我们的网站为什么显示成这样?

可能因为您的浏览器不支持样式,您可以更新您的浏览器到最新版本,以获取对此功能的支持,访问下面的网站,获取关于浏览器的信息:

|本期目录/Table of Contents|

中医辨证联合抗病毒治疗对乙型肝炎肝硬化失代偿发生率的影响(PDF)

《云南中医学院学报》[ISSN:1000-2723/CN:53-1048/R]

期数:
2017年03期
页码:
41-46
栏目:
临床研究
出版日期:
2017-07-17

文章信息/Info

Title:
The Impact of the TCM Syndrome Differentiation Treatment Combined with Antiviral Treatmenton the Incidence of HBV Related Decompensated Liver Cirrhosis
作者:
董亚男倪赛赛戴黎陈建杰△
上海中医药大学附属曙光医院,上海 200021
Author(s):
DONG YananNI SaisaiDAI LiCHEN Jianjie
Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200021, China
关键词:
中医辨证论治 抗病毒治疗 乙型肝炎肝硬化代偿期 回顾性队列研究
Keywords:
TCM syndrome differentiation and treatment antiviral treatment HBV related compensated liver cirrhosis retrospective cohort study
分类号:
R259
DOI:
10.19288/j.cnki.issn.1000-2723.2017.03.010
文献标识码:
A
摘要:
目的 研究中医辨证论治联合抗病毒治疗乙型肝炎肝硬化代偿期患者的失代偿累积发病率,并探究失代偿发生的相关影响因素。方法 采用回顾性队列研究,收集4个分中心共计453例乙型肝炎肝硬化代偿期患者,根据是否接受中医辨证论治治疗,分为中西医结合队列(中医辨证论治联合抗病毒治疗组)和西医队列(单纯抗病毒治疗组)(226例 vs 227例)。观察两队列间肝硬化失代偿的累积发病率,并探究其发生的相关影响因素。结果 治疗第3、5年,中西医结合队列和西医队列的乙型肝炎肝硬化失代偿的累积发病率分别为4.42% vs 18.5%和5.31% vs 21.59%,差别均有统计学意义(P<0.05)。辨证论治联合抗病毒治疗方案可以减少肝硬化失代偿的发生率7.63%以上。两队列腹水和食管胃底静脉曲张破裂出血的发生率分别为4.87% vs 17.62%和0.44% vs 5.29%,差别均有统计学意义(P<0.05)。发生乙型肝炎肝硬化失代偿的相关影响因素可能有:年龄大于50岁(OR=2.744,95%CI=1.521-4.950)、有过敏史(OR=2.148,95%CI=1.016-4.543)、家族史(OR=1.833,95%CI=1.108-3.035)、基线HBsAg数值大于1000(OR=2.294,95%CI=1.307-4.027)、发生影像学改善(OR=0.077,95%CI=0.011-0.557)等。结论 乙型肝炎肝硬化代偿期患者接受中医辩证论治联合抗病毒治疗,可以一定程度上减少肝硬化失代偿的累积发病率。发生影像学改善可能是肝硬化代偿期患者的保护因素,年龄大于50岁、有过敏史、家族史、基线HBsAg数值大于1000可能是发生肝硬化失代偿的危险因素。
Abstract:
Objective To observe the clinical efficacy of the TCM syndrome differentiation treatment combined with antiviral treatment in HBV related compensated liver cirrhosis patients. Explore the related causative factors of the happening of decompensated liver cirrhosis. Methods In accordance with the method of retrospective cohort study, a total of 453 patients of compensated liver cirrhosis are divided into integrated Chinese and Western medicine cohort(TCM therapy and antiviral therapy) and Western medicine cohort(single antiviral treatment)(226 cases vs 227 cases) according to whether or not to accept the treatment of TCM. Observe and explore the accumulation incidence rates and the related causative factors of the happening of decompensated liver cirrhosis. Results In the third and fifth year, the accumulation incidence rates of decompensated liver cirrhosis of the integrated Chinese and western medicine cohort and the western medicine cohort are 4. 42% and 18.5%, 5.31% and 21.59% respectively, the differences have statistical significance(P<0.05). The TCM syndrome differentiation treatment combined with antiviral treatment can reduce the incidence rate of decompensated liver cirrhosis by more than 7.63%. The incidence rates of ascites and esophagogastric variceal bleeding(EGVB) of the two cohorts are 4.42% and 18.5%, 5.31% and 21.59% respectively, the differences have statistical significance(P<0.05). The related influence factors of decompensated cirrhosis happening might be older than 50 years(OR=2.744, 95%CI=1.521-4.950), and having history of allergies(OR=2.148, 95%CI=1.016-4.543), family(OR=1.833, 95%CI=1.108-3.035), baseline HBsAg values higher than 1000(OR=2.294, 95%CI=1.307-4.027) and imaging improvement(OR=0.077, 95%CI=0.011-0.557), etc. Conclusion The TCM syndrome differentiation treatment combined with antiviral treatment has good clinical effect, can reduce the cumulative incidence of decompensated liver cirrhosis to a certain extent. Imaging improvement may be the protection factor of HBV related compensated liver cirrhosis patients. Older than 50 years, and has allergies, family history and baseline HBsAg values higher than 1000 may be the risk factors of the liver decompensation cirrhosis.

参考文献/References

[1] Wang FS,Fan JG,Zhang Z,et al. The global burden of liver disease:the major impact of China[J]. Hepatology,2014,60(6):2099-2108.
[2] Lefton HB,Rosa A,Cohen M. Diagnosis and epidemiology of cirrhosis[J]. Med Clin North Am,2009,93(4):787-799.
[3] Fattovich G,Bortolotti F,Donato F. Natural history of chronic hepatitis B:special emphasis on disease progression and prognostic factors[J]. J Hepatol,2008,48(2):335-352.
[4] Liu CJ,Chen PJ,Chen DS,et al. Hepatitis B virus reactivation in patients receiving cancer chemotherapy:natural history,pathogenesis,and management[J]. Hepatol Int,2013,7(2):316-326.
[5] Arends P,Sonneveld MJ,Zoutendijk R,et al. Entecavir treatment does not eliminate the risk of hepatocellular carcinoma in chronic hepatitis B:limited role for risk scores in Caucasians[J]. Gut,2015,64(8):1289-1295.
[6] Gounder PP,Bulkow LR,Snowball M,et al. Nested case-control study:hepatocellular carcinoma risk after hepatitis B surface antigen seroclearance[J]. Alimen Pharmacol Ther,2016,43(11):1197-1207.
[7] 中华医学会肝病学分会,中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015年更新版)[J]. 临床肝胆病杂志,2015,31(12):1941-1960.
[8] 黄英. 乙型肝炎后肝硬化的发生与性别的关系[J]. 现代医药卫生,2004,20(20):2088-2089.
[9] Yasuda M,Shimizu I,Shiba M,et al. Suppressive effects of estradiol on dimethylnitrosamine-induced fibrosis of the liver in rats[J]. Hepatology,1999,29(3):719-727.
[10] Shimizu I,Mizobuchi Y,Yasuda M,et al. Inhibitory effect of oestradiol on activation of rat hepatic stellate cells in vivo and in vitro[J]. Gut,1999,44(1):127-136.
[11] 王吉耀,涂传涛. 肝硬化合并胃底食管静脉曲张破裂出血的治疗[J]. 中华肝脏病杂志,2005,13(6):457.
[12] Amodio P,Montagnese S,Gatta A,et al. Characteristics of minimal hepatic encephalopathy[J]. Metabolic Brain Disease,2004,19(3-4):253-267.
[13] Weissenborn K,Ennen JC,Schomerus H,et al. Neuropsychological characterization of hepatic encephalopathy[J]. J Hepatol,2001,34(5):768-773.
[14] Chen YC,Chu CM,Liaw YF. Age-specific prognosis following spontaneous hepatitis B e antigen seroconversion in chronic hepatitis B[J]. Hepatology,2010,51(2):435-444.
[15] 科技部十二五重大专项联合课题组专家. 乙型肝炎病毒相关肝硬化的临床诊断、评估和抗病毒治疗的综合管理[J]. 临床肝胆病杂志,2014,22(2):99-108.
[16] 全国酒精性肝病调查协作组. 全国酒精性肝病的多中心调查分析[J]. 中华消化杂志,2007,27(4):231-234.

备注/Memo

备注/Memo:
* 基金项目: 陈建杰上海市名中医工作室(ZYSNXD.cc—MZY003);中管局重点学科建设——中医传染病学
收稿日期: 2017 - 04- 18
作者简介: 董亚男(1988-),女,河北沧州人,在读博士研究生,研究方向:中医药治疗肝病。
△通信作者:陈建杰,Email:jianjie_chen@hotmail.com
更新日期/Last Update: 2017-06-20