中西医结合治疗乙型肝炎相关肝衰竭临床研究

目的 观察中西医结合疗法对乙型肝炎相关肝衰竭的临床疗效.方法 收集入组乙型肝炎相关慢性肝衰竭(HBV-related acute on chronic liver failure,HBV-ACLF)患者51例及乙型肝炎相关慢加急性肝衰竭(HBV-related acute on chronic liver failure,HBV-ACLF)患者52例.HBV-CLF对照组24例,治疗组27例;HBV-ACLF 对照组26例,治疗组26例.对照组给予常规保肝、抗病毒、对症支持等治疗,疗程4 周.治疗组在对照组相同治疗基础上给予辨证中药治疗.结果 HBV-CLF治疗组临床有效率为63.0%,对照组为54.2%(P>0.05);治疗组凝血酶原活动度(PTA)恢复情况更好,肝性脑病发生率有所降低(P<0.05).HBV-ACLF治疗组临床有效率为80.8%,对照组为53.8%(P<0.05);治疗组总胆红素(TBil)、PTA、胆碱酯酶(CHE)、白蛋白(ALB)恢复情况更好,腹水、肝性脑病发生率有所降低(P<0.05).结论 中西医结合治疗可提高HBV-ACLF 临床疗效;对HBV-CLF未见明显优势,但在部分改善指标及降低并发症方面有一定作用.

Treatment of HBV-related liver failure with integrated Traditional Chinese and Western Medicine

Objective To observe the therapeutic effect of integrated Traditional Chinese and Western Medicine on HBV-related liver failure.Methods Fifty-one patients with HBV-related chronic liver failure(HBV-CLF) and 52 patients with HBV-related acute on chronic liver failure(HBV-ACLF) were enrolled in this study.The HBV-CLF patients were divided into control group(n=24) and treatment group(n=27) The HBV-ACLF patients were divided into control group(n=26) and treatment group(n=26).The patients in control groups received routine liver protection,anti-virus and expectant treatment while those in treatment groups underwent routine liver protection,anti-virus and expectant treatment plus Traditional Chinese Medicine treatment for 4 weeks based on differentiation of their symptoms and signs.Results The effective rate of HBV-CLF was 63.0% and 54.3% respectively in treatment group and control group(P>0.05).The prothrombin activity(PTA) and the incidence of hepatic encephalopathy were lower in treatment group than in control group(P<0.05).The effective rate of HBV-ACLF was significantly higher in treatment group than in control group(80.8% vs 53.8%,P<0.05).The TBil,PTA,CHE and ALB levels and the incidence of ascites and hepatic encephalopathy were significantly lower in treatment group than in control group(P<0.05).Conclusion Integrated Traditional Chinese and Western Medicine can improve the therapeutic effect on HBV-ACLF.Although it cannot significantly improve the therapeutic effect on HBV-CLF,it plays a role in improving certain laboratory indications and in reducing complications of HBV-CLF.