摘要
目的:观察加味茵陈蒿汤对熊去氧胆酸(UDCA)应答不佳的原发性胆汁性胆管炎(PBC)患者肝纤维化指标及血清转化生长因子β_(1)(TGF-β_(1))、Smad3水平的影响。方法:纳入61例UDCA应答不佳的PBC患者,随机分为治疗组30例和对照组31例。两组患者均给予足量UDCA治疗,治疗组患者在此基础上加用加味茵陈蒿汤口服,两组疗程均为12个月。治疗前后,检测并比较两组患者的血清碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)、透明质酸(HA)、TGF-β_(1)、Smad3水平;采用肝脏瞬时弹性扫描仪(FibroScan)检测两组患者的肝脏硬度测量(LSM)值;评估两组患者的天冬氨酸氨基转移酶与血小板比率指数(APRI)评分。结果:试验过程中,治疗组2例患者脱落,对照组3例患者脱落或剔除,最终治疗组28例、对照组28例纳入统计分析。(1)治疗后,两组患者的ALP、GGT水平较治疗前均降低(P<0.05,P<0.01),且治疗组患者的ALP、GGT水平均低于对照组(P<0.05,P<0.01)。(2)治疗后,两组患者的LSM值及血清HA水平较治疗前均降低(P<0.05,P<0.01),且治疗组患者的LSM值及血清HA水平均低于对照组(P<0.05)。(3)治疗后,治疗组患者的APRI评分较治疗前明显降低(P<0.05),且治疗组患者的APRI评分低于对照组(P<0.05)。(4)治疗后,两组患者的血清TGF-β_(1)、Smad3水平较治疗前均降低(P<0.05,P<0.01),且治疗组患者的血清TGF-β_(1)、Smad3水平低于对照组(P<0.01)。结论:加味茵陈蒿汤作为一种有效且安全的联合治疗手段,可改善UDCA应答不佳的PBC患者的肝纤维化,其作用机制可能与调节TGF-β_(1)/Smad3途径相关。
Objective:To observe the influence of Modified Yinchenhao Decoction on the indexes of liver fibrosis and the serum levels of transforming growth factor-β_(1)(TGF-β_(1))and Smad3 in patients of primary biliary cholangitis(PBC)with poor response to ursodeoxycholic acid(UDCA).Methods:A total of 61 PBC patients with poor response to UDCA were included and randomly divided into the treatment group(30 cases)and the control group(31 cases).The patients in both groups were treated with UDCA at full dose,and the patients in the treatment group were orally treated with Modified Yinchenhao Decoction based on above.The treatment course of the two groups was 12 months.Before and after treatment,the serum levels of alkaline phosphatase(ALP),γ-glutamyl transpeptidase(GGT),hyaluronic acid(HA),TGF-β_(1) and Smad3 in both groups were detected and compared;the liver stiffness measurement(LSM)value in both groups was detected by FibroScan;the score of aspartate aminotransferase-to-platelet ratio index(APRI)in both groups was evaluated.Results:In the course of trial,2 patients in the treatment group shed and 3 patients in the control group were excluded or shed.Finally,28 cases in the treatment group and 28 cases in the control group were included for statistical analysis.(1)After treatment,the levels of ALP and GGT in both groups were decreased compared with those before treatment(P<0.05,P<0.01),and the levels of ALP and GGT in the treatment group were lower than those in the control group(P<0.05,P<0.01).(2)After treatment,the LSM value and the serum HA level in both groups were decreased compared with those before treatment(P<0.05,P<0.01),and the LSM value and the serum HA level in the treatment group were lower than those in the control group(P<0.05).(3)After treatment,the score of APRI in the treatment group was significantly decreased compared with that before treatment(P<0.05),and the score of APRI in the treatment group was lower than that in the control group(P<0.05).(4)After treatment,the serum levels of TGF-β_(1) and S
作者
陈逸云
郑玥琪
时桢
谢婵
周峰峰
陈建杰
唐苾芯
CHEN Yiyun;ZHENG Yueqi;SHI Zhen;XIE Chan;ZHOU Fengfeng;CHEN Jianjie;TANG Bixin(l.gongli hospital,pudong new area,shanghai 200135,china;shanghai university of traditional chinese medicine,shanghai 201203,china;jinshazhou hospital of guangzhou university of chinese medicine,guangzhou 510168,guangdong,china;shuguang hospital affiliated to shanghai university of traditional chinese medicine,shanghai 201203,china)
出处
《上海中医药大学学报》
CAS
2021年第3期28-32,共5页
Academic Journal of Shanghai University of Traditional Chinese Medicine
基金
上海市浦东新区卫健委领先人才培养项目(PWR12019-04)
上海中医药大学预算内科研项目(2020WK118)。
