清熱解毒法治療肝硬化患者療效研究

[摘要] 目的 探討清熱解毒法治療肝膽濕熱型肝硬化的臨床療效。 方法 將86例黃疸型肝硬化患者分成治療組和對(duì)照組，對(duì)照組給予拉米夫定治療，治療組給予拉米夫定聯(lián)合清熱解毒法治療，觀察兩組臨床療效、ALT復(fù)常率、YMDD變異率、HBeAg和HBVDNA低于監(jiān)測(cè)下限的比率。 結(jié)果 治療組的總有效率為97.67%，明顯高于對(duì)照組的88.37% （P<0.05）；治療結(jié)束12個(gè)月后，治療組的ALT復(fù)常率、HBeAg轉(zhuǎn)陰率和低于檢測(cè)下限的比率、HBVDNA低于監(jiān)測(cè)下限的比率均高于對(duì)照組，YMDD變異率低于對(duì)照組，組間比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。 結(jié)論 清熱解毒法可明顯改善肝功能，促進(jìn)HBeAg轉(zhuǎn)陰，降低YMDD變異率，提高總有效率，聯(lián)合拉米夫定療效顯著，值得臨床推廣使用。

[關(guān)鍵詞]乙型肝炎；肝硬化；清熱解毒法

[中圖分類(lèi)號(hào)] R259 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 2095-0616（2012）21-66-02

Efficacy researches in heat-clearing and detoxicating remedy on the treatment of patients with hepatic cirrhosis

LIANG Jiebin

Department of Traditional Chinese Medicine，Chenxinghai Hospital of Zhongshan City in Guangdong Province， Zhongshan 528415，China

[Abstract] Objective To investigate the clinical efficacy of the heat-clearing and detoxicating remedy on the treatment of hepatic cirrhosis with liver-gallbladder dampness-heat syndrome. Methods 86 patients of icteric hepatic cirrhosis were divided into the treatment group and the control group. The control group was treated with lamivudine，while the treatment group was treated with heat-clearing and detoxicating remedy additionally. Clinical efficacy，ALT recovery rate，YMDD mutation rate，and rates of HBeAg and HBVDNA below the monitoring floor are observed. Results The ORR of the treatment group is 97.67%，significantly higher than 88.37% of the control group （P<0.05）. As for the treatment group，12 months after treatment，its ALT recovery rate，and HBeAg negative converting rate and HBVDNA rate below the monitoring floor were all lower than those of the control group，while the YMDD mutation rate was higher than that of the control group （P<0.05）. Conclusion The heat-clearing and detoxicating remedy can significantly improve liver functions，enhance the negative transformation of HBeAg，reduce the YMDD mutation rate and increase the ORR. Therefore，combined with lamivudine，the remedy is worthy of clinical application.

[Key words] Hepatitis B；Hepatic cirrhosis；Heat-clearing and detoxicating remedy

乙型肝炎是由乙型肝炎病毒引起的一種傳染性疾病，主要有黃疸型和無(wú)黃疸型。肝硬化是眾多慢性肝病發(fā)展到晚期的共同結(jié)果[1]。在治療上多采用中藥治療，中藥中清熱解毒法使用頻率最高。清熱解毒法使用苦寒清熱藥物，以清熱邪、解熱毒方劑組成治療各種熱毒病癥的方法。中醫(yī)認(rèn)為黃疸型肝炎引起的肝硬化屬肝膽濕熱型，可采用清熱解毒法治療。為探討清熱解毒法治療肝膽濕熱型肝硬化的臨床療效，筆者對(duì)近年來(lái)收治的肝硬化患者采用了清熱解毒法治療，療效顯著，現(xiàn)報(bào)道如下。

1 資料與方法

1.1 一般資料

本次研究對(duì)象來(lái)自2010年4月～2011年6月在筆者所在醫(yī)院治療的黃疸型肝硬化者，共86例。均符合《病毒性肝炎防治方案》中的肝炎肝硬化診斷標(biāo)準(zhǔn)。……