| 引用本文:姚耀，柴梅，曹玉鹃，苏杰.自拟温阳消饮汤对脾肾阳虚证肝硬化合并肝肾综合征患者肝肾功能保护、血流动力学指标及外周血肿瘤坏死因子-α、一氧化氮、可溶性细胞黏附因子-1的影响[J].世界中医药,2019,(07):. |
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| 自拟温阳消饮汤对脾肾阳虚证肝硬化合并肝肾综合征患者肝肾功能保护、血流动力学指标及外周血肿瘤坏死因子-α、一氧化氮、可溶性细胞黏附因子-1的影响 |
| Effects of Self-made Wenyang Xiaoyin Decoction on Liver and Kidney Function Protection,Hemodynamic Indexes and Peripheral Blood TNF-α,NO and sICAM-1 Levels in Treating Spleen-kidney Yang Deficiency Syndrome Patients with Liver Cirrhosis and Hepatorenal Syndrome |
| 投稿时间：2018-05-11 |
| DOI：10.3969/j.issn.1673-7202.2019.07.026 |
| 中文关键词: 肝硬化；肝肾综合征；脾肾阳虚证；自拟温阳消饮汤；肝肾功能保护；血流动力学；肿瘤坏死因子-α 一氧化氮 可溶性细胞黏附因子-1 |
| English Keywords:Cirrhosis of the liver Hepatorenal syndrome Spleen-kidney yang deficiency syndrome Self-designed Wenyang Xiaoyin Decoction Liver and kidney function protection Hemodynamics TNF-α NO sICAM-1 |
| 基金项目:河北省2017年中医药局课题(2018510) |
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| 中文摘要: |
| 目的：观察自拟温阳消饮汤对脾肾阳虚证肝硬化合并肝肾综合征患者肝肾功能保护、血流动力学指标及外周血清肿瘤坏死因子-α(TNF-α)、一氧化氮(NO)、可溶性细胞黏附因子-1（sICAM-1）的影响。方法：选取2016年2月至2018年1月沧州市传染病医院收治的肝硬化合并肝肾综合征患者102例作为研究对象，按照随机数字表法分为对照组和观察组，每组51例。对照组患者给予前列地尔静脉滴注治疗，观察组患者则在对照组治疗基础上给予自拟温阳消饮汤经验方内服。对比临床效果，检测肝肾功能相关生化指标变化，观察门脉血流动力学变化，监测外周TNF-α、NO、sICAM-1水平。结果：观察组的有效率88.23%明显高于对照组的70.59%，差异有统计学意义（χ2=6.074，P<0.05）；治疗后观察组患者的肝功能丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBiL)水平则较对照组明显降低，白蛋白(Alb)水平则明显升高，差异有统计学意义（P<0.05）；肾功能其相关指标24 h尿蛋白定量、血尿素氮(BUN)、尿β2微球蛋白(β2-MG)、血肌酐(SCr)则较对照组明显降低，差异有统计学意义（P<0.05）；观察组患者的门静脉、脾静脉血流动力学指标脾门处脾静脉的内径(SVD)、门静脉主干内径(PVD)、门、脾静脉血流量(PVQ、SVQ)水平则较对照组明显降低，差异有统计学意义（P<0.05）；外周血TNF-α、NO、sICAM-1水平显著低于对照组，差异有统计学意义（P<0.05）。结论：加用自拟温阳消饮汤利于提高肝肾功能，使患者的门脉内径缩小、血流量减少，其机制与调控血清中TNF-α、NO、sICAM-1水平以减轻局部炎性损伤、改善肝脏内血流循环、降低门脉血管阻力、发挥肝肾保护作用有关。 |
| English Summary: |
| To observe the effects of self-made Wenyang Xiaoyin Decoction on liver and kidney function protection,hemodynamic indexes and peripheral blood tumor necrosis factor-α(TNF-α),nitric oxide(NO）and soluble cell adhesion factor-1(sICAM-1）levels in treating spleen-kidney yang deficiency syndrome patients with liver cirrhosis and hepatorenal syndrome.Methods：A total of 102 patients with liver cirrhosis and hepatorenal syndrome admitted in Cangzhou Infectious Diseases Hospital from February 2016 to January 2018 were selected as research objects,and randomly divided into control group and observation group,with 51 cases in each group.Patients in the control group were treated with alprostadil injections for intravenous drip,while patients in the observation group were treated with self-made Wenyang Xiaoyin Decoction orally on the treatment basis of the control group.Clinical efficacy was compared,changes biochemical indicators related toliver and kidney function were detected,portal hemodynamic changes were observed,and the levels of TNF-α,NO and sICAM-1 in peripheral blood were monitored.Results：The effective rate of the observation group was 88.23%,which was significantly higher than 70.59% in the control group(χ2 = 6.074,P<0.05); after the treatment,the levels of ALT,AST and TBiL of patients in the observation group were significantly lower than those in the control group,and the Alb level was significantly increased(P<0.05); the levels of renal function related indicators like 24 h urine protein quantitation(UPR),BUN,β2-MG and SCr was significantly lower than those in the control group(P<0.05); the levels of hemodynamic indicators like PVD,SVD,PVQ and SVQ of the portal vein and splenic vein in the observation group were significantly lower than those in the control group(P<0.05); the levels of TNF-α,NO and sICAM-1 in peripheral blood were significantly lower than those in the control group(P<0.05).Conclusion：Adding self-made Wenyang Xiaoyin Decoction is good to improve liver and kidney function,narrow the inner diameter of the portal vein and reduce the blood flow.The mechanism may be associated with regulating the serum levels of TNF-α,NO and sICAM-1 to alleviate the local inflammatory injury,improve blood circulation in the liver,reduce portal vascular resistance and play the role of liver and kidney protection. |
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