摘要
目的观察新清开方防治慢性乙型肝炎后肝硬化合并轻微型肝性脑病(MHE)的临床疗效。方法将68例慢性乙型肝炎后肝硬化合并MHE患者随机分为防治组和对照组,每组34例。在常规抗病毒、保肝及对症支持治疗的基础上,防治组予新清开方口服,对照组予乳果糖口服溶液口服,两组疗程均为30 d。观察两组临床转归情况,比较神经心理学测试指标(NCT-A、DST)、相关生化指标[肝功能中的丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、白蛋白(A)及血氨、内毒素]、肠道菌群的微生物学定量分析指标等的变化情况。结果 (1)最终完成试验者共64例,防治组33例,对照组31例。(2)治疗前后组内比较,两组NCT-A、DST水平差异均有统计学意义,其中NCT-A水平均明显降低,DST水平均明显升高(P<0.05);组间治疗后比较,NCT-A、DST水平的改善情况,防治组均明显优于对照组(P<0.05)。(3)治疗前后组内比较,两组ALT、AST、A、血氨、内毒素水平差异均有统计学意义,其中ALT、AST、血氨、内毒素水平明显降低,A水平明显升高(P<0.05);组间治疗后比较,ALT、AST、A、血氨、内毒素水平的改善情况,防治组均明显优于对照组(P<0.05)。(4)治疗前后组内比较,两组大肠埃希菌、粪肠球菌、双歧杆菌、乳酸杆菌水平差异均有统计学意义,其中大肠埃希菌水平明显降低,粪肠球菌、双歧杆菌、乳酸杆菌水平明显升高(P<0.05);组间治疗后比较,防治组大肠埃希菌水平明显低于对照组,双歧杆菌水平明显高于对照组(P<0.05)。(5)疗程结束后,两组均未出现转重为临床型肝性脑病者。两组复常率比较(27.3%与6.5%),防治组明显高于对照组(P<0.05)。结论新清开方可以更好地提高慢性乙型肝炎后肝硬化合并MHE患者的认知能力,改善其肝功能及血氨、内毒素水平,调节肠道菌群,改善其临床转归情况,对本病有一定的防治作用。
Objective To observe the clinical effect of Xinqingkai Decoction on chronic HBV infection-induced liver cirrhosis complicated with mild hepatic encephalopathy(MHE). Methods Sixty-eight patients with chronic HBV infection-induced liver cirrhosis complicated with MHE were randomly divided into prevention and treatment group(n=34) and control group(n=34). On the basis of routine treatment of antivirus and liver protection, as well as symptomatic support treatment, the prevention and treatment group was administered with Xinqingkai Decoction orally, while the control group was administered with Lactulose Oral Solution. The course of treatment in both groups was 30 days. The clinical prognosis of the two groups was observed,and the changes of neuropsychological test indexes( NCT-A,DST),related biochemical indexes [alanine aminotransferase( ALT),aspartate aminotransferase( AST),albumin( A),blood ammonia and endotoxin in liver function] and microbiological quantitative analysis indexes of intestinal microbiota were compared before and after intervention. Results(1) A total of 64 cases completed the experiment,33 cases in the prevention and treatment group and 31 cases in the control group.(2)There were significant differences in NCT-A and DST levels before and after treatment within both groups. NCT-A levels reduced significantly and DST levels increased significantly after treatment( P<0.05);After treatment,the improvement of NCT-A and DST levels in the prevention and treatment group was significantly better than that in the control group( P<0.05).(3)There were significant differences in levels of ALT,AST,albumin,blood ammonia and endotoxin before and after treatment within two groups. The levels of ALT,AST,blood ammonia and endotoxin decreased significantly and the level of albumin increased significantly( P<0.05);After treatment,the improvement of ALT,AST,albumin,blood ammonia and endotoxin levels in the prevention and treatment group was significantly better than that in the control group( P < 0. 05).(4) The levels of Escherichia coli,Enterococcus faecalis,Bifidobacterium and Lactobacillus were significantly different before and after treatment within the two groups. The levels of Escherichia coli decreased significantly,while the levels of Enterococcus faecalis,Bifidobacterium and Lactobacillus increased significantly( P<0.05). After treatment,the level of Escherichia coli in the prevention and treatment group was significantly lower than that in the control group,and the level of Bifidobacterium was significantly higher than that in the control group( P < 0. 05).(5) After the course of treatment,no case was found turning into clinical hepatic encephalopathy in both groups. The recovery rate of the two groups was 27.3% and 6.5%,respectively,and the recovery rate was significantly higher in the prevention and control group than that in the control group( P< 0.05). Conclusion Xinqingkai Decoction has certain prevention and treatment effects on chronic HBV infectioninduced liver cirrhosis complicated with MHE as it can better improve the cognitive ability,liver function,blood ammonia and endotoxin levels,regulate intestinal microbiota and improve the clinical outcome.
作者
廖冰灵
祝峻峰
王灵台
赵钢
LIAO Bingling;ZHU Junfeng;WANG Lingtai;ZHAO Gang(Department of Castroenterology,Serenth People's Hospital Affiliated to Shanghai University of Traditional ChineseMedicine,Shanghai 200137,China;Department of Hepatology,Shanghai Hospital of Traditional Chinese Medicine Afiliated to ShanghaiUniversity of Traditional Chinese Medicine,Shanghai 200071,China;Department of Hepatology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200021,China)
出处
《上海中医药杂志》
2021年第2期63-67,共5页
Shanghai Journal of Traditional Chinese Medicine
基金
国家“艾滋病和病毒性肝炎等重大传染病防治”科技重大专项资助项目(2018ZX10725-505)
上海市科委科研计划项目(17401933600)
上海市卫计委促进市级医院临床技能与临床创新能力三年行动计划项目(16CR3075B)
上海市卫计委中医优势病种培育项目(zybz-2017012)
上海中医药大学附属第七人民医院人才培养计划项目(XX2019-07)。
关键词
新清开方
轻微型肝性脑病
慢性乙型肝炎后肝硬化
临床转归
肠道菌群
肝肠循环
王灵台
Xinqingkai Decoction
mild hepatic encephalopathy
chronic HBV infection-induced liver cirrhosis
clinical prognosis
intestinal microbiota
hepato-intestinal circulation
Wang Lingtai
