温阳利湿化瘀方早期干预治疗120例小儿胆道闭锁的临床观察

目的观察温阳利湿化瘀方早期干预小儿胆道闭锁的临床疗效。方法将120例胆道闭锁患儿按随机数字表法分为中药组和对照组,每组60例。中药组予温阳利湿化瘀方,对照组予熊去氧胆酸,疗程均为4周,观察两组治疗前后肝脏功能包括ALT、TBIL、DBIL、ALP、胆碱酯酶(CHE)、γ-谷氨酰转移酶(GGT)]、凝血功能包括凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)]、肝纤维化四项血清透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原(PC-Ⅲ)、纤维粘连蛋白(FN)]、肝移植例数、Kasai手术与肝移植间隔时间。结果两组最终纳入合格病例共109例,中药组56例,对照组53例。与本组治疗前比较,治疗后中药组GGT、ALP、CHE、TBIL、DBIL、APTT、HA、LN、PC-Ⅲ、FN均明显下降(P<0.05),且中药组低于对照组(P<0.05);与对照组比较,中药组治疗后总有效率明显升高(χ2=10.347,P<0.05),肝移植例数明显减少(P<0.05),中药组明显推迟肝移植时间(P<0.05)。结论温阳利湿化瘀方通过降低GGT、ALP、CHE、TBIL、DBIL、APTT、HA、LN、PC-Ⅲ、FN,疏通梗阻的肝内外胆道,延缓肝纤维化,延长Kasai手术与肝移植间隔时间,降低肝脏移植率。

Clinical Observation on 120 Cases of Pediatric Biliary Atresia Treated by Early Treatment of Wenyang Lishi Huayu Recipe

Objective To observe the clinical efficacy of early intervention of Wenyang Lishi Huayu Recipe(WLHR)on biliary atresia in children.Methods Totally 120 children with biliary atresia were divided into Chinese medicine group and control group,60 in each group.Patients in Chinese medicine group took WLHR,those in the control group took Ursodeoxycholic Acid.The treatment course was 4 weeks for all.The liver functionALT,TBIL,DBIL,ALP,cholinesterase(CHE),gamma glutamyl transpeptidase(GGT)],coagulation functionprothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)],serum hyaluronic acid(HA),laminin(LN),procollagenⅢ(PCⅢ),fibronectin(FN),the number of cases of liver transplantation,the interval between Kasai operation and liver transplantation were observed before and after treatment in the two groups.Results There were 109 qualified cases in the two groups,56 in the Chinese medicine group and 53 in the control group.After treatment,the GGT,ALP,CHE,TBIL,DBIL,APTT,HA,LN,PCⅢ,and FN in the Chinese medicine group were significantly lower than those before treatment(P<0.05),and the above indicators were lower than those in the control group(P<0.05).The total effective rate after treatment in the Chinese medicine group was significantly higher than that in the control group(χ2=10.347,P<0.05).The number of liver transplantation cases in the Chinese medicine group was significantly lower than that in the control group(P<0.05).Compared with the control group,the time of liver transplantation in the Chinese medicine group was significantly delayed(P<0.05).Conclusion WLHR could reduce GGT,ALP,Che,TBIL,DBIL,APTT,HA,LN,PC-Ⅲ,FN,dredge the obstructive intrahepatic and extrahepatic biliary tract,delay liver fibrosis,prolong the interval between Kasai operation and liver transplantation,and reduce the rate of liver transplantation.