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目的:评价当归芍药散治疗酒精性肝硬化(alcoholic cirrhosis,AC)伴门脉高压性腹水的疗效,并探讨其作用机制。方法:将符合条件的70例患者按1∶1比例随机分至治疗组和对照组,两组均予常规的西医治疗,治疗组在此基础上加用当归芍药散,疗程为1个月。记录其体重、腹围及24 h尿量的变化;采用彩色多普勒超声仪测定门静脉主干及脾静脉内径、计算门静脉血流量,全自动生化分析法测血清丙氨酸转氨酶(alanine aminotransferase,ALT),白蛋白(albumin,ALB),总胆红素(total bilirubin,TBIL)水平,全自动血凝分析法测凝血酶原时间活动度(prothrombin activity,PTA)水平,ELISA法测血清内皮素-1(endothelin-1,ET-1)含量,放射免疫法测血清血管内皮生长因子(vascular endothelial growth factor,VEGF)含量。结果:两组基线方面的差异无显著性,具有可比性。疗程结束后,治疗组在体重、腹围和尿量的改善及总体疗效方面均显著优于对照组(P<0.05);在门静脉血流量、门静脉主干及脾静脉内径的降幅上均大于对照组(P<0.05);在血清ALB,TBIL和血浆PTA水平方面的改善优于对照组(P<0.05);在血清ET-1和VEGF含量的下降幅度上均要大于对照组(P<0.05);而在血清ALT水平上两者无显著性差异。结论:当归芍药散具有促进酒精性肝硬化门脉高压性腹水消退、改善肝功能及凝血功能的综合作用,其疗效机制可能与抑制ET-1和VEGF的活性有关。
Objective: To evaluate the curative effect of Danggui Shaoyao San on alcoholic cirrhosis (AC) with portal hypertension ascites and to explore its mechanism. Methods: Seventy patients who met the criteria were randomly divided into treatment group and control group according to the ratio of 1: 1. Both groups were given routine Western medical treatment. On the basis of this, the treatment group was given Danggui Shaoyao San for 1 month. The changes of body weight, abdominal circumference and 24-hour urine output were recorded. The diameters of portal vein and splenic vein were measured by color Doppler sonography, and the portal vein blood flow was calculated. Alanine aminotransferase (ALT (ALB), total bilirubin (TBIL), prothrombin activity (PTA) level by automatic hemagglutination assay, serum endothelin- 1, endothelin-1 (ET-1) were measured by radioimmunoassay. The content of serum vascular endothelial growth factor (VEGF) was measured by radioimmunoassay. Results: The baseline differences between the two groups were insignificant and comparable. After treatment, the treatment group was significantly better than the control group in improving body weight, abdominal circumference and urine output and overall curative effect (P <0.05); in the portal vein blood flow, the diameter of the portal vein and the diameter of the splenic vein decreased more than the control group (P <0.05). The improvement of serum ALB, TBIL and plasma PTA levels was better than that of the control group (P <0.05). The decrease of serum ET-1 and VEGF levels was greater than that of the control group (P <0.05) ; While there was no significant difference between the two groups in serum ALT level. Conclusion: Danggui Shaoyao San can promote alcoholic cirrhosis portal hypertension ascites subside and improve the liver function and blood coagulation function, its mechanism of action may be related to the inhibition of the activity of ET-1 and VEGF.