益气消鼓汤合利水贴对乙型肝炎肝硬化腹水患者GH、IGF-1的影响
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R442.5;R657.3+1

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河北省中医药管理局科研基金项目(2015253)


Yiqi Xiaogu Tang and Lishui Patch Has Effect on GH and IGF-1 of Patients with HBV-related Posthepatitic Cirrhosis Ascties
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    摘要:

    目的:观察益气消鼓汤合利水贴对乙型肝炎肝硬化腹水患者的治疗效果并探讨其可能的机制。方法:将68例乙型肝炎肝硬化腹水患者随机分为2组各34例,对照组采用常规治疗,治疗组在此基础上加用益气消鼓汤口服合利水贴外贴脐部。治疗8周后,比较2组治疗前后症状、体征、肝功能、血清生长激素(GH)、胰岛素样生长因子-1(IGF-1)。结果:2组临床疗效比较,总有效率治疗组94.12%,对照组85.29%,差异有统计学意义(P<0.05)。治疗后,2组体质量减少量、腹围减少量分别比较,差异均有统计学意义(P<0.05)。治疗组24 h总尿量多于对照组,差异有统计学意义(P<0.05)。治疗组平均每日大便次数与对照组比较,明显增多,差异有统计学意义(P<0.05)。治疗组呋噻米、螺内酯应用量均明显少于对照组,2组比较,差异均有统计学意义(P<0.05)。对照组应用白蛋白的病例数明显多于治疗组,差异有统计学意义(P<0.05)。2组白蛋白应用量比较,因方差不齐,应用两独立样本的秩和检验,差异有统计学意义(P<0.05)。2组肝功能、凝血功能等指标丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、白蛋白(Alb)、总胆红素(TBil)、凝血酶原活动度(PTA)分别与治疗前比较,差异均有统计学意义(P<0.05);治疗后治疗组白蛋白/球蛋白(A/G) 与治疗前比较,差异有统计学意义(P<0.05)。治疗后,2组ALT、AST、Alb、TBil、PTA、A/G分别比较,差异均有统计学意义(P<0.05)。治疗后,治疗组GH较本组治疗前及对照组治疗后均低,差异均有统计学意义(P<0.05);治疗组IGF-1较本组治疗前及对照组治疗后均高,差异均有统计学意义(P<0.05)。结论:益气消鼓汤合利水贴治疗乙型肝炎肝硬化腹水患者具有较好的疗效,可以减轻临床症状,可能通过刺激IGF-1升高,进而刺激肝脏蛋白质的合成,克服肝硬化的生长激素抵抗有关。

    Abstract:

    Objective:To observe the therapeutic effect of Yiqi Xiaogu tang and Lishui patch on patients with cirrhosis ascites caused by hepatitis B virus and explore its possible mechanism.Methods:Divided 68 cases of patients with cirrhosis ascites caused by hepatitis B virus into two groups randomly,34 cases in each group.The control group was given routine treatment,while the treatment group was additionally given oral administration of Yiqi Xiaogu tang and Lishui patch attached to the umbilicus based on the treatment of the control group.After eight weeks of treatment,compared the symptoms,signs,liver function,growth hormone(GH)in serum and insulin-like growth factor-1(IGF-1)before and after treatment in the two groups.Results:Compared the clinical effect in the two groups,the total effective rate was 94.12%in the treatment group and was 85.29%in the control group,the difference being significant(P<0.05).After treatment,the respectivecomparison of weight loss and the reduction of abdominal circumference between the two groups showed significance in differences(P<0.05,P<0.01).The total urine volume within 24 hours in the treatment group was more than that in the control group,the difference being significant(P<0.05).The average times of daily defecation in the treatment group was obviously increased when compared with that in the control group,the difference being significant(P<0.05).The dosage of furosemide and spironolactone in the treatment group was obviously less than that in the control group,differences being significant(P<0.05).There were more cases of albumin used in the control group than in the treatment group,the difference being significant(P<0.05).When compared the dosage of albumin between the two groups,due to the heterogeneity of variance and the application of rank sum test of two independent samples,the difference was significant(P<0.05).The comparisons ofliverfunction and indexes ofprothrombin activity as Alanine aminotransferase(ALT),Aspartate aminotransferase(AST), Albumin(Alb), Total bilirubin(TBil)and prothrombin time activity(PTA)in the two groups showed significance in differences when respectively compared with those before treatment(P<0.05).The A/G after treatment in the treatment group was compared with that before treatment,difference being significance(P<0.05).After treatment, the comparisons of the ALT,AST,Alb,TBil,PTA and A/G between the two groups showed significance in differences(P<0.05).After treatment,the GH in the treatment group was lower than that before treatment and was also lower than that in the control group after treatment,differences was significant(P<0.05).The IGF-1 in the treatment group was higher than that before treatment and was also higher than that in the control group after treatment,differences was significantP< 0.05).Conclusion:The therapy of Yiqi Xiaogu tang and Lishui patch has good curative effect in treating patients with cirrhosis ascites caused by hepatitis B virus,which can relieve the clinical symptoms.The mechanism is possibly related to that the therapy stimulates the increase of IGF-1 so as to stimulate the synthesis of liver proteins and overcome the growth hormone resistance of cirrhosis.

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王兴,田力铭,刘建涛,梁震峰,吴凤影,李敏轩,孟明辉.益气消鼓汤合利水贴对乙型肝炎肝硬化腹水患者GH、IGF-1的影响[J].新中医,2018,50(5):79-83

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  • 在线发布日期: 2018-05-03
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