加味茵陈蒿汤对UDCA应答不佳的原发性胆汁性胆管炎患者肝纤维化的影响
Effects of Modified Yinchenhao Decoction on liver fibrosis in patients of primary biliary cholangitis with poor response to UDCA
- 上海中医药大学学报 2021年35卷第3期 页码：28-32
- 作者机构：
1.上海市浦东新区公利医院（上海 200135）
2.上海中医药大学（上海 201203）
3.广州中医药大学金沙洲医院（广东 广州 510168）
4.上海中医药大学附属曙光医院（上海 201203）
- 作者简介：
陈逸云，女，博士，主治医师，主要从事中医内科临床研究
唐苾芯，主任医师；E-mail：xiaoliutang1@126.com
- 基金信息：上海市浦东新区卫生系统领先人才项目(PWR12019-04);上海中医药大学预算内科研项目(2020WK118)
DOI：10.16306/j.1008-861x.2021.03.006
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陈逸云, 郑玥琪, 时桢, 等. 加味茵陈蒿汤对UDCA应答不佳的原发性胆汁性胆管炎患者肝纤维化的影响[J]. 上海中医药大学学报, 2021,35(3):28-32.
CHEN Yiyun, ZHENG Yueqi, SHI Zhen, et al. Effects of Modified Yinchenhao Decoction on liver fibrosis in patients of primary biliary cholangitis with poor response to UDCA[J]. Academic Journal of Shanghai University of Traditional Chinese Medicine, 2021,35(3):28-32.
陈逸云, 郑玥琪, 时桢, 等. 加味茵陈蒿汤对UDCA应答不佳的原发性胆汁性胆管炎患者肝纤维化的影响[J]. 上海中医药大学学报, 2021,35(3):28-32. DOI： 10.16306/j.1008-861x.2021.03.006.
CHEN Yiyun, ZHENG Yueqi, SHI Zhen, et al. Effects of Modified Yinchenhao Decoction on liver fibrosis in patients of primary biliary cholangitis with poor response to UDCA[J]. Academic Journal of Shanghai University of Traditional Chinese Medicine, 2021,35(3):28-32. DOI： 10.16306/j.1008-861x.2021.03.006.
摘要
目的：,2,观察加味茵陈蒿汤对熊去氧胆酸（UDCA）应答不佳的原发性胆汁性胆管炎（PBC）患者肝纤维化指标及血清转化生长因子β,1,（TGF-β,1,）、Smad3水平的影响。,方法：,2,纳入61例UDCA应答不佳的PBC患者，随机分为治疗组30例和对照组31例。两组患者均给予足量UDCA治疗，治疗组患者在此基础上加用加味茵陈蒿汤口服，两组疗程均为12个月。治疗前后，检测并比较两组患者的血清碱性磷酸酶（ALP）、谷氨酰转肽酶（GGT）、透明质酸（HA）、TGF-β,1,、Smad3水平；采用肝脏瞬时弹性扫描仪（FibroScan）检测两组患者的肝脏硬度测量（LSM）值；评估两组患者的天冬氨酸氨基转移酶与血小板比率指数（APRI）评分。,结果：,2,试验过程中，治疗组2例患者脱落，对照组3例患者脱落或剔除，最终治疗组28例、对照组28例纳入统计分析。①治疗后，两组患者的ALP、GGT水平较治疗前均降低（,P,<,0.05，,P,<,0.01），且治疗组患者的ALP、GGT水平均低于对照组（,P,<,0.05，,P,<,0.01）。②治疗后，两组患者的LSM值及血清HA水平较治疗前均降低（,P,<,0.05，,P,<,0.01），且治疗组患者的LSM值及血清HA水平均低于对照组（,P,<,0.05）。③治疗后，治疗组患者的APRI评分较治疗前明显降低（,P,<,0.05），且治疗组患者的APRI评分低于对照组（,P,<,0.05）。④治疗后，两组患者的血清TGF-β,1,、Smad3水平较治疗前均降低（,P,<,0.05，,P,<,0.01），且治疗组患者的血清TGF-β,1,、Smad3水平低于对照组（,P,<,0.01）。,结论：,2,加味茵陈蒿汤作为一种有效且安全的联合治疗手段，可改善UDCA应答不佳的PBC患者的肝纤维化，其作用机制可能与调节TGF-β,1,/Smad3途径相关。
Abstract
Objective:,2,To observe the influence of Modified Yinchenhao Decoction on the indexes of liver fibrosis and the serum levels of transforming growth factor-β,1,(TGF-β,1,) and Smad3 in patients of primary biliary cholangitis(PBC) with poor response to ursodeoxycholic acid(UDCA) .,Methods:,2,A total of 61 PBC patients with poor response to UDCA were included and randomly divided into the treatment group(30 cases) and the control group(31 cases) .The patients in both groups were treated with UDCA at full dose, and the patients in the treatment group were orally treated with Modified Yinchenhao Decoction based on above.The treatment course of the two groups was 12 months.Before and after treatment, the serum levels of alkaline phosphatase(ALP), γ-glutamyl transpeptidase(GGT), hyaluronic acid(HA), TGF-β,1,and Smad3 in both groups were detected and compared; the liver stiffness measurement(LSM) value in both groups was detected by FibroScan; the score of aspartate aminotransferase-to-platelet ratio index(APRI) in both groups was evaluated.,Results:,2,In the course of trial, 2 patients in the treatment group shed and 3 patients in the control group were excluded or shed.Finally, 28 cases in the treatment group and 28 cases in the control group were included for statistical analysis.①After treatment, the levels of ALP and GGT in both groups were decreased compared with those before treatment(,P,<,0.05,P,<,0.01), and the levels of ALP and GGT in the treatment group were lower than those in the control group(,P,<,0.05,P,<,0.01) .②After treatment, the LSM value and the serum HA level in both groups were decreased compared with those before treatment(,P,<,0.05,P,<,0.01), and the LSM value and the serum HA level in the treatment group were lower than those in the control group(,P,<,0.05) .③After treatment, the score of APRI in the treatment group was significantly decreased compared with that before treatment(,P,<,0.05), and the score of APRI in the treatment group was lower than that in the control group(,P,<,0.05) .④After treatment, the serum levels of TGF-β,1,and Smad3 in both groups were decreased compared with those before treatment(,P,<,0.05,P,<,0.01), and the serum levels of TGF-β,1,and Smad3 in the treatment group were lower than those in the control group(,P,<,0.01) .,Conclusion:,2,As an effective and safe combination therapy, Modified Yinchenhao Decoction can improve the liver fibrosis in PBC patients with poor response to UDCA, and its mechanism may be related to the regulation of TGF-β,1,/Smad3 pathway.
关键词
原发性胆汁性胆管炎加味茵陈蒿汤熊去氧胆酸转化生长因子β1；Smad3
Keywords
primary biliary cholangitismodified Yinchenhao Decoctionursodeoxycholic acidtransforming growth factor-β1Smad3
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