护肠清毒微丸结肠靶向给药阻断慢性乙型肝炎患者肠源性内毒素血症Colon-specific deliveryhuchang Qingdu pellets in blocking intestinal endotoxemia in patients with chronic hepatitis B
石建美;胡冬青;张向磊;孙欢娜;李勇;
摘要(Abstract):
目的探讨护肠清毒微丸结肠靶向给药阻断慢性乙型肝炎患者肠源性内毒素血症的疗效。方法收集2012年11月-2016年2月符合纳入标准的慢性乙型肝炎肠源性内毒素血症患者180例,按双盲双模拟随机对照原则分为口服护肠清毒微丸组、乳果糖组各90例,2组患者在中药肝荣汤的基础上,分别口服护肠清毒微丸和乳果糖微丸,每次1.5 g,3次/d,疗程为20 d,观察治疗前后临床症状、中医证候积分、肝功能及内毒素水平的变化,护肠清毒丸:大黄、茯苓、薏苡仁、黄芩、甘草等。结果护肠清毒微丸组和乳果糖组治疗后中医证侯积分分别为(8.37±3.26)(7.76±2.18),均较治疗前显著降低。2组患者治疗后临床症状、肝功能、内毒素水平改善明显。护肠清毒微丸组对改善烦躁易怒、口苦、大便异常、胁痛、乏力、纳差等临床症状方面疗效显著(P<0.05)。护肠清毒微丸组在降低血浆内毒素、转氨酶及总胆红素水平方面显著优于乳果糖组(P<0.05),在升高白蛋白水平方面差异无统计学意义(P>0.05)。结论护肠清毒微丸结肠靶向给药可有效改善慢性乙型肝炎患者的临床症状、清除血浆毒素,改善肝功能等,从而阻断慢性乙型病毒性肝炎患者肠源性内毒素血症的发生。
关键词(KeyWords): 护肠清毒微丸;慢性乙型肝炎;肠源性内毒素血症
基金项目(Foundation): 国家中医临床研究基地业务建设科研专项编号(JDZX2012065);; 山东省自然科学基金编号(ZR2015PH055)
作者(Author): 石建美;胡冬青;张向磊;孙欢娜;李勇;
Email:
DOI: 10.13463/j.cnki.jlzyy.2017.08.011
参考文献(References):
- [1]韩德五.肠源性内毒素血症是肝炎、肝病的危险因素[J].山西医科大学学报,2006,37(1):1-4.
- [2]韩德五.肠源性内毒素血症.见:王家马龙,李绍白.肝脏病学[M].3版.北京:人民卫生出版社,2013,330-343.
- [3]高方媛,王宪波.肠源性内毒素血症在肝衰竭发生发展中的作用[J].临床肝胆病杂志,2014,30(08):825-828.
- [4]毛毛,李勇,黄书婷.大黄解毒汤灌肠治疗慢性乙型病毒性肝炎肠源性内毒素血症45例[J].陕西中医,2010,31(5):515-516.
- [5]唐世霞,李勇.肝荣汤治疗慢性乙型肝炎[J].长春中医药大学学报,2016,32(01):99-101
- [6]唐世霞,李勇.李勇教授治疗慢性乙型肝炎[J].吉林中医药,2015,35(12):1205-1208.
- [7]郑筱萸,任德权,曹文庄,等.中药新药临床研究指导原则[M].北京:中国医药科技出版社.2002:150-151.
- [8]NOLAN J P.The role of intestinal endotoxin in liver injury:a long and evolving history[J].Hepatology,2010,52:1829-1835.
- [9]MEHTA A K,LYON GM3rd.Infectious diseases in endstage liver disease patients[J].Crit Care Nurs Clin North Am,2010,22:291-307.
- [10]ANNA CHIARA PISCAGLIA,VINCENZO ARENA,STEFANO PASSALACQUA,et al.A Case of Granulocyte-Colony Stimulating Factor/Plasmapheresis–Induced Activation of Granulocyte-Colony Stimulating Factor–Positive Hepatic Progenitors in Acute-on-Chronic Liver Failure[J].HEPATOLOGY.2015,62(2):649-652.
- [11]S.GAO,F.-K.SUN,Y.-C.FAN,et al.Aberrant GSTP1 promoter methylation predicts short-term prognosis in acute-onchronic hepatitis B liver failure[J].Alimentary Pharmacology and Therapeutics,Aliment Pharmacol Ther 2015,42:319–329.
- [12]ZUXIONG HUANG,CHUN LIN,JIANKAI FANG,et al.Acute kidney injury in hepatitis B-related acute-on-chronic liver failure without preexisting liver cirrhosis[J],Hepatol Int,2015,9:416–423.
- [13]LI L,WU Z,MA W,et al.Changes in intestinal microflora in patients with chronic severe hepatitis[J].Chin Med J(Engl),2001,114(8):869-872.
- [14]DEEPAK AMARAPURKAR,MRUGUL V D H A R O D,MADHURI CHANDNANI,et al.Acute-on-chronic liver failure:A prospective study to determine the clinical profi le,outcome,and factors predicting mortality[J].Indian J Gastro enterol,2015,34(3):216–224.
- [15]SHIV KUMAR SARIN,CHANDAN KUMAR KEDARISETTY,ZAIGHAM ABBAS,et al.Acute-on-chronic liver failure:consensus recommendations of the Asian Pacifi c Association for the Study of the Liver(APASL)[J],Hepatol Int,2014,8:453–471.
- [16]RICHARD MOREAU,RAJIV JALANK,VICENTE ARROYO.Acute-on-Chronic Liver Failure:Recent Concepts[J],J O U R N A L O F C L I N I C A L A N D E X P E R I M E N TA L HEPATOLOGY,2015,5(1):81-85.
- [17]ZAIGHAM ABBAS,LUBNA SHAZI.Pattern and profile of chronic liver disease in acute on chronic liver failure[J].Hepatol Int 2015,9:366–372.
- [18]李勇.病毒性肝炎的中医思维理念与思考[J].世界中医药,2008,3(1):8-9.
- [19]李晓玲,张声生.张声生教授治疗脾胃病用药经验[J].天津中医药,2015,32(10):577-580
- [20]张向磊,卢立伟,唐世霞,等.治养并重、养治结合防治乙型病毒性肝炎[J].吉林中医药,2016,36(07):656-658.
- [21]王国栋,刘璇.“肝病实脾”法对ACLF大鼠内毒素血症的影响[J].湖南中医药大学学报,2015,35(03):12-15.
- [22]LI Y,WANG L,SU C,et a1.Clinical observation on the treatment of chronic severe hepatisis B by retention enema with huchang jiedu decoction[J].Chin J Integr Med,2010,16(4):348-352