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目的:观察茵陈五苓散加味对恶性梗阻性黄疸(MOJ)行经皮肝穿刺胆道引流术(PTCD)术后退黄、护肝疗效,并从抗氧化应激和炎症反应方面探讨了其作用机制。方法:将128例MOJ患者,采用SAS软件生成,随机按住院先后顺序分为对照组和观察组各64例。患者均行PTCD术。对照组给予葡醛酸钠注射液,2mL(0.266g)/次,静脉注射,2次/d;口服鹅去氧胆酸胶囊,0.25 g/次,3次/d,;口服复方联苯双酯颗粒,10 g/次,3次/d。观察组在对照组治疗的基础上给予茵陈五苓散加味口服,1剂/d。两组疗程均治疗28 d。于术前及术后7 d和28 d分别检测比较两组患者的总胆红素(TBIL),直接胆红素(DB1L),碱性磷酸酶(ALP)及γ-谷氨酰转移酶(GGT),总胆汁酸(TBA),丙氨酸氨基转移酶(ALT)和丨与蛋白(ALB)等指标;进行治疗前后湿热蕴结证的评分;采用癌症患者生命质量测定量表(EORTC QLQ-C30)和恶性梗阻性黄疸患者特异性条目池(QLQ-MOJ11),评价患者治疗前后的生活质量;检测治疗前后丙二醛(MDA),超氧化物歧化酶(SOD),肿瘤坏死因子-α(TNF-α)和白细胞介素-6(lL-6)的水平。结果:观察组临床愈显率为75%,高于对照组的56.25%(χ~2=4.987,P<0.05);观察组患者在术后1 cl和28 cl,TBlL,DBIL,TBA,ALP,GGT和ALT均低于对照组(P<0.01),在术后28 d观察组AL3高于对照组(P<0.01);观察组湿热蕴结证各症状评分及总积分均低于对照组<0.01);观察组患者QLQ-BR30量表5个功能领域评分和整体生活质量评分均高于对照组(P<0.01);QLQ-BR30量表3个症状领域和QLQ-MOJ11量表的黄疸、瘙痒、消化等三类症状领域及消瘦、发热评分均低于对照组(P<0.01);观察组患者血清MDA,IL-6和TNF-α水平均低于对照组(P<0.01),SOD水平高于对照组(P<0.01)。结论:对恶性梗阻性黄疸PTCD术后患者,在常规利胆、降酶、护肝治疗的基础上,采用茵陈五苓散加味,能减轻黄疸,促进肝功能恢复,减轻临床症状,提高患者的生活质量,具有减轻抗氧化应激损伤和炎症损伤的作用。
Objective: To observe the curative effect of Yinchen Wuling San flavor on the treatment of patients with malignant obstructive jaundice (MOJ) undergoing percutaneous transhepatic biliary drainage (PTCD) and the mechanism of anti-oxidative stress and inflammatory reaction. Methods: 128 cases of MOJ patients were generated by SAS software and randomly divided into control group and observation group according to the order of hospitalization. Patients underwent PTCD surgery. Control group was given sodium gluconate injection, 2mL (0.266g) / times, intravenous injection, 2 times / d; oral chenodeoxycholic acid capsules, 0.25 g / times, 3 times / d, oral diphenyl bis Ester particles, 10 g / time, 3 times / d. The observation group was given oral administration of Yinchen Wuling powder on the basis of the treatment of the control group, one dose / d. The two groups were treated for 28 days. The levels of total bilirubin (TBIL), direct bilirubin (DB1L), alkaline phosphatase (ALP) and γ-glutamyltransferase (GGT), total bile acid (TBA), alanine aminotransferase (ALT) and protein and albumin (ALB) were measured before and after treatment. C30) and patients with malignant obstructive jaundice (QLQ-MOJ11) to evaluate the quality of life of patients before and after treatment; before and after treatment to detect the content of malondialdehyde (MDA), superoxide dismutase (SOD), tumor necrosis factor- α (TNF-α) and interleukin-6 (IL-6) levels. Results: The clinical cure rate in the observation group was 75%, higher than 56.25% in the control group (χ ~ 2 = 4.987, P <0.05). In the observation group, the postoperative 1 cl and 28 cl, TBL, DBIL, , GGT and ALT were lower than those in the control group (P <0.01), and the AL3 in the observation group was significantly higher than that in the control group on the 28th day (P <0.01). The symptoms scores and the total scores of the syndrome of damp-heat accumulation in the observation group were lower than those in the control group <0.01). The scores of 5 functional domains and overall quality of life of QLQ-BR30 in the observation group were higher than those in the control group (P <0.01). The QLQ-BR30 scale in 3 symptom areas and QLQ-MOJ11 jaundice , Pruritus, digestion and so on. The serum levels of MDA, IL-6 and TNF-α in the observation group were lower than those in the control group (P <0.01) SOD level was higher than the control group (P <0.01). Conclusion: The patients with malignant obstructive jaundice after PTCD, based on the conventional treatment of Ligusticum, Jiangni, and Hugan, can reduce jaundice, promote the recovery of liver function, relieve the clinical symptoms and improve the life of patients Quality, with the role of reducing antioxidant stress injury and inflammation damage.