一贯煎组方治疗肝肾阴虚型干燥综合征肝损伤的临床观察及机制(1)
摘要 目的：探究一贯煎组方治疗肝肾阴虚型干燥综合征肝损伤的临床效果及对可能的作用机制。方法：选择96例干燥综合征肝损伤患者随机分为对照组和观察组患者，各48例。对照组患者给予谷胱甘肽静脉滴注，观察组患者则加用一贯煎组方治疗，2周为1个疗程，连续用药4个疗程。比较2组的临床效果，通过Schirmer试验及唾液流率观察口干眼干情况，监测治疗前后血清免疫炎性指标Toll样受体9(TLR9)蛋白浓度、红细胞沉降率(ESR)、免疫球蛋白G(IgG)、C反应蛋白(CRP)水平及肝功能相关指标天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、总胆红素(TBIL)水平变化。结果：观察组有效率为91.7%，显著高于对照组的75%(P<0.05)；2组患者经治疗后的Schirmer试验水平及唾液流率水平均有所上升，血清TLR9浓度及ESR、IgG、CRP、AST、ALT、TBIL水平均有所下降，以观察组的变化程度更为明显(P<0.05)。结论：一贯煎组方治疗肝肾阴虚型干燥综合征肝损伤患者疗效肯定，利于改善眼干、口干症状，提高肝功能，其机制与抑制血清中TLR9、ESR、IgG、CRP水平有一定相关性。
关键词 干燥综合征；肝损伤；一贯煎组方；肝肾阴虚证；作用机制
Abstract Objective：To investigate the efficacy and mechanism of treating liver-kidney yin deficiency type sjogren′s syndrome with liver damage by All-Along decoction.Methods：A total of 96 patients were randomly divided into a control group (48 cases) and an observation group (48 cases).Patients in the control group were treated with Glutathione intravenous drip； while patients in the observation group received All-Along decoction treatment on the basis of control treatment.The research was aimed at evaluating the efficacy by comparing its Schirmer′s test and salivary flow rate results，and monitoring the levels of TLR9，ESR，IgG，CRP，AST，ALT and TBIL.Results：The effective rate of the observation group was 91.7%，which was higher than that of the control group′s 75.0% (P<0.05)； The Schirmer′s test and salivary flow rate of patients in both two groups after treatment went up，and the levels of TLR9，ESR，IgG，CRP，AST，ALT and TBIL went down compared after the treatment，the degree of the changes in observation group was more significant (P<0.05).Conclusion：The clinical efficacy of All-Along decoction in treating liver-kidney yin deficiency type sjogren′s syndrome with liver syndrome is satisfactory as it can improve the symptoms of dry eyes and dry mouth and liver function，the mechanism may be associated with regulating the levels of TLR9，ESR，IgG and CRP.
Key Words Sjogren′s syndrome； Liver damage； All-Along Decoction； Liver-kidney Yin Deficiency Type； Mechanism
中圖分类号：R289；R593文献标识码：Adoi：10.3969/j.issn.1673-7202.2017.11.020
干燥综合征(Sjogren Syndrome，SS)是一种慢性炎性自身免疫性疾病，以泪腺、唾液腺等外分泌腺受损为特征，以干燥性角、结膜炎、口腔干燥等为主要表现，重则累及肝、肺、肾、胰腺等重要脏器，出现肺动脉高压、肺间质纤维化、肝损害、肾小管酸中毒等严重病变[1-3]。流行病学统计显示，SS好发于女性，发病率为0.5%～1%[4]。肝损伤是其并发症之一。西医临床诊治SS并无根治的方案，多以激素、免疫抑制剂等常规西药治疗，疗效欠佳[5]。中医学认为，SS的主要病机体现在“虚、燥、瘀、毒”4个方面，因虚致瘀、因燥致瘀、燥蕴成毒、瘀久成毒，内攻脏腑，外攻皮毛[6-7]。针对其病机特点，中医药通过整体把握、辨证论治，在改善患者的症状、体征，避免药物的不良反应，提高生命质量，减少复发率等方面有很大的优势[8]。本研究选择“肝肾阴虚证”SS肝损伤患者为研究对象，以一贯煎组方内服进行辨治，探讨其临床效果及可能的作用机制，现报道如下。, 百拇医药(姜淑华 胡丽伟 平利峰 孙凤艳 孙志娟 王晓磊)
关键词 干燥综合征；肝损伤；一贯煎组方；肝肾阴虚证；作用机制
Abstract Objective：To investigate the efficacy and mechanism of treating liver-kidney yin deficiency type sjogren′s syndrome with liver damage by All-Along decoction.Methods：A total of 96 patients were randomly divided into a control group (48 cases) and an observation group (48 cases).Patients in the control group were treated with Glutathione intravenous drip； while patients in the observation group received All-Along decoction treatment on the basis of control treatment.The research was aimed at evaluating the efficacy by comparing its Schirmer′s test and salivary flow rate results，and monitoring the levels of TLR9，ESR，IgG，CRP，AST，ALT and TBIL.Results：The effective rate of the observation group was 91.7%，which was higher than that of the control group′s 75.0% (P<0.05)； The Schirmer′s test and salivary flow rate of patients in both two groups after treatment went up，and the levels of TLR9，ESR，IgG，CRP，AST，ALT and TBIL went down compared after the treatment，the degree of the changes in observation group was more significant (P<0.05).Conclusion：The clinical efficacy of All-Along decoction in treating liver-kidney yin deficiency type sjogren′s syndrome with liver syndrome is satisfactory as it can improve the symptoms of dry eyes and dry mouth and liver function，the mechanism may be associated with regulating the levels of TLR9，ESR，IgG and CRP.
Key Words Sjogren′s syndrome； Liver damage； All-Along Decoction； Liver-kidney Yin Deficiency Type； Mechanism
中圖分类号：R289；R593文献标识码：Adoi：10.3969/j.issn.1673-7202.2017.11.020
干燥综合征(Sjogren Syndrome，SS)是一种慢性炎性自身免疫性疾病，以泪腺、唾液腺等外分泌腺受损为特征，以干燥性角、结膜炎、口腔干燥等为主要表现，重则累及肝、肺、肾、胰腺等重要脏器，出现肺动脉高压、肺间质纤维化、肝损害、肾小管酸中毒等严重病变[1-3]。流行病学统计显示，SS好发于女性，发病率为0.5%～1%[4]。肝损伤是其并发症之一。西医临床诊治SS并无根治的方案，多以激素、免疫抑制剂等常规西药治疗，疗效欠佳[5]。中医学认为，SS的主要病机体现在“虚、燥、瘀、毒”4个方面，因虚致瘀、因燥致瘀、燥蕴成毒、瘀久成毒，内攻脏腑，外攻皮毛[6-7]。针对其病机特点，中医药通过整体把握、辨证论治，在改善患者的症状、体征，避免药物的不良反应，提高生命质量，减少复发率等方面有很大的优势[8]。本研究选择“肝肾阴虚证”SS肝损伤患者为研究对象，以一贯煎组方内服进行辨治，探讨其临床效果及可能的作用机制，现报道如下。, 百拇医药(姜淑华 胡丽伟 平利峰 孙凤艳 孙志娟 王晓磊)
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