理气健脾方预防乙型肝炎肝硬化合并重度食管胃底静脉曲张患者1年内出血的疗效评价

侯艺鑫; 杨志云; 杨玉英; 江宇泳; 王宪波

doi:10.3969/j.issn.1001-5256.2019.04.015

理气健脾方预防乙型肝炎肝硬化合并重度食管胃底静脉曲张患者1年内出血的疗效评价

DOI: 10.3969/j.issn.1001-5256.2019.04.015

首都医科大学附属北京地坛医院中西医结合二科

基金项目:

国家自然科学基金(81774234,81473641)；北京市医院管理局临床医学发展专项经费资助(ZYLX201707)；北京市科学技术委员会“首都临床特色应用研究”资助项目(Z181100001718052)；

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中图分类号: R259
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出版历程
- 出版日期: 2019-04-20

Clinical effect of Liqi Jianpi prescription in preventing hemorrhage within one year in patients with hepatitis B cirrhosis and severe esophageal and gastric varices

Second Department of Integrated Traditional Chinese and Western Medcine, Beijing Ditan Hospital, Capital Medical University

Research funding:

摘要

摘要: 目的探究理气健脾方对乙型肝炎肝硬化合并重度食管胃底静脉曲张患者1年内出血风险的影响。方法选取2010年1月-2017年8月在北京地坛医院住院确诊为乙型肝炎肝硬化合并食管胃底静脉曲张重度的患者117例,分为治疗组（n=52）与对照组（n=65）,2组患者均给予临床常规治疗,治疗组在此基础上加用理气健脾方汤剂口服。观察患者1年内上消化道出血发生率及治疗前后肝功能、胃镜检查、Child-Pugh分级情况。符合正态分布的计量资料组间比较采用t检验;不符合正态分布的计量资料组间比较采用Mann-Whitney U检验;计数资料组间比较采用χ2检验。结果治疗组1年内食管胃底静脉曲张破裂出血率为19. 2%,对照组为38. 5%,两组比较差异有统计学意义（χ2=4. 112,P=0. 038）;治疗组治疗后的血清Alb水平与治疗前比较差异有统计学意义（t=0. 934,P=0. 037）,与对照组治疗后比较,差异亦有统计学意义（t=2. 928,P <0. 05）。治疗组患者门静脉宽度治疗前为（14. 1±2. 7） mm,治疗后为（12. 2±2....
- 肝炎,乙型,慢性 /
- 肝硬化 /
- 食管和胃静脉曲张 /
- 胃肠出血 /
- 理气健脾方 /
- 治疗结果
Abstract: Objective To investigate the effect of Liqi Jianpi prescription on the risk of hemorrhage within one year in patients with hepatitis B cirrhosis and severe esophageal and gastric varices. Methods The patients who were hospitalized in Beijing Ditan Hospital from January2010 to August 2017 and were diagnosed with hepatitis B cirrhosis and esophageal and gastric varices were enrolled and divided into treatment group and control group. All patients were given conventional treatment, and the patients in the treatment group were given oral Liqi Jianpi decoction in addition to the conventional treatment. The incidence of upper gastrointestinal bleeding within one year was observed, and liver function, gastroscopy findings, and Child-Pugh class were observed before and after treatment. 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. Results There was a significant difference in the rate of esophagogastric variceal bleeding within one year between the treatment group and the control group ( 19. 2%vs 38. 5%, χ2= 4. 112, P = 0. 038) . The treatment group had a significant change in serum albumin level after treatment ( t = 0. 934, P <0. 05) , and there was a significant difference in serum albumin level between the two groups after treatment ( t = 2. 928, P < 0. 05) . In the treatment group, portal vein width decreased significantly from 14. 1 ± 2. 7 mm before treatment to 12. 2 ± 2. 4 mm after treatment ( t =2. 829, P < 0. 01) ; in the control group, portal vein width was 14. 6 ± 2. 8 mm before treatment and 14. 3 ± 2. 5 mm after treatment ( t =0. 718, P < 0. 05) . After treatment, the treatment group had a significantly smaller portal vein width than the control group ( t = 1. 715, P <0. 05) . In the treatment group, the number of patients with red color sign decreased significantly from 20 before treatment to 9 after treatment ( χ2= 0. 884, P = 0. 08) ; after treatment, the degree of esophageal and gastric varices was alleviated, and the number of patients with severe varices decreased from 52 before treatment to 38 after treatment ( χ2= 0. 982, P = 0. 038) . Conclusion In patients with hepatitis B cirrhosis and severe esophageal and gastric varices, Liqi Jianpi prescription can reduce the incidence rate of upper gastrointestinal bleeding within one year, improve liver function, reduce portal vein width, and improve the degree of esophageal and gastric varices.
- hepatitis B, chronic /
- liver cirrhosis /
- esophageal and gastric varices /
- gastrointestinal hemorrhage /
- Liqi Jianpi Fang /
- treatment outcome

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参考文献(15)

[1]DAMICO G, DEFRANCHIS R.Upper digestive bleeding in cirrhosis[J].Hepatology, 2003, 38 (3) :599-612.

[2]CARBONELL N, PAUWELS A, SERFATY L, et al.Improved survival after variceal bleeding in patients with cirrhosis over the past two decades[J].Hepatology, 2004, 40 (3) :652-659.

[3]ZHANG C, THABUT D, KAMATHP S, et al.Oesophageal varices in cirrhotic patients:From varicealscreening to primary prophylaxis of the firs oesophageal variceal bleeding[J].Liver Int, 2011, 31:108-119.

[4]Chinese Society of Hepatology, Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B (2010 version) [J].J Clin Hepatol, 2011, 27 (1) :Ⅰ-ⅩⅥ. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2010版) [J].临床肝胆病杂志, 2011, 27 (1) :Ⅰ-ⅩⅥ.

[5]WANG JY.Internal medicine (2nd edition) [M].Beijing:People's Medical Publishing House, 2010. (in Chinese) 王吉耀.内科学 (第二版) [M].北京:人民卫生出版社, 2010.

[6]Chinese Society of Hepatology, Chinese Medical Association;Chinese Society of Gastroenterology, Chinese Medical Association;Chinese Society of Endoscopy, Chinese Medical Association.Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J].J Clin Hepatol, 2016, 32 (2) :203-219. (in Chinese) 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].临床肝胆病杂志, 2016, 32 (2) :203-219.

[7]YANG Q, FENG YY, JIANG SL.Experiences of professor Yao Xixian in treating chronic hepatic fibrosis based on blood stasis theory[J].China J Tradit Chin Med Pharma, 2007, 22 (3) :168-171. (in Chinese) 杨倩, 冯玉彦, 蒋树林.姚希贤瘀血论治慢性肝纤维化经验[J].中华中医药杂志, 2007, 22 (3) :168-171.

[8]SHEN Z, WANG F.Yin Changjian’s experience in treating liver fibrosis of chronic liver disease[J].Shandong J Tradit Chin Med, 2011, 30 (4) :264-266. (in Chinese) 神州, 王芳.尹常健治疗慢性肝病肝纤维化经验[J].山东中医杂志, 2011, 30 (4) :264-266.

[9]HAO JM, CHEN XN, YUAN C, et al.Professor Yang Zhen’s experience in differentiating liver fibrosis from chronic liver disease[J].Chin J Integr Tradit West Med Liver Dis, 2013, 23 (1) :52-54. (in Chinese) 郝建梅, 陈香妮, 袁超, 等.杨震教授分型辨治慢性肝病肝纤维化的经验[J].中西医结合肝病杂志, 2013, 23 (1) :52-54.

[10]LIU Y.Clinical study and TCM syndromes analysis of combined Chinese and Western medicine treatment of cirrhosis associated with intestinal dysfunction[D].Beijing:Beijing University of Chinese Medicine, 2014. (in Chinese) 刘洋.肝硬化伴肠功能障碍中西医结合治疗的临床研究及中医证候分析[D].北京:北京中医药大学, 2014.

[11]ZHANG T, ZHANG B, WU M, et al.Research progress of liver-soothing and spleen-invigorating therapy in the treatment of post-hepatitis B cirrhosis[J].J Changchun Univ Chin Med, 2018, 34 (6) :1218-1221. (in Chinese) 张涛, 张斌, 吴眉, 等.疏肝健脾法治疗乙肝后肝硬化临床应用概述[J].长春中医药大学学报, 2018, 34 (6) :1218-1221.

[12]YANG TY.Effect of spleen humidification and detoxification on the model of acute liver failure induced by TAA[D].Beijing:Beijing University of Chinese Medicine, 2013. (in Chinese) 杨天翼.健脾化湿解毒方对TAA诱导的急性肝衰竭小鼠模型的影响[D].北京:北京中医药大学, 2013.

[13]BOSE S, HANK W, LEEM J, et al.Intestinal protective effects of herbal-based formulations in rats against neomycin insult[J].Evid Based Complement Alternat Med, 2013, 2013:161-178.

[14]CAO M, WANG P, SUN C, et al.Amelioration of IFN-γand TNF-α-induced intestinal epithelial barrier dysfunction by berberine via suppression of MLCK-MLC phosphorylation signaling pathway[J].PLo S One, 2013, 8 (5) :e61944.

[15]HUNG ZP, LIANG KH.Effects of DangGui on portal hemodynamics in normal and cirrhotic dogs[J].Chin J Dig, 1994, 14 (1) :31-33. (in Chinese) 黄自平, 梁扩寰.当归对正常及肝硬化犬门脉血液动力学的影响[J].中华消化杂志, 1994, 14 (1) :31-33.

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