【作者】 宋洪泉；

【导师】 尹常健；

【作者基本信息】 山东中医药大学 ， 中西医结合临床， 2009， 博士

【摘要】 目的:总结茵兰益肝颗粒治疗急性药物性肝损伤的临床疗效并探讨其作用机制。方法:临床选择符合纳入标准的急性药物性肝损伤患者61例,随机分为两组,治疗组31例给予茵兰益肝颗粒,对照组30例给予西利宾胺片,观察两组的临床疗效;以不同剂量茵兰益肝颗粒与西利宾胺对对乙酰氨基酚(AP)造成的昆明系小鼠急性肝损伤模型进行预防,分析茵兰益肝颗粒防治急性药物性肝损伤的作用机制。结果:临床研究显示,茵兰益肝颗粒对胁肋疼痛、脘闷腹胀、口干而苦、烦躁易怒、大便秘结等症状的改善明显优于西利宾胺,对小便色黄、纳差、困倦乏力的消除和改善优于西利宾胺,对身目色黄、口中粘腻、大便溏泄、肝脾肿大等症状的改善与西利宾胺相似,茵兰益肝颗粒总有效率明显优于西利宾胺片;茵兰益肝颗粒能降低急性药物性肝损伤患者ALT、AST等肝功能指标,降低程度与西利宾胺片相似;在降低血清ALP、TBil等肝功指标上,疗效优于西利宾胺片;茵兰益肝颗粒与西利宾胺片对肝脏B超的改善程度相似。实验结果显示,茵兰益肝颗粒可对抗AP所致小鼠急性肝损害,升高GSH、SOD水平,降低TNF-α及MDA水平,抑制CYP2E1表达,减轻肝细胞脂肪变性。结论:茵兰益肝颗粒能消除和改善急性药物性肝损伤的临床症状,促进肝功能的恢复,疗效优于西利宾胺,是治疗急性药物性肝损伤的有效药物,其作用机制与维持GSH含量、抑制CYP2E1表达、抗肝细胞变性及抑制炎症反应、减少细胞因子尤其是TNFα的释放、抗氧应激和脂质过氧化有关,尚有其他机制参与其中。更多还原

【Abstract】 Objective: To observe the effect of Yinlanyigan granules on the Acute Drug-induced Disease and explore the mechanism of it. Methods: Clinical study :61 patients with Acute Drug-induced Disease were divided into two groups at random:the treatment group and the control group. The treatment group was given Yinlanyigan granules,the control group was given Silybin Meglumine Tablets. Observe the clinical efficacy. Experiment study: 72 normal KD mice were randomly divided into 6 groups. The Acute Drug-induced Disease rat Model were established with AP. Observe the decoction effects of Yinlanyigan granules on ALT, AST, TNF-α, SOD , GSH, CYP2E1, fat content and cell construction. Results: The treatment group’s main effective rate of the syndrome of TCM、the results of liver function test are better than the control group’s. Yinlanyigan granules can improve SOD and GSH, reduce TNF-αand MDA, restrain the expression of CYP2E1, correct lipid metabolism mess. Conclusions: Yinlanyigan granules is a effective drug of treating Acute Drug-induced Disease, it can moderate clinical symptom, alleviate the patients’sufferings rapidly. The mechanism contains improving SOD and GSH, reducing TNF-αand MDA, restraining the expression of CYP2E1 and correcting lipid metabolism mess.更多还原