【作者】 刘熳天；

【导师】 薛博瑜；

【作者基本信息】 南京中医药大学 ， 中医内科肝胆病， 2012， 硕士

【摘要】 研究背景：原发性胆汁性肝硬化(PBC)是欧美等发达国家常见病之一,既往在我国发病率较低,但调查研究显示我国发病率呈逐年上升趋势,本病患者90%以上为35-65岁女性,男女发病比率为1：10,有明显家族聚集倾向,临床可见标志性自身抗体,免疫球蛋白升高,合并免疫系统疾病。本病病因和发病机制不明确,治疗上无法针对病因治疗,仍以对症支持治疗为主,尚缺乏特异性治疗药物。疏肝利胆活血化瘀法,从“湿热瘀毒”理论出发,基于国医大师周仲英教授治疗慢性肝病的多年临证经验,结合本病发病特点,以疏肝、清化共奏利胆之功。临证运用时在此基础上辨证加减,以达到祛邪顾正,邪去正安的功效。研究目的：通过临床试验,观察疏肝利胆活血化瘀法联合UDCA治疗原发性胆汁性肝硬化的临床疗效,为本病的临床治疗提供有效方药。方法：选择30例符合入选标准的PBC患者,随机分为治疗组和对照组,治疗组予以疏肝利胆活血化瘀为治法的中药联合熊去氧胆酸(优思弗)治疗,对照组予优思弗治疗,疗程为6个月,记录治疗前后两组患者症状体征、肝功能、凝血、肝纤维化等指标的变化,采用SPSS13.0进行统计学处理,对比分析疗效,评价疏肝利胆活血化瘀法的临床疗效。结果：治疗组能明显改善患者乏力、胁痛、黄疸、皮肤瘙痒等临床症状及体征,对于ALT、ALP、TBil、GGT等肝功能指标改善作用显著,在改善患者凝血功能、肝纤维化等指标方面较对照组具有明显优势。结论：疏肝利胆活血化瘀法治疗PBC临床疗效显著,值得进一步深入研究。更多还原

【Abstract】 Background:Primary biliary cirrhosis (PBC) is one of the common diseases of Europe and the United States and other developed countries, the past incidence is relatively low in China, but research shows that China’s incidence rate showed an increasing trend, the patients with more than90%35-65year-old female, male and female incidence ratio of1:10, there is significant familial aggregation tendency, visible clinical signs of autoantibodies, elevated immunoglobulin combined immune system diseases, the etiology and pathogenesis of this disease is not clear, the treatment can not betreatment for the cause is still symptomatic and supportive therapy, yet the lack of specific therapy ways, the treatment of promoting blood circulation for removing blood stasis and dispersing stagnated liver qi for promoting bile flow, based on years of clinical experience of the National Medical master Professor Zhou Zhongying the treatment of chronic liver disease, starting from the theory of damp-heat and blood-stasis-toxin characterized by the chronic liver dieases, Clearing damp-heat and blood-stasis-toxin and dispersing stagnated liver qi totally played the achievements of promoting bile flow. On this basis, the use of the Clinical dialectical addition and subtraction, care is to achieve the banishment of evil spirits, evil to positive safety efficacy.Objective:through clinical trials to observe the clinical efficacy treatment of promoting blood circulation for removing blood stasis and dispersing stagnated liver qi for promoting bile flow combined with UDCA treatment of primary biliary cirrhosis, the clinical treatment of this disease provide a valid prescription.Methods:30cases of PBC patients met the inclusion criteria, treatment combinations were randomly divided into control group, main square of the Chinese medicine combined with ursodeoxycholic acid (UDCA) treatment in the control group to the UDCA treatment, treatment for six months, two groups of patients with symptoms and signs, liver function, blood coagulation and other indicators of change in the record before and after treatment, using SPSS13.0for statistical analysis, comparative analysis of efficacy evaluation treatment of promoting blood circulation for removing blood stasis and purging liver and gallbladder with dispersing stagnated liver qi for promoting bile flow is the clinical efficacy of the law.Result:The treatment group significantly improved the clinical symptoms and signs of patients with fatigue, hypochondriac pain, jaundice, skin itching, role of ALT、ALP、TBil and GGT and other liver function indicators improved significantly in improving the blood coagulation, liver fibrosisthan the control group has obvious advantages. Conclusion:treatment of promoting blood circulation for removing blood stasis and dispersing stagnated liver qi for promoting bile flow, the clinical efficacy of the treatment of PBC significantly, is worth further study.更多还原