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补气活血汤对乙型肝炎肝硬化门静脉高压患者血流动力学及肝纤维化指标的影响
Huoxue decoction on hemodynamics and liver fibrosis indices in hepatitis B patients with cirrhotic portal hypertension
文章发布日期:2017年01月06日  来源:  作者:白志芹,宋会颖,吴瑞卿,等  点击次数:1739次  下载次数:337次

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【摘要】:目的观察补气活血汤对乙型肝炎肝硬化门静脉高压患者血流动力学及肝纤维化指标的影响。方法选取2013年12月-2015年8月保定市清苑区人民医院收治的乙型肝炎肝硬化患者79例,将患者随机分为研究组(n=41)和对照组(n=38)。2组患者均给予恩替卡韦(0.5 mg,1次/d)和双环醇片(25 mg/次,3次/d)口服,对照组在此基础上加用普萘洛尔(10 mg/次,3次/d),研究组加用补气活血汤,疗程均为12周。比较2组患者治疗前及治疗12周后血流动力学及肝纤维化指标的变化。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果治疗12周后,2组患者门静脉内径、脾静脉内径、门静脉血流量均较治疗前下降,门静脉血流速度较治疗前升高,差异均有统计学意义(t值分别为3.847、4.672、3.524、5.237、3.578、3.829、3468、3673,P值分别为0.041、0.036、0.047、0.032、0.045、0.042、0.048、0.046),且与对照组相比,研究组变化幅度更明显[(1286±234) mm vs (13.65±2.45) mm,t=-3.725,P=0.044;(9.50±1.26) mm vs (11.15±1.37) mm,t=-6.672,P=0012;(1.23±0.35) L/min vs (1.38±0.44) L/min,t=-3.521,P=0.047;(19.50±4.65) cm/s vs (17.57±2.40) cm/s,t=-6225,P=0024]。治疗12周后2组患者肝纤维化4项指标(透明质酸、层黏连蛋白、Ⅲ型前胶原、Ⅳ型胶原)均有所下降,但研究组下降幅度更明显[(285.2±53.4) μg/L vs (347.5±63.4) μg/L,t=-7.252,P=0.012;(89.5±25.6) μg/L vs (116.5±29.7) μg/L,t=-6.503,P=0.018;(63.5±20.6) μg/L vs (98.7±28.4) μg/L,t=-5.279,P=0.031;(85.5±23.7) μg/L vs (122.5±26.4) μg/L,t=-6.977,P=0.015]。2组患者治疗过程中均未出现用药不良反应。结论补气活血汤能够显著改善肝硬化门静脉高压患者的血流动力学及血清肝纤维化指标。
【Abstract】:ObjectiveTo investigate the effect of Buqi Huoxue decoction on hemodynamics and liver fibrosis indices in hepatitis B patients with cirrhotic portal hypertension. MethodsA total of 79 patients with hepatitis B cirrhosis who were admitted to The People′s Hospital of Qingyuan District from December 2013 to August 2015 were enrolled and randomly divided into study group (41 patients) and control group (38 patients). The patients in both groups were given oral entecavir (0.5 mg, once a day) and bicyclol tablets (25 mg, three times a day); the patients in the control group were given propranolol (10 mg, three times a day) in addition, and those in the study group were given Buqi Huoxue decoction in addition. The course of treatment was 12 weeks for both groups. The hemodynamics and liver fibrosis indices were compared between the two groups before treatment and after 12 weeks of treatment. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsAfter 12 weeks of treatment, both groups had significant reductions in diameter of the portal vein, diameter of the splenic vein, and portal vein flow and a significant increase in portal vein blood flow velocity (t=3.847, 4.672, 3.524, 5.237, 3.578, 3.829, 3.468, and 3.673, P=0.041, 0.036, 0.047, 0.032, 0.045, 0.042, 0.048, and 0.046), and the study group had significantly greater changes in these parameters compared with the control group (diameter of the portal vein: 12.86±2.34 mm vs 13.65±2.45 mm, t=3.725, P=0.044; diameter of the splenic vein: 9.50±1.26 mm vs 11.15±1.37 mm, t=-6.672, P=0.012; portal vein flow: 1.23±0.35 L/min vs 1.38±0.44 L/min, t=-3.521, P=0.047; portal vein blood flow velocity: 19.50±4.65 cm/s vs 17.57±2.40 cm/s, t=-6.225, P=0.024). After 12 weeks of treatment, both groups had reductions in the four liver fibrosis indices hyaluronic acid, laminin, procollagen type Ⅲ, and collagen type Ⅳ, and the study group had significantly greater reductions than the control group (hyaluronic acid: 285.2±53.4 μg/L vs 347.5±63.4 μg/L, t=-7.252, P=0.012; laminin: 89.5±25.6 μg/L vs 116.5±29.7 μg/L, t=-6.503, P=0.018; procollagen type Ⅲ: 635±20.6 μg/L vs 98.7±28.4 μg/L, t=-5.279, P=0.031; collagen type Ⅳ: 85.5±23.7 μg/L vs 122.5±26.4 μg/L, t=-6977, P=0.015). No patient experienced adverse drug reactions during the treatment. ConclusionBuqi Huoxue decoction can significantly improve hemodynamics and serum hepatic fibrosis indices in patients with cirrhotic portal hypertension.
【关键字】:肝炎, 乙型; 肝硬化; 高血压, 门静脉; 补气活血汤
【Key words】:hepatitis B; liver cirrhosis; hypertension, portal; Buqi Huoxue decoction
【引证本文】:白志芹, 宋会颖, 吴瑞卿, 等. 补气活血汤对乙型肝炎肝硬化门静脉高压患者血流动力学及肝纤维化指标的影响[J]. 临床肝胆病杂志, 2017, 33(2): 272-276.

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