摘要
目的探究理气健脾方对乙型肝炎肝硬化合并重度食管胃底静脉曲张患者1年内出血风险的影响。方法选取2010年1月-2017年8月在北京地坛医院住院确诊为乙型肝炎肝硬化合并食管胃底静脉曲张重度的患者117例,分为治疗组(n=52)与对照组(n=65),2组患者均给予临床常规治疗,治疗组在此基础上加用理气健脾方汤剂口服。观察患者1年内上消化道出血发生率及治疗前后肝功能、胃镜检查、Child-Pugh分级情况。符合正态分布的计量资料组间比较采用t检验;不符合正态分布的计量资料组间比较采用Mann-Whitney U检验;计数资料组间比较采用χ~2检验。结果治疗组1年内食管胃底静脉曲张破裂出血率为19. 2%,对照组为38. 5%,两组比较差异有统计学意义(χ~2=4. 112,P=0. 038);治疗组治疗后的血清Alb水平与治疗前比较差异有统计学意义(t=0. 934,P=0. 037),与对照组治疗后比较,差异亦有统计学意义(t=2. 928,P <0. 05)。治疗组患者门静脉宽度治疗前为(14. 1±2. 7) mm,治疗后为(12. 2±2. 4) mm,治疗前后比较差异具有统计学意义(t=2. 829,P=0. 006);对照组患者门静脉宽度治疗前为(14. 6±2. 8) mm,治疗后为(14. 3±2. 5) mm,治疗前后比较差异无统计学意义(t=0. 718,P=0. 925);治疗组治疗后与对照组治疗后比较,门静脉宽度显著下降,差异具有统计学意义(t=1. 715,P <0. 05)。治疗组患者治疗前红色征患者20例,治疗后为9例,治疗前后比较差异具有统计学意义(χ~2=0. 884,P=0. 008);治疗后,食管胃底静脉曲张程度较前缓解,重度患者由52例下降至38例,差异具有统计学意义(χ~2=0. 982,P=0. 038)。结论理气健脾方可能具有降低乙型肝炎肝硬化合并食管胃底静脉曲张重度患者1年内上消化道出血发生率,改善患者肝功能,降低门静脉宽度,改善食管胃底静脉曲张程度的作用。
Objective To investigate the effect of Liqi Jianpi prescription on the risk of hemorrhage within one year in patients with hepatitis B cirrhosis and severe esophageal and gastric varices.Methods The patients who were hospitalized in Beijing Ditan Hospital from January2010 to August 2017 and were diagnosed with hepatitis B cirrhosis and esophageal and gastric varices were enrolled and divided into treatment group and control group.All patients were given conventional treatment,and the patients in the treatment group were given oral Liqi Jianpi decoction in addition to the conventional treatment.The incidence of upper gastrointestinal bleeding within one year was observed,and liver function,gastroscopy findings,and Child-Pugh class were observed before and after treatment.The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups;the chi-square test was used for comparison of categorical data between groups.Results There was a significant difference in the rate of esophagogastric variceal bleeding within one year between the treatment group and the control group(19.2%vs 38.5%,χ~2=4.112,P=0.038).The treatment group had a significant change in serum albumin level after treatment(t=0.934,P<0.05),and there was a significant difference in serum albumin level between the two groups after treatment(t=2.928,P<0.05).In the treatment group,portal vein width decreased significantly from 14.1±2.7 mm before treatment to 12.2±2.4 mm after treatment(t=2.829,P<0.01);in the control group,portal vein width was 14.6±2.8 mm before treatment and 14.3±2.5 mm after treatment(t=0.718,P<0.05).After treatment,the treatment group had a significantly smaller portal vein width than the control group(t=1.715,P<0.05).In the treatment group,the number of patients with red color sign decreased significantly from 20 before treatment to 9 after treatment(χ~2=0.884,P=0.08);after treatment,the degree of esophageal and gastric varices was alleviated,and the number of patients with severe varices decreased from 52 before treatment to 38 after treatment(χ~2=0.982,P=0.038).Conclusion In patients with hepatitis B cirrhosis and severe esophageal and gastric varices,Liqi Jianpi prescription can reduce the incidence rate of upper gastrointestinal bleeding within one year,improve liver function,reduce portal vein width,and improve the degree of esophageal and gastric varices.
作者
侯艺鑫
杨志云
杨玉英
江宇泳
王宪波
HOU Yixin;YANG Zhiyun;YANG Yuying(Second Department of Integrated Traditional Chinese and Western Medcine,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2019年第4期780-784,共5页
Journal of Clinical Hepatology
基金
国家自然科学基金(81774234
81473641)
北京市医院管理局临床医学发展专项经费资助(ZYLX201707)
北京市科学技术委员会"首都临床特色应用研究"资助项目(Z181100001718052)
关键词
肝炎
乙型
慢性
肝硬化
食管和胃静脉曲张
胃肠出血
理气健脾方
治疗结果
hepatitis B,chronic
liver cirrhosis
esophageal and gastric varices
gastrointestinal hemorrhage
Liqi Jianpi Fang
treatment outcome
