文章摘要
通腑化瘀法治疗重症急性胰腺炎早期肝损伤的临床研究
The clinical therapeutic effect of Tongfu Huayu fomula for treatment of Severe Acute Pancreatitis with early liver injury
投稿时间:2021-01-17  修订日期:2021-04-13
DOI:
中文关键词: 重症急性胰腺炎  肝损伤  通腑化瘀  高迁移率族蛋白B1
英文关键词: Severe acute pancreatitis  liver injury  Tongfu Huayu  high mobility group box 1 protein
基金项目:河南省中医药科学研究专项课题
作者单位邮编
王晓 河南中医药大学第一附属医院 450000
杨国红 河南中医药大学第一附属医院 
王晨晓 河南中医药大学第一附属医院 
张秀梅 河南中医药大学第一附属医院 
李春颖 河南中医药大学第一附属医院 
李建松 河南中医药大学第一附属医院 
马素平 河南中医药大学第一附属医院 
张丽慧 河南中医药大学第一附属医院 
朱沛文 河南省中医院 
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中文摘要:
      目的 评价通腑化瘀法治疗重症急性胰腺炎(SAP)早期肝损伤的临床疗效。方法 40例SAP患者被随机分为两组。对照组20例,给予西医常规治疗。治疗组20例,在对照组基础上给予通腑化瘀方药颗粒剂灌胃、灌肠。疗程14天。观察两组患者胃肠动力恢复情况,血淀粉酶(AMS)、脂肪酶、C反应蛋白(CRP)复常时间,谷丙转氨酶(ALT)、谷草转氨酶(AST)、血清致炎因子高迁移率族蛋白B1(HMGB1)、NF-κB水平。结果 治疗组腹胀消失时间(d:3.91±2.03 比 5.58±2.49)、腹痛消失时间(d:3.99±2.01 比5.82±2.64)、肠鸣音恢复时间(d:4.02±1.65 比 6.35±2.28)、AMS 恢复正常时间(d:3.89±2.12 比 5.95±2.43)、脂肪酶恢复正常时间(d:5.57±2.11 比 6.85±2.10)、CRP 恢复正常时间(d:7.66±2.68 比 9.02±2.84)均较西医对照组明显缩短(均 P<0.05);血清ALT水平(U/L:51.36±20.64 比75.61±24.62)、AST水平(U/L:49.57±19.18比73.27±20.43)均较西医对照组明显下降(均 P<0.05);两组治疗后14 d 血清HMGB1、NF-κB 水平均较治疗前降低,且以治疗组治疗后 14 d 的下降程度较同期西医对照组更显著〔HMGB1(ng/mL):0.16±0.08 比 1.88±0.24,NF-κB(μg/mL):6.08±2.27比10.16±3.14,均 P<0.05〕。结论 通腑化瘀法对SAP早期肝损伤患者有较好的临床疗效,可较快改善SAP胃肠动力及肝功,降低血清致炎因子HMGB1、NF-κB水平,减轻胰腺炎症反应,能阻断SAP病情进展,从而减少病死率。
英文摘要:
      Objective To evaluate the clinical efficacy of Tongfu Huayu fomula in treating severe acute pancreatitis with early liver injury. Methods 40 patients with SAP in Department of Digestology of the First Affiliated Hospital of Henan University of TCM from January 2019 to December 2020 were divided into combined TCM and western medicine treatment group (20 cases) and western medicine control group (20 cases) by random number table method. Conventional western medicine treatment was given to both groups, and the combined treatment group was additionally treated by the therapy of the TCM, including Intra-gastric administration of Tongfu Huayu fomula decoction and retention enema with Tongfu Huayu fomula decoction. The time for abdominal pain and distention disappearance, the time for normal bowel sounds recovery, the times for recovery to normal levels of serum amylase, lipase, C-reaction protein (CRP) and the changes of levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), high migration rate of serum inflammatory factors Group protein B1 (HMGB1) and NF-κB of patients before and after treatment for 14 days in both groups were observed. Results The times for disappearance of abdominal distention (days: 3.91±2.03 vs. 5.58±2.49), for abdominal pain (days: 3.99±2.01 vs. 5.82±2.64), and the recovery times to normal levels of bowel sounds (days: 4.02±1.65 vs. 6.35±2.28), blood amylase (days: 3.89±2.12 vs. 5.95±2.43), lipase (days: 5.57±2.11 vs. 6.85±2.10) and CRP (days: 7.66±2.68 vs. 9.02±2.84) in combined treatment group were significantly shorter than those of the western medicine control group (all P< 0.05). on the 14th day after treatment, the serum ALT, AST HMGB1 andNF-κB levels of the two groups were lower than those before treatment, and the descent levels of above indexes on the 14th day in the combined treatment group were more significant than those in the western medicine control group [ALT(U/L):51.36±20.64 vs. 75.61±24.62)、AST(U/L:49.57±19.18 vs. 73.27±20.43, HMGB1(ng/mL):0.16±0.08 vs. 1.88±0.24,NF-κB(μg/mL):6.08±2.27 vs.10.16±3.14, all P < 0.05]. Conclusion Tongfu Huayu fomula has a good clinical effect on SAP patients with early liver injury. It can quickly improve gastrointestinal motility and liver function, reduce serum inflammatory factors HMGB1 and NF-κB levels, and can block the progress of SAP, thereby it reduces the mortality rate.
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