摘要
目的探讨抗肝纤维化中成药对于酒精性肝病(ALD)相关肾功能减退的影响。方法回顾性收集首都医科大学附属北京地坛医院2008年8月1日-2016年3月1日收治的ALD住院患者592例,根据应用扶正化瘀胶囊、安络化纤丸或复方鳖甲软肝片是否≥180累计日剂量分为中药组及对照组,对入组患者进行1∶1倾向评分匹配,得到两组患者各187例,记录病史、饮酒量、血常规、肝肾功能、凝血机制和腹部影像学等结果。符合正态分布的计量资料两组间比较采用t检验,非正态分布采用Mann-Whitney U检验,计数资料两组间比较采用χ^2检验,Kalplan-Merier法比较两组患者肾功能减退累积发生率。结果两组患者年龄、饮酒量、合并高血压、糖尿病比例、基线AST、估算肾小球滤过率(eGFR)、尿酸、凝血酶原时间均无显著性差异(P值均>0.05),随访时间36(23~54)个月。尿酸(HR=1.003,95%CI:1.001~1.005,P=0.001)、凝血酶原时间(HR=1.103,95%CI:1.034~1.177,P=0.003)和红细胞体积分布宽度(HR=1.024,95%CI:1.011~1.038,P<0.001)是ALD发生肾功能减退的独立危险因素,抗肝纤维化中成药(HR=0.170,95%CI=0.053~0.552,P=0.003)是发生肾功能减退的独立保护因素,中药组肾功能减退发生率明显低于对照组(16.6%vs 32.1%,χ^2=10.263,P=0.001)。对中药组患者的亚组分析中,累计应用中药治疗>24个月时效果最佳(HR=0.210,95%CI:0.084~0.525,P=0.001)。中药组肾功能减退发生时间明显晚于对照组(36个月vs 24个月,Z=-2.652,P=0.008)。结论抗肝纤维化中成药可以降低ALD患者肾功能减退发生率,延缓肾功能减退发生时间。
Objective To investigate the effect of anti-liver fibrosis Chinese patent drugs on renal hypofunction associated with alcoholic liver disease(ALD).Methods A retrospective analysis was performed for 592 patients with ALD who were admitted to Beijing Ditan Hospital,Capital Medical University,from August 1,2008 to March 1,2016,and according to whether they were treated with Fuzheng Huayu capsules,Anluo Huaxian pills,or Fufang Biejia Ruangan tablets for≥180 cumulative defined daily doses,they were divided into Chinese medicine group and control group.After propensity score matching at a ratio of 1∶1,two groups were obtained with 187 patients in each group.Related data were recorded,including medical history,drinking amount,routine blood test results,liver and renal function,coagulation,and abdominal imaging findings.The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups;the chi-square test was used for comparison of categorical data between groups;the Kaplan-Meier method was used to compare the cumulative incidence rate of renal hypofunction between two groups.Results There were no significant differences between the two groups in age,drinking amount,proportion of patients with hypertension or diabetes,baseline aspartate aminotransferase,estimated glomerular filtration rate,uric acid,and prothrombin time,and the patients were followed up for 36 months(range 23-54 months).Uric acid(hazard ratio[HR]=1.003,95%confidence interval[CI]:1.001-1.005,P=0.001),prothrombin time(HR=1.103,95%CI:1.034-1.177,P=0.003),and red cell volume distribution width(HR=1.024,95%CI:1.011-1.038,P<0.001)were independent risk factors for renal hypofunction in patients with ALD,and anti-liver fibrosis Chinese patent drug was an independent protective factor against renal hypofunction(HR=0.170,95%CI:0.053-0.552,P=0.003).The Chinese medicine group had a significantly lower incidence rate of renal hypof
作者
孟培培
刘尧
周梅月
于浩
杨玉英
江宇泳
MENG Peipei;LIU Yao;ZHOU Meiyue;YU Hao;YANG Yuying;JIANG Yuyong(Department of Integrative Medicine,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine,Beijing 100007,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2020年第9期2030-2034,共5页
Journal of Clinical Hepatology
基金
首都卫生科研发展专项(首发2020-2-2172)
北京中医药科技基金(JJ2018-44)
十三五科技重大专项(2018ZX10725505-001)。
关键词
肝疾病
酒精性
肾功能不全
中成药
liver diseases,alcoholic
renal insufficiency
CHINESE PATENT DRUGS
