摘要
目的探讨中成药联合西医内科治疗对于重症酒精性肝炎(SAH)患者发生慢加急性肝衰竭(ACLF)的干预效果。方法回顾性收集SAH患者258例,根据是否联合使用中成药治疗分为中药组95例及非中药组163例。非中药组给予西医内科治疗,中药组给予西医内科治疗联合利湿退黄类、理气活血类、清热解毒类中成药。记录患者一般资料、实验室指标、Child-Turcotte-Pugh (CTP)评分、终末期肝病模型(MELD)评分、中成药使用情况,结局指标为SAH患者住院期间是否发生ACLF。并以SAH患者是否进展为ACLF为二分类变量,对两组患者匹配前后的临床资料进行Cox单因素回归分析,探讨SAH进展为ACLF影响因素。结果两组患者基线资料总胆红素(TBiL)、肌酐(Cr)、白蛋白(ALB)、血红蛋白(Hb)水平差异存在统计学意义(P<0.05),不具有可比性。因此,对入组患者进行1∶1倾向性评分匹配后获得每组各83例患者。匹配前服用利湿退黄类中成药77例,服用理气活血类中成药38例,服用清热解毒类中成药16例;服用单一种类的中成药70例,联合服用两类或两类以上中成药25例,以利湿退黄类+理气活血类13例居多。匹配后中药组发生ACLF 20例(24.1%),非中药组发生ACLF 39例(46.9%),中药组ACLF发生率低于非中药组(P=0.002)。中药组及非中药组患者均以肝功能衰竭发生最多,分别为13例(15.7%)及28例(33.7%),组间差异有统计学意义(P<0.05)。匹配后中药治疗(OR=0.463,95%CI:0.261-0.823,P=0.009)为患者发生ACLF的独立影响因素。结论 SAH患者在西医内科治疗基础上联合使用利湿退黄、理气活血、清热解毒类中成药能够降低住院期间ACLF发生率。
Objective To explore the effect of Chinese patent medicine(CPM) combined with Western internal medicine on the progression of severe alcoholic hepatitis(SAH) to acute-on-chronic liver failure(ACLF).Methods Clinical data of 258 hospitalized SAH patients was collected for retrospective study.Patients were divided into CPM group(95 cases) and non-CPM group(163 cases) according to whether taking CPM for treatment or not.Patients in the CPM group were treated with Western internal medicine plus CPM having function of draining dampness and removing jaundice,regulating qi and invigorating blood,clearing heat and resolving toxins,while those in the non-CPM group received Western internal medicine alone.The patients’ baseline characteristics,laboratory indicators,ChildTurcotte-Pugh(CTP) score,model for end-stage liver disease(MELD) score and the use of Chinese patent medicine were recorded.The outcome measurement was whether ACLF occurs in SAH patients during the hospitalization.Whether ACLF occurs was taken as a binary variable,and Cox univariate analysis was performed to explore the risk factor of SAH progression into ACLF.Results The baseline data of the total bilirubin(TBiL),creatinine(Cr),albumin(ALB),and hemoglobin(Hb) levels were significantly different between groups(P<0.05),which were not comparable.Therefore,prospensity score matching at ratio of 1:1 were performed,and 83 patients in each group were matched.Before matching,77 patients took dampness-draining and jaundice-removing CHM;38 patients took qi-regulating and blood-invigorating CHM;16 patients took heat-clearing and toxins-resolving CPM;70 patients took single type of CHM,while 25 patients received two or more types of CPM,of which dampness-draining and jaundiceremoving CPM in combination of qi-regulating and blood-invigorating CPM was mostly seen in 13 cases.After matching,there were 20 cases(24.1%) of ACLF in CPM group,significantly lower than 39 cases(46.9%) in non-CPM group(P=0.009).Liver failure occurred mostly in both CPM(13,15.7%)and non-CPM gro
作者
王浩宇
全卉
江宇泳
刘慧敏
侯艺鑫
于浩
杨志云
王宪波
WANG Haoyu;QUAN Hui;JIANG Yuyong;LIU Huimin;HOU Yixin;YU Hao;YANG Zhiyun;WANG Xianbo(Beijing Ditan Hospital,Capital Medical University,Beijing,100015;Dongzhimen Hospital,Beijing University of Chinese Medicine)
出处
《中医杂志》
CSCD
北大核心
2022年第2期143-148,共6页
Journal of Traditional Chinese Medicine
基金
首都卫生发展科研专项(首发2020-2-2172)
北京中医药科技发展资金(JJ2018-44)
北京市医院管理中心重点医学发展计划(ZYLX202127)
国家中医药管理局全国名老中医药专家传承工作室建设项目。
关键词
重症酒精性肝炎
中成药
慢加急性肝衰竭
利湿退黄
理气活血
清热解毒
evere alcoholic hepatitis
Chinese patent medicine
acute-on-chronic liver failure
draining dampnessand removing jaundice
regulating qi and invigorating blood
clearing heat and resolving toxins
