温阳通络中药复方联合西医综合疗法治疗HBV相关性慢加急性肝衰竭晚期的临床研究【摘要】目的：观察温阳通络中药复方联合西医综合疗法治疗HBV相关性慢加急性肝衰竭晚期临床疗效及经济学评价。方法：将符合标准的HBV相关性慢加急性肝衰竭晚期患者80例随机分为对照组和治疗组，对照组给予规范西医综合疗法，治疗组在西医治疗基础上加用温阳通络中药，在治疗第2周、第4周、第8周中医症候评分，第8周时评价实验室血清指标（血清总胆红素、直接胆红素、血清丙氨酸氨基转移酶、天冬氨酸氧基转移酶、白蛋白、凝血功能：凝酶原活动度、血浆氨等）、血清炎症因子（内毒素、IL-1、IL-6、TNFα）、肠道菌群及住院费用、人工肝次数、人工肝费用等经济学指标，评估第8、12、24周时患者死亡率，并观察分别在治疗第2周、第4周、第6周、第8周时血、尿、便常规及肾功并记录患者不良事件发生情况。结果：1.治疗第8周时：（1）治疗组总有效79.9%，明显优于对照组（总有效64.9%）；（2）两组患者中医证候积分均明显低于治疗前，治疗后治疗组患者中医证候积分低于对照组；（3）两组患者TBi、AST、ALT、ALB、PT、NH3等指标均显著降低，治疗后与对照组比较，治疗组TBi、AST、ALT、ALB、PT等指标显著减低；（4）治疗组患者的住院费用、人工肝次数、人工肝费用等指标明显低于对照组；（5）治疗组内毒素、IL-1、IL-6、TNF-α及对照组内毒素、IL-1水平显著降低。与对照组比较，治疗组内毒素、IL-1、IL-6、TNF-α水平显著降低；（6）治疗后治疗组肠球菌属、双歧杆菌属和乳杆菌属的菌落数明显增加，酵母样真菌菌落数明显降低，与治疗组治疗前及对照组治疗后比较，以上比较，差异均具有统计学意义（P＜0.05，P＜0.01）。2.治疗组死亡率治疗后第8周21.1%、第12周23.6%、第24周26.3%，明显低于对照组，两组比较差异有统计学意义（P＜0.05）。3.治疗期间，与对照组比较，治疗组与治疗明确相关的严重不良反应未见显著增多。结论：温阳通络中药复方可以提高西医治疗HBV相关性慢加急性肝衰竭的有效率，可能与减轻体内炎症反应、稳定肠道微生态有关。【关键词】温阳通络；HBV相关性慢加急性肝衰竭；临床R259B2095-1752（2018）26-0340-04TheclinicalStudyonTreatmentofLate-stageHBV-relatedacute-on-chronicliverfailurewithChineseMedicineCompoundofWenyangTongluocombinedwithWesternMedicineComprehensiveTherapyZhuJing1,ZhangXuemei2.1Departmentofintensivecare,suiningcityhospitaloftraditionalChinesemedicine,suining,Sichuan,6290002Departmentofcriticalcare,affiliatedhospitalofchengduuniversityoftraditionalChinesemedicine,chengdu,Sichuan,610075【Abstract】ObjectiveToobservetheclinicalefficacyandeconomicevaluationofChinesecompoundcompoundofWenyangTongluocombinedwithWesternmedicinetherapyinthetreatmentofHBV-relatedacute-on-chronicliverfailure.MethodsEightypatientswhomeetthecriteriawererandomlypidedintoacontrolgroupandatreatmentgroup.Thecontrolgroupwasgivenacomprehensivewesternmedicinetreatment.ThetreatmentgroupwastreatedwithWesternmedicineplusWenyangTongluomedicine.TCMsymptomsarescoredatthe2nd,4th,8th,and8thweeksoftreatment.Laboratoryserummarkers(serumtotalbilirubin,serumalanineaminotransferase,aspartateoxtransferaseareevaluated.Etc.),economicindicatorsofseruminflammatoryfactors(endotoxins,IL-1,IL-6,TNFα),intestinalflora,hospitalizationcosts,artificialliverfrequency,artificiallivercosts,etc.Mortalitywasassessedatweeks8,12,and24,andblood,urine,stoolroutine,andrenalfunctionwererecordedatthe2nd,4th,6th,and8thweeksoftreatment,andadverseeventswererecorded.ResultAtthe8thweekoftreatment,thetotaleffectiverateofthetreatmentgroupwas79.9%,whichwassignificantlybetterthanthatofthecontrolgroup(64.9%oftotaleffective).TheTCMsyndromescoresofthetwogroupsweresignificantlylowerthanthosebeforethetreatment,andt...