【作者】 袁渊；

【导师】 王陆军； 薛博瑜；

【作者基本信息】 南京中医药大学 ， 中医学， 2012， 硕士

【摘要】 目的：观察加味瓜蒌散治疗肝炎后肝硬化门脉高压症的临床疗效,并与心得安对照组相比较,评价加味瓜蒌散对乙型肝炎后肝硬化门脉高压症的治疗效果。方法：选择住院治疗的乙型肝炎后肝硬化门静脉高压症患者97例,分为治疗组(49例)和对照组(48例),治疗组服用中药方剂“加味瓜蒌散”,对照组口服心得安片剂。疗程为3个月。在治疗前后分别观察患者的临床症状、体征、肝功能、肝纤维化指标、血流动力学及血管内皮生长因子的变化,比较两组患者的疗效。结果：(1)临床症状体征比较：两组患者在治疗后胁痛、乏力、纳差、腹胀、胁下痞块、口干苦、舌象、脉象等主要临床症状、体征均有不同程度好转,总积分值下降。两组病例的总积分前后差异具有显著性(P<0.05)。(2)肝功能比较：两组病例治疗后ALT、TBIL、ALB三项指标均有不同程度的改善。组间比较,两组病例治疗后在ALT、TBIL方面差异具有统计学意义(P<0.05)。两组治疗后ALB均升高,但治疗组与对照组之间的差异无显著性(P>0.05)。(3)肝纤维化指标的比较：两组治疗后HA、PCIII、 IVC、LN均有不同程度下降,对照组治疗前后比较差异无统计学意义(P>0.05),治疗组治疗前后差异有显著性(P<0.05或0.01)。(4)血流动力学结果：治疗组服用加味瓜蒌散3个月后门静脉内径、血流量与用药前比较差异具有显著性(P<0.05),血流速度治疗前后与对照组比较无显著差异(P>0.05)。(5)血管内皮生长因子改变情况：治疗组服用加味瓜蒌散3个月后血管内皮生长因子与用药前比较差异显著(P<0.05),与对照组比较有显著差异(P<0.05)。结论：加味瓜蒌散能有效改善乙型肝炎后肝硬化门脉高压患者的临床症状及体征,改善肝功能,降低肝纤维化指标水平,能够使患者门静脉内径缩小,血流速度、血流量减慢或降低,并能有效降低患者血管内皮生长因子水平。其作用机制可能与其抗纤维化,阻止肝硬化形成,降低门脉压力,改善肝脏微循环等有关。更多还原

【Abstract】 Objective:This research aims to observe the clinical efficacy of the flavored Gualou San treatment of hepatitis, cirrhosis and portal hypertension, and a control group taking propranolol compared to evaluate the efficacy of the flavored Gualou San treatment of hepatitis, cirrhosis and portal hypertension.Methods:97cases of hepatitis B cirrhosis and portal hypertension in patients hospitalized divided into treatment group (49cases) and control group (48cases), the treatment group taking Chinese medicines the flavored Gualou San,the control group was treated with propranolol. Course of three months. Efficacy observed in patients with clinical symptoms and signs before and after treatment, liver function, liver fibrosis, hemodynamics and vascular endothelial growth factor changes between the two groups.Results:(1) Clinical signs and symptoms:After treatment, hypochondriac pain, fatigue, anorexia, abdominal distension, Pollution lump in the abdomen, dry mouth, bitter, tongue, pulse, etc. The main clinical symptoms and signs were improved to varying degrees. The total score decreased. The total score before and after the two groups were significantly different (P<0.05).(2) The liver function:The two groups of patients, theALT, TBIL, ALB, three indicators have improved to varying degrees. Between the two groups, two groups of patients in the ALT, TBIL and aspects of statistical treatment (P<0.05) statistically significant. After treatment, ALB increased,no significant differences between the treatment and control groups (P>0.05).(3) Liver fibrosis:two groups after treatment of HA, PC III, the IVC, LN decreased, no significant difference in the control group before and after treatment, significant difference (P <0.05or0.01) before treatment.(4) Hemodynamic results:the treatment group taking the portal vein diameter the flavored Gualou San three months, before the blood flow and drug significantly different (P<0.05), blood flow velocity before and after treatment with the control group showed no significant difference (P>0.05).(5) Vascular Endothelial Growth Factor: The treatment group was given the flavored Gualou San three months after the vascular endothelial growth factor before treatment difference significant (P<0.05) compared with the control group, significant differences (P<0.05)Conclusion:the flavored Gualou San can effectively alleviate the clinical symptoms and signs of portal hypertension, can improve liver function, regulating the level of liver fibrosis, enabling patients with portal vein diameter was significantly reduced, blood flow velocity, blood flow to slow down or reduce and vascular endothelial growth factor levels can be reduced effectively. And its mechanism may be related to anti-fibrosis, prevents cirrhosis to reduce portal pressure, improve hepatic microcirculation and so on.更多还原