中西医结合治疗HBV相关慢加急性肝衰竭合并肝性脑病的效果分析

宫嫚; 周超; 张宁; 孙克伟; 张振刚; 李瀚旻; 李秀惠; 杨宏志; 李芹; 王林; 周小舟; 毛德文; 过建春; 卓蕴慧; 王宪波; 邓欣; 王介非; 曹武奎; 张淑琴; 张明香; 李筠

doi:10.3969/j.issn.1001-5256.2018.04.020

中西医结合治疗HBV相关慢加急性肝衰竭合并肝性脑病的效果分析

DOI: 10.3969/j.issn.1001-5256.2018.04.020

1. 中国人民解放军第三〇二医院中西医结合肝病中心
2. 湖南中医药大学第一附属医院
3. 华中科技大学附属同济医院
4. 湖北省中医院
5. 首都医科大学附属北京佑安医院
6. 中山大学附属第三医院
7. 福州市传染病医院
8. 成都市公共卫生临床医疗中心
9. 深圳市中医院
10. 广西中医药大学第一附属医院
11. 杭州市西溪医院
12. 上海中医药大学附属曙光医院
13. 首都医科大学附属北京地坛医院
14. 深圳市第三人民医院
15. 上海公共卫生临床中心
16. 天津市第二人民医院
17. 吉林省肝胆病医院
18. 沈阳市第六人民医院

基金项目:

国家科技重大专项(2012ZX10005-005,2018ZX10725506-002)；国家中医药管理局专项课题(JDZX2015187)；

详细信息

中图分类号: R575.3;R747.9
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出版历程
- 出版日期: 2018-04-20

Clinical effect of integrated traditional Chinese and Western medicine therapy in patients with hepatitis B virus-related acute-on-chronic liver failure complicated by hepatic encephalopathy

Liver Disease Center for Combined TCM and Western Medicine, 302 Hospital of PLA

Research funding:

摘要

摘要:
目的探讨中西医结合治疗HBV相关慢加急性肝衰竭（ACLF）合并肝性脑病（HE）患者8周病死率情况,分析影响其预后的独立危险因素。方法选取2012年1月-2015年2月18家医院收治的HBV-ACLF患者,采用随机对照设计分为试验组和对照组,分别给予中西医结合治疗和单纯西医综合治疗,纳入所有0周合并HE的患者125例。观察2组8周病死率情况。计量资料2组间比较采用t检验或Mann-Whitney U检验,计数资料2组间比较采用χ2检验,生存分析采用Kaplan-Meier方法及logrank检验,危险因素分析采用Cox比例风险回归模型。结果试验组及对照组8周病死率分别为27.5%、50.0%（χ2=5.630,P=0.018）,8周内中位生存时间分别为41.2 d、28.4 d,累积生存概率分别为60.4%、32.5%（χ2=6.187,P=0.013）;Cox回归分析结果显示与对照组相比,试验组是HBV-ACLF合并HE患者预后的保护因素[风险比（HR）=0.424,P=0.018,95%可信区间（95%CI）:0.2080
- 肝功能衰竭 /
- 肝性脑病 /
- 肝炎病毒,乙型 /
- 中西医结合疗法
Abstract:
Objective To investigate the 8-week mortality rate of patients with hepatitis B virus (HBV) -related acute-on-chronic liver failure (ACLF) complicated by hepatic encephalopathy (HE) treated with integrated traditional Chinese and Western medicine therapy, as well as independent prognostic factors.Methods A total of 125 HBV-ACLF patients with HE who were admitted to 18 hospitals from January 2012 to February 2015 were enrolled and divided into trial group and control group using a randomized controlled design.The patients in the trial group were given integrated traditional Chinese and Western medicine therapy, and those in the control group were given Western medicine therapy alone.The 8-week mortality rate was observed for both groups.The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups; the chi-square test was used for comparison of categorical data between groups; the Kaplan-Meier method and the log-rank test were used for survival analysis; the Cox proportional hazards regression model was used for the analysis of risk factors.Results The 8-week mortality rate was 27.5% in the trial group and 50.0% in the control group (χ2= 5.630, P = 0.018) , the median survival time was 41.2 days in the trial group and 28.4 days in the control group, and the 8-week cumulative probability of survival was 60.4% in the trial group and 32.5% in the control group (χ2= 6.187, P = 0.013) .The Cox regression analysis showed that compared with the control group, the trial group was a protective factor in patients with HBV-ACLF complicated by HE (hazard ratio [HR]= 0.424, 95% confidence interval [CI]:0.208-0.864, P = 0.018) .There were significant differences between the two groups in total bilirubin (TBil) (HR = 1.063, 95% CI:1.002-1.128, P = 0.042) , prothrombin activity (PTA) (HR = 0.942, 95% CI:0.890-0.998, P = 0.044) , ACLF stage (HR = 2.737, 95% CI:1.287-5.818, P = 0.009) , and the presence or absence of gastrointestinal hemorrhage (HR = 5.291, 95% CI:1.736-16.126, P = 0.003) .Conclusion Traditional Chinese medicine treatment can significantly reduce the 8-week mortality rate of HBV-ACLF patients with HE, increase their 8-week survival probability, and prolong survival time.TBil, PTA, ACLF stage, and gastrointestinal hemorrhage are independent prognostic factors.
- liver failure /
- hepatic encephalopathy /
- hepatitis B virus /
- TCM WM therapy

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参考文献(24)

[1]JALAN R, GINES P, OLSON JC, et al.Acute-on chronic liver failure[J].J Hepatol, 2012, 57 (6) :1336-1348.

[2]ZHAO ZG, HAN T, GAO YT, et al.Causes and clinical outcomes of acute-on-chronic liver failure in patients with hepatitis B virus infection:an analysis of 289 cases[J].World Chin J Dig, 2009, 17 (31) :3269-3272. (in Chinese) 赵振刚, 韩涛, 高英堂, 等.乙型肝炎患者并发慢加急性肝衰竭诱因及转归分析289例[J].世界华人消化杂志, 2009, 17 (31) :3269-3272.

[3]Organization Committee of 13th Asia-Pacific Congress of Clinical Microbiology and Infection.13th Asia-Pacific Congress of Clinical Microbiology and Infection Consensus Guidelines for diagnosis and treatment of liver failure[J].Hepatobiliary Pancreat Dis In, 2013, 12 (4) :346-354.

[4] BUSTAMANTE J, RIMOLA A, VENTURA PJ, et al.Prognostic significance of hepatic encephalopathy in patients with cirrhosis[J].J Hepatol, 1999, 30 (5) :890-895.

[5]Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association.Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association.Diagnostic and treatment guidelines for liver failure[J].Chin J Infect Dis, 2006, 24 (6) :422-425. (in Chinese) 中华医学会感染病学分会肝功能衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝功能衰竭诊疗指南[J].中华传染病杂志, 2006, 24 (6) :422-425.

[6]Committee of Diagnosis and Treatment of Hepatic Encephalopathy.Consensus on the diagnosis and treatment of hepatic encephalopathy[J/CD].Chin J Exp Clin Infect Dis:Electronic Edition, 2009, 3 (4) :449-473. (in Chinese) 肝性脑病诊断治疗专家委员会.肝性脑病诊断治疗专家共识[J/CD].中华实验和临床感染病杂志:电子版, 2009, 3 (4) :449-473.

[7]BUSTAMANTE J, RIMOLA A, VENTURA PJ, et al.Prognostic significance of hepatic encephalopathy inpatients with cirrhosis[J].J Hepatol, 1999, 30 (5) :890-895.

[8]VOLK ML, TOCCO RS, BAZICK J, et al.Hospital readmissions among patients with decompensated cirrhosis[J].Am J Gastroenterol, 2012, 107 (2) :247-252.

[9]MAO DW, QIU H, WEI AL.The research of the TCM syndrome and treatment of encephalopathy[J].Tianjin J Tradit Chin Med, 2007, 24 (3) :225-227. (in Chinese) 毛德文, 邱华, 韦艾凌.肝性脑病的中医证治研究[J].天津中医药, 2007, 24 (3) :225-227.

[10] JALAN R, GINES P, OLSON JC, et al.Acute-on chronic liver failure[J].J Hepatol, 2012, 57 (6) :1336-1348.

[11]DAJANI R, SANLIOGLU S, ZHANG Y, et al.Pleiotropic functions of TNF-alpha determine distinct IKK beta-dependent hepatocellular fates in response to LPS[J].Am J Physiol Gastrointest Liver Physiol, 2007, 292 (1) :242-252.

[12]CHEN LC, GORDON RE, LASKIN JD, et al.Role of TLR-4 in liver macrophage and endothelial cell responsiveness during acute endotoxemia[J].Exp Mol Pathol, 2007, 83 (3) :311-326.

[13]LI YT, YANG YD.Effects of gut microflora imbalance on severe hepatitis[J].Chin J Hepatol, 2013, 21 (1) :7-8. (in Chinese) 李永涛, 杨益大.肠道菌群失衡对重型肝炎的影响[J].中华肝脏病杂志, 2013, 21 (1) :7-8.

[14]BAJAJ JS, RIDLON JM, IIYLEMON PB, et al.Linkage of gut microbiome with cognition in hepatic encephalopathy[J].Am J Physiol Gastrointest Liver Physiol, 2012, 302:168-175.

[15]SEYAN AS, ILUGHES RD, SHAWCROSS DL.Changing face of hepatic encephalopathy:role of inflammation and oxidative stress[J].World J Gastroenterol, 2010, 16:3347-3357.

[16]XU LZ, CHEN WN, ZHANG W, et al.The anti-inflammatory and immunologic effect of ethanol of rubia cordifolia L[J].J Weifang Med Coll, 2002, 24 (1) :1-3. (in Chinese) 许兰芝, 陈维宁, 张薇, 等.茜草醇提物的抗炎免疫作用[J].潍坊医学院学报, 2002, 24 (1) :1-3.

[17]GENG QB, HUANG HL, WENG ZF, et al.Effects of rubia cordifolia and charred r.cordifolia on coagulation-fibrinolytic system of normal rats[J].Chin J Exp Med Formul, 2013, 19 (13) :279-282. (in Chinese) 耿启彬, 黄海龙, 翁壮锋, 等.茜草和茜草炭对正常大鼠凝血-纤溶系统的影响[J].中国实验方剂学杂志, 2013, 19 (13) :279-282.

[18]SUN GC, YU XF, LI DY.Compound Xiqiancao (siegesbeckiae) capsule on content of IL-1β、IL-8 in rats'inflammatory articulus caused by sodium urate[J].World J Integr Tradit Western Med, 2007, 2 (6) :329-331. (in Chinese) 孙贵才, 于学峰, 李登宇.复方豨莶草胶囊对尿酸钠致大鼠关节炎滑膜IL-1β、IL-8含量的影响[J].世界中西医结合杂志, 2007, 2 (6) :329-331.

[19]WANG P.Study of improving microcirculation and antipruritus effects of ethanolic extracts of siegesbeckia orientalis[J].J Medical Forum, 2003, 24 (12) :19-21. (in Chinese) 王鹏.豨莶草乙醇提取物改善微循环及止痒的研究[J].医药论坛杂志, 2003, 24 (12) :19-21.

[20]ZHU LZ, LW.Study of effects of herba siegesbeckiae capusles on blood coagulation function and hemorheology in rats[J].Heilongjiang Med J, 2010, 23 (2) :191-192. (in Chinese) 朱兰镇, 李伟.豨莶草胶囊对大鼠血液流变学及凝血功能影响的研究[J].黑龙江医药, 2010, 23 (2) :191-192.

[21]LIN FL, YANG CY, YANG WW, et al.Modern research overview of bletilla striata[J].Chin Hosp Pharm J, 2013, 33 (7) :571-573. (in Chinese) 林福林, 杨昌云, 杨薇薇, 等.中药白芨的现代研究概况[J].中国医院药学杂志, 2013, 33 (7) :571-573.

[22]SUN JG.Effect of modified yinchenhao decoction medicated by retention enema on endotoxin and blood ammonia of chronic severe hepatitis patients[J].J Sichuan Tradit Chin Med, 2013, 31 (1) :75-77. (in Chinese) 孙建光.加味茵陈蒿汤保留灌肠对慢性重症肝炎患者内毒素和血氨的影响[J].四川中医, 2013, 31 (1) :75-77.

[23]YAO C, YAO F, XIE W, et al.Clinical observation on rhubarb decoction retention enema in treatment of minimal hepatic encephalopathy[J].Liaoning J Tradit Chin Med, 2013, 40 (3) :474-476. (in Chinese) 姚春, 姚凡, 谢武, 等.大黄煎剂保留灌肠治疗轻微肝性脑病临床研究[J].辽宁中医杂志, 2013, 40 (3) :474-476.

[24]LI Y, ZHAN J, WANG ZF.Prognostic factors for patients with hepatitis B virus-related acute-on-chronic liver failure[J].J Clin Hepatol, 2017, 33 (3) :497-501. (in Chinese) 李蓥, 詹婧, 王中峰.HBV相关慢加急性肝衰竭患者预后危险因素分析[J].临床肝胆病杂志, 2017, 33 (3) :497-501.

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