消臌软坚丸对肝炎肝硬化腹水患者的疗效及对血NO、ET-1水平的调控作用

作者：戚忠玺,杨牧祥,张一昕,耿兰书【摘要】目的探讨中药复方消臌软坚丸对肝炎肝硬化腹水患者的疗效及对血中一氧化氮(no)、内皮素(et-1)水平的调控作用。

方法对133例肝炎肝硬化腹水患者采取随机分组对照治疗的方法。

对照组予西医常规对症处理(限制水盐、保肝、利尿、抗感染等),治疗组在此基础上加用消臌软坚丸,观察2组患者腹水的变化,治疗前后肝功能、门静脉内径与脾厚的变化,血浆no、et-1的含量以及伴有自发性细菌性腹膜炎(sbp)、肾功能不全等患者血no、et-1水平的调控。

结果治疗组在消退腹水的总有效率,改善肝功能、门静脉内径与脾厚,以及调控血no、et-1水平等方面均优于对照组(p<0.05,p<0.01),其中伴有sbp、肾功能不全患者中,治疗组在调控血no和et-1水平及其它方面也均优于对照组(p<0.05,p<0.01)。

结论消臌软坚丸能明显降低血no和et-1水平,改善肝功能、缓解门脉高压,这可能为本方有效治疗肝硬化腹水的作用机理之一。

【关键词】肝硬化；腹水；一氧化氮；内皮素；消臌软坚丸abstract：objective to research the effect of xiaoguruanjian pill on liver cirrhosis ascites patients and the regulation on blood no and et-1. methods 133 liver cirrhosis ascites were divided into two groups randomly. 45 cases of the control group were treated with routine western medicine according to the patients state of illness, 88 cases of the treatment group were treated with chinese herbal compounds xiaoguruanjian pill on the basis of routine western medicine. the total effective rate, liver function test, ultrasonogram of liver and spleen, the contents of blood no and et-1 of two groups were detected before and after the treatment, and the effect on blood no and et-1 of patients with sbp and renal dysfunction were observed too. results there was a significant difference between the two groups in the total effective rate, improvement of the liver function test,ultrasonogram of portal vein diameter and spleen, and the regulation of blood no and et-1 level (p<0.05～0.01). the treatment group was significant superior to control group in the regulation of blood no andet-1 level of the patients with sbp and renal dysfunction (p<0.05～0.01). conclusion xiaoguruanjian pill can lower the contents of no and et-1 of blood plasma, improve the liver function test, relieve the portal hypertension, which is one of the potential efficacy mechanisms of this pill on the liver cirrhosis ascites. key words：cirrhosis；ascites；no；et；xiaoguruanjian pill 腹水是肝硬化门脉高压征的主要临床表现之一,其出现意味着肝脏功能的失代偿期,5年生存率不足20%。

Clinical Journal of Chinese Medicine 2017 V ol.(9) No.4 -68-信息,2013,6(13):376-377.[7]袁齐.观察中医辨证治疗糖尿病合并高血压的临床疗效[J].中外健康文摘,2013,5(52):249-250.[8]庞丽.观察中医辨证治疗糖尿病合并高血压的临床疗效[J].中外健康文摘,2014,2(25):281-282.作者简介：肖姗（1979-），女，江西永新人，硕士研究生，主治中医师。

编辑：段苏婷编号：EA-4160511084（修回：2017-02-02）消臌软坚丸治疗肝炎肝硬化腹水88例临床观察Clinical observation on treating 88 cases of hepatitis cirrhosis ascites with Xiaogu Ruanjian Wan彭喜娜（南阳市中医院，河南南阳，473000）中图分类号：R575.2文献标识码：A文章编号：1674-7860（2017）04-0068-证型：IB【摘要】目的：探究消臌软坚丸治疗肝炎肝硬化腹水88例的临床疗效。

方法：选取我院2014年3月-2015年6月收治的88例肝炎肝硬化腹水患者，按照患者住院尾号的奇偶数分成观察组和对照组，各44例。

观察组在西药治疗的基础上联合消臌软坚丸治疗，对照组予单纯西药治疗，对比两组的临床疗效、治疗前后肝功能指标改善情况。

结果：观察组的治疗总有效率为95.45%，明显优于对照组的79.55%，差异具有统计学意义，P<0.05。

治疗后，两组肝功能各项指标进行比较，差异均具有统计学意义，P<0.05。

结论：肝炎肝硬化腹水经消臌软坚丸治疗，可在较短的时间消退患者的腹水情况，临床疗效较佳，具有重要的临床价值。

【关键词】消臌软坚丸；肝炎肝硬化腹水；临床疗效【Abstract】Objective: Clinical effects of Xiaogu Ruanjian Wan on hepatitis cirrhosis ascites were investigated. Methods: 88 patients with liver cirrhosis and ascites from March 2014 to June 2015 in our hospital were divided into the observation group and control group according to the tail number of hospitalization, 44 cases in each. The observation group was treated with western medicine plus Xiaogu Ruanjian Wan, and the control group was treated with western medicine alone. The clinical curative effect and the improvement of liver function before and after treatment were compared between groups. The total efficiency in the treatment group was 95.45%, significantly better than 79.55% in the control group, the difference was statistically significant, P<0.05. After treatment, the liver function in groups were compared, the difference was statistically significant, P<0.05. Conclusion: Treating hepatitis cirrhosis ascites with Xiaogu Ruanjian Wan showed better curative effects, and the ascites of the patients could be dissipated in a short time, with important clinical value.【Keywords】Xiaogu Ruanjian Wan; Hepatitis cirrhosis ascites; Clinical effectsdoi:10.3969/j.issn.1674-7860.2017.04.031肝硬化腹水，属于中医学中“臌胀”的范畴，研究人员认为这类病症的发生和肝脾肾损伤有直接的联系，进而使得患者产生血瘀、气滞和水蓄等症状，预后效果并不理想[1]。

第11卷 第5期 2009 年 5 月辽宁中医药大学学报JOURNAL OF LIAONING UNIVERSITY OF TCMVol. 11No. 5May，2009肝硬化是临床常见的慢性进行性肝脏疾病，是由一种或多种病因长期或反复作用造成的弥散性肝脏损害，肝硬化腹水是肝硬化门脉高压征的主要临床表现。

消臌软坚丸是我院治疗肝硬化腹水的制剂，临床研究显示对腹水具有良好效果[1]。

为了进一步阐明其作用机理，本实验采用复合因素造模法复制肝硬化大鼠模型，然后给予药物治疗，以观察消臌软坚丸对肝硬化大鼠肝组织病理学和血清和肝组织转化生长因子-α（TGF-α）的影响，以揭示其延缓肝硬化进程，治疗肝硬化腹水的作用机理。

1 材料与方法1.1材料1.1.1 实验动物 健康SD大鼠60只，体重（180±20）g，雌雄各半，由河南安阳华兴实验动物养殖场提供，动物合格证号：SCXK（豫）2004-0007。

1.1.2 实验用药 消臌软坚丸由河北中医肝病医院制剂室制备（该院自拟方，由黄芪30g，车前子30g，葶苈子15g，沉香6g，鳖甲30g等组成，课题组监制）。

实验时用蒸馏水将其配制成所需浓度的混悬液。

1.1.3 复方鳖甲软肝片（阳性药对照组）由内蒙古福瑞制药有限责任公司提供，国药准字（2005）Z-71号。

实验时用蒸馏水将其配制成所需浓度的混悬液。

1.1.4 主要试剂 转化生长因子-α（TGF-α）试剂盒（批号：20051202），购自解放军总医院科技开发中心放免所。

1.1.5 主要仪器722型光栅分光光度计，上海第三分析仪器厂；1-15K型高速冷冻离心机，美国Sigma公司；HH-W21-600型电热恒温水箱，天津泰斯特仪器有限公司；LEICA RM2125型切片机，德国LEICA公司；TDL-5-A型离心机，上海安亭科学仪器厂。

1.2方法1.2.1 模型制备60只大鼠均适应性喂养1周，随机分为造模组48只和正常组12只。