Study on the curative effect of Huoturbidity Kangxian Lishui Decoction on ascites of cirrhosis
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摘要: 目的 探讨化浊抗纤利水汤通过改善肝功能、肝纤维化标志物和调节基质金属蛋白酶-1(matrix metalloproteinase-1，MMP-1)或者基质金属蛋白酶抑制剂-1(tissue inhibitor of metalloproteinase-1，TIMP-1)平衡治疗肝硬化腹水患者的疗效。方法 选取2020年3月-2022年3月在邢台医学高等专科学校第二附属医院进行治疗的120例肝硬化腹水患者为研究对象，按照随机数字表法将其分为观察组与对照组，每组各60例。对照组患者进行常规西药治疗，观察组在对照组的基础上使用化浊抗纤利水汤治疗，比较两组患者的临床疗效、症状消失时间、腹围、24 h尿量、肝功能指标、MMP-1以及TIMP-1水平。结果 观察组患者的治疗有效率明显高于对照组(95.00% vs. 81.67%)，差异有统计学意义(P < 0.05)，中医证候积分低于对照组，差异有统计学意义(P < 0.05)；观察组患者的腹胀消失时间、腹腔积液消失时间、腹痛消失时间以及下肢水肿消失时间都明显短于对照组患者，均差异有统计学意义(均P < 0.05)；治疗后，观察组患者的腹围明显比对照组要低，但24 h尿量明显高于对照组，均差异有统计学意义(均P < 0.05)；治疗后，观察组患者的谷草转氨酶、谷丙转氨酶、Ⅲ型前胶原以及血清透明质酸水平明显低于对照组患者，均差异有统计学意义(均P < 0.05)；治疗后，观察组患者的MMP-1明显高于对照组，而TIMP-1明显低于对照组，均差异有统计学意义(均P < 0.05)。结论 使用化浊抗纤利水汤能够有效改善肝硬化腹水患者的肝功能指标及临床症状，同时能够明显减少患者的肝纤维化指标，调节MMP-1以及TIMP-1的表达水平，值得在临床中推广应用。
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关键词:
- 化浊抗纤利水汤 /
- 肝功能 /
- 肝硬化腹水 /
- 基质金属蛋白酶-1 /
- 基质金属蛋白酶抑制剂-1
Abstract: Objective To explore the therapeutic effect of Huoturbidity Kangxian Lishui Decoction on ascites of cirrhosis by improving liver function, liver fibrosis markers and regulating matrix metalloproteinase-1(MMP-1) or tissue inhibitor of metalloproteinase-1(TIMP-1) balance.Methods One hundred and twenty patients with ascites of cirrhosis who were treated in the Second Affiliated Hospital of Xingtai Medical College from March 2020 to March 2022 were selected and divided into the observation group and the control group according to random number table method, with 60 cases in each group. The control group was treated with conventional western medicine, and the observation group was treated with Huoturbidity Kangxian Lishui Decoction on the basis of the control group. The clinical efficacy, symptom disappearance time, abdominal circumference, 24 h urine volume, liver function indexes, MMP-1, and TIMP-1 indexes of the two groups were compared.Results The effective rate of observation group was significantly higher than that of the control group(95.00% vs. 81.67%, P < 0.05), Traditional Chinese Medicine(TCM) syndrome score was lower than the control group(P < 0.05). The disappearance time of abdominal distension, abdominal effusion, abdominal pain and lower limb edema in observation group were significantly shorter than those in the control group(all P < 0.05). The abdominal circumference of the observation group was significantly lower than that of the control group, but the 24 h urine volume of the observation group was significantly higher than that of the control group(all P < 0.05). The indexes of aspartate aminotransferase(AST), alanine aminotransferase(ALT), type Ⅲ procollagen(PC-Ⅲ) and serum hyaluronic acid(HA) in observation group were significantly lower than those in the control group(P < 0.05). The MMP-1 index of observation group was significantly higher than that of the control group, while the TIMP-1 index was significantly lower than that of the control group(all P < 0.05).Conclusion The Huoturbidity Kangxian Lishui Decoction can effectively improve the liver function indexes of patients with ascites of cirrhosis, reduce the clinical symptoms of patients, at the same time can significantly reduce the liver fibrosis indexes of patients, regulate MMP-1 and TIMP-1, worthy of clinical application. -
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表 1 两组患者的临床资料比较
例，X ± S 组别 例数 性别 年龄/岁 病程/月 Child-Pugh分级 男 女 B级 C级 观察组 60 34 26 63.94±9.03 11.03±3.15 16 44 对照组 60 29 31 64.38±9.25 11.31±3.26 19 41 χ2/t 0.835 0.264 0.478 0.363 P 0.361 0.793 0.633 0.547 
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表 2 两组患者的临床疗效比较
例(%) 组别 例数 治愈 有效 无效 总有效 观察组 60 16(26.67) 41(68.33) 3(5.00) 57(95.00) 对照组 60 9(15.00) 40(66.67) 11(18.33) 49(81.67) χ2 5.175 P 0.023
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表 3 两组患者治疗前后的中医证候积分比较
分，X ± S 组别 例数 治疗前 治疗后 观察组 60 19.72±2.85 8.92±2.71 对照组 60 19.54±2.57 12.94±3.12 t 0.297 6.152 P 0.768 <0.001
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表 4 两组患者的症状消失时间比较
d，X ± S 组别 例数 腹腔积液消失时间 腹胀消失时间 腹痛消失时间 下肢水肿消失时间 观察组 60 10.01±1.15 9.15±2.16 8.13±1.48 8.32±1.26 对照组 60 13.59±1.88 13.23±2.76 11.09±2.04 10.78±1.90 t 12.583 9.017 9.097 8.358 P <0.001 <0.001 <0.001 <0.001
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表 5 两组患者的腹围比较
cm，X ± S 组别 例数 治疗前 治疗后 观察组 60 90.32±5.28 82.92±4.51 对照组 60 88.68±5.71 84.95±5.93 t 1.633 2.111 P 0.105 0.037
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表 6 两组患者的24 h尿量比较
mL，X ± S 组别 例数 治疗前 治疗后 观察组 60 843.95±49.03 1 105.31±44.25 对照组 60 845.42±51.35 1 056.64±42.53 t 0.160 6.143 P 0.873 <0.001
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表 7 两组患者的肝功能以及肝纤维化指标比较
X ± S 组别 例数 AST/(U/L) ALT/(U/L) PC-Ⅲ/(ng/L) HA/(ng/L) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 观察组 60 98.32± 12.14 39.67± 9.04 108.62± 11.97 31.43± 9.13 134.57± 5.21 59.74± 3.64 160.43± 9.95 113.48± 10.19 对照组 60 98.48± 12.03 53.38± 11.32 110.08± 12.36 38.75± 11.89 135.74± 5.36 67.43± 4.85 161.28± 10.63 148.48± 11.94 t 0.073 7.331 0.657 3.782 1.212 9.823 0.452 17.271 P 0.942 <0.001 0.512 <0.001 0.228 <0.001 0.652 <0.001
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表 8 两组患者的MMP-1、TIMP-1水平比较
X ± S 组别 例数 MMP-1 TIMP-1 治疗前 治疗后 治疗前 治疗后 观察组 60 10.53±4.85 12.37±6.04 208.68±69.37 124.52±41.94 对照组 60 9.47±5.87 8.86±4.89 189.96±71.04 172.94±62.03 t 1.078 3.499 1.460 5.009 P 0.283 0.001 0.147 <0.001
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