基于MELD评价解毒凉血法治疗慢性乙型重型肝炎的疗效

摘要

目的 评价解毒凉血法对慢性乙型重型肝炎患者的治疗作用;在中医辩证基础上,应用终末期肝病模型(MELD)评分系统,探讨解毒凉血法治疗能够改善慢性乙型重型肝炎预后的适应人群.方法 374例辩证为湿热内蕴、疫毒瘀阻证的慢性乙型重型肝炎患者,分为基础治疗+中药治疗组(即解毒凉血法治疗组)和基础治疗组,两组均给予综合内科治疗,解毒凉血法组在综合内科治疗的基础上服用解毒凉血活血方;通过血清总胆红素(TBil)、血清肌酐(Cr)、凝血酶原时间(PT)的国际标准化比值(INR)建立MELD评分;采用SPSS10.0软件包进行处理,比较分析两组治疗前后MELD评分变化、病死率以及二者的关系.结果 MELD分值<17的患者解毒凉血法治疗后TBil、PT的INR、MELD评分分别为(290.45±147.42)μmol/L、1.54±0.52和11.87±2.04;明显低于治疗前的(314.48±145.4)μmol/L、1.78±0.43和13.81±1.78.差异有统计学意义(P<0.05);解毒凉血法治疗组患者的病死率为14.4%(22/153),明显低于基础治疗组的29.7%(46/155),差异有统计学意义(P<0.05).MELD分值≥17的患者解毒凉血法治疗后的TBil、PT的INR及MELD评分分别为(401.38±139.2)μmol/L、3.30±1.44、18.46±0.72,虽然高于治疗前的(398.86±121.82)μmol/L、3.15±1.6、18.34±0.64,但差异无统计学意义(P>0.05);解毒凉血法组患者病死率为31.3%(10/32).基础治疗组35.3%(12/34),差异无统计学意义(P>0.05).结论 解毒凉血法能够通过改善肝脏功能降低慢性乙型重型肝炎病死率;解毒凉血法治疗可降低MEL吩值<17的慢性乙型重型肝炎患者的病死率,但不能降低MELD分值≥17的患者的病死率.%Objective To study the effect of Jieduliangxuefa in patients with chronic severe hepatitis B and to determine the opinion of the treatment crowd by using model for end-stage liver disease (MELD) scoring system.Methods 374 patients were randomly divided into Jieduliangxuefa group and control group, both the groups were treated with comprehensive physical treatment and MELD score was calculated according to the original formula for each patient.The efficacy of Jieduliangxuefa was assessed by mortality and improvement in biochemical parameters and MELD score.Results The levels of total bilirubin (TBil), INR and MELD score of patients whose MELD scores were lower than 17 [TBil, (290.45±147.42)μmol/L; INR, 1.54±0.52; MELD, 11.87±2.04]were lower than those before Jieduliangxuefa treatment [TBil, (314.48±145.4)μmol/L; INR, 1.78±0.43; MELD, 13.81±1.78].The levels of TBil and INR and MELD score of patients whose MELD scores were higher than 17 [TBil, (401.38±139.27)μmol/L; INR, 3.30±1.44; MELD , 18.46±0.72]were higher than those before Jieduliangxuefa treatment [TBil, (398.86±121.82)μmol/L; INR, 3.15±1.6; MELD, 18.34±0.64].The mortality of patients in Jieduliangxuefa group with MELD score were lower than 17 was 14.4％, while it was 29.7％ in control group, showing significant difference between Jieduliangxuefa group and control group(P＜0.05).The mortality of patients with MELD scores were higher than 17 was 31.3％ in Jieduliangxuefa group and 35.3％ in control group, showing no significant difference between the two groups (P＞0.05).Conclusion Jieduliangxuefa can decrease the serum TBil level, INR and MELD score of patients with fulminant hepatitis and improve liver function.Compare with the control group, Jieduliangxuefa can significantly decrease the mortality of patients in Jieduliangxuefa group with MELD score lower than 17, but no effect was observed in patients with MELD score higher than 17.