, Yang HZ, Guan WB, et al.Therapeutic effect of tra-ditional Chinese medicine on coagulation disorder and accom-panying intractable jaundice in hepatitis B virus-related liver cirrhosis patients[J].World J Gastroenterol, 2008, 14 (39) :6060-6064.

[2]Tang H, Min GT, Ge B, et al.Evaluation of protective effects of Chi-Zhi-Huang decoction on Phase I drug metabolism of liver injured rats by cocktail probe drugs[J].J Ethnopharmacol, 2008, 117 (3) :420-426.

[3]Zhang XP, Jiang J, Yu YP, et al.Effect of Danshen on apop-tosis and NF-кB protein expression of the intestinal mucosa of rats with severe acute pancreatitis or obstructive jaundice[J].Hepato Pancreatic Dis Int, 2010, 9 (5) :537-546.

[4]王宇亮, 朱平生, 王颖芳.健脾活血法治疗慢性乙型肝炎轻度黄疸23例[J].河南中医学院学报, 2006, 21 (6) :43-44.

[5]许奎, 严兆洪, 王辉, 等.温阳祛瘀化痰方治疗慢性肝炎、肝硬化轻度黄疸32例[J].安徽中医学院学报, 2002, 21 (2) :15-18.

[6] 中华医学会肝病学分会感染病学分会.慢性乙型肝炎防治指南 (2010年版) [J].临床肝胆病杂志, 2011, 27 (1) :I-XVI.

[7]郑筱萸.中药新药临床研究指导原则 (试行) [M].北京:中国医药科技出版社, 2002:143-151.

[8]上海市卫生局.上海市中医病证诊疗常规[M].上海:上海中医药大学出版社, 2003:44-45.

[9]Gores GJ.Mechanisms of cell injury and death in cholestasis and hepatoprotection by ursodeoxycholic acid[J].J Hepa-tol, 2000, 32 (Suppl2) :11-13.

[10]梁扩寰, 李绍白.肝脏病学[M].北京:人民卫生出版社, 2006:515-561.

[11]杨宗国, 陈晓蓉, 刘成.慢性乙型肝炎肝内胆汁淤积性黄疸发病机制的研究概况[J].临床肝胆病杂志, 2011, 27 (12) :1323-1326.

[12]杨沛华, 蔡志诚, 陈怡文, 等.乙肝残留黄疸的发病机制及中西医治疗[J].中国中西医结合消化杂志, 2010, 18 (6) :413-415.

[13]林屹.慢性乙型肝炎重视从“瘀”论治的思路[J].临床医学工程, 2009, 16 (5) :63-64.

[14]刘绍能, 陶夏平, 王融冰, 等.慢性乙型肝炎中医病因病机演变规律研究[J].中国中医药信息杂志, 2007, 14 (12) :14-16.

[15]陆云飞, 陈晓蓉, 慕永平, 等.消黄方联合西药治疗难治性黄疸51例临床观察[J].上海中医药杂志, 2010, 44 (5) :60-62.

[16]陆云飞, 慕永平, 陈晓蓉.消黄方对异硫氰酸-α-萘酯诱导大鼠急性肝损伤的干预作用研究[J].甘肃中医, 2009, 22 (8) :68-70.

[17]陆云飞, 刘成, 陈晓蓉, 等.消黄方对α-萘异硫氰酸酯大鼠黄疸模型肝组织氧化应激的影响[J].中华中医药杂志, 2012, 27 (2) :460-462.

[18]陈灏珠, 林果为.实用内科学[M].北京:人民卫生出版社, 2009:373-389.

[19]Nath NC, Rahman MA, Khan MR, et al.Serum hyaluronic acid (HA) as a predictor of fibrosis in chronic hepatitis B&C virus infection[J].Mymensingh Med J, 2011, 20 (4) :614-619.

[20]Li CH, Piao DM, Xu WX, et al.Morphological and serum hy-aluronic acid, laminin and type IV collagen changes in dimeth-ylnitrosamine-induced hepatic fibrosis of rats[J].World J Gastroenterol, 2005, 11 (48) :7620-7624.

[21]谢仕斌, 姚集鲁, 郑荣琴, 等.血清透明质酸、III型前胶原、IV型胶原水平与肝纤维化的关系[J].中华传染病杂志, 1999, 17 (4) :238-240.

[22]Della CC, Alisi A, Nobili V.Indirect markers of fibrosis in chronic liver diseases:Is aspartate transaminase-to-plate-let ratio (APRI) a useful test?[J].Hepat Mon, 2011, 11 (7) :558-559.

[23]Mahtab MA, Rahman S, Khan M, et al.APRI is not an use-ful predictor of fibrosis in CHE[J].Hepatol, 2008, 48 (suppl 2) :S247.

[24]Shin WG, Park SH, Jang MK, et al.Aspartate aminotransferase to platelet ratio index (APRI) can predict liver fibrosis in chronic hepatitis B[J].Dig Liver Dis, 2008, 40 (4) :267-274.

[25]Shin WG, Jang MK, Park SH, et al.Efficacy of aspartate aminotransferase to platelet ratio index (APRI) on prediction of hepatic fibrosis in chronic hepatitis B[J].Gastroenterolo-gy, 2007, 132 (4) :A763.

[26]Liu HB, Zhou JP, Zhang Y, et al.Prediction on liver fibrosis using different APRI thresholds when patient age is a cate-gorical marker in patients with chronic hepatitis B[J].Clin Chim Acta, 2001, 412 (1-2) :33-37.

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