Effect of Modified<italic style="font-style: italic"> Jianpi Huashi Formula</italic> （健脾化湿方） on Rebleeding Rate within One Year and the Levels of Endotoxin and Cytokines in Patients with HBV-related Liver Cirrhosis and Esophageal Variceal Bleeding

YU Hao; HOU Yixin; JIANG Yuyong; YANG Yuying; MENG Peipei; WU Tong; SUN Le; JI Xiaomin

doi:10.13288/j.11-2166/r.2022.15.011

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Effect of Modified Jianpi Huashi Formula （健脾化湿方） on Rebleeding Rate within One Year and the Levels of Endotoxin and Cytokines in Patients with HBV-related Liver Cirrhosis and Esophageal Variceal Bleeding

更新时间：2023-02-21

- Effect of Modified Jianpi Huashi Formula （健脾化湿方） on Rebleeding Rate within One Year and the Levels of Endotoxin and Cytokines in Patients with HBV-related Liver Cirrhosis and Esophageal Variceal Bleeding
- Journal of Traditional Chinese Medicine Vol. 63, Issue 15, Pages: 1456-1462(2022)
- 作者机构：
  
  首都医科大学附属北京地坛医院，北京市朝阳区京顺东街8号，100015
- 作者简介：
- 基金信息：
- DOI：10.13288/j.11-2166/r.2022.15.011
  CLC：
- Received：18 November 2021，
  
  Revised：2022-02-20，
  
  Published：02 August 2022
- 稿件说明：
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于浩,侯艺鑫,江宇泳等.健脾化湿方加减对乙型肝炎肝硬化合并食道胃底静脉曲张出血患者1年内再出血及内毒素、细胞因子的影响[J].中医杂志,2022,63(15):1456-1462.

YU Hao,HOU Yixin,JIANG Yuyong,et al.Effect of Modified Jianpi Huashi Formula （健脾化湿方） on Rebleeding Rate within One Year and the Levels of Endotoxin and Cytokines in Patients with HBV-related Liver Cirrhosis and Esophageal Variceal Bleeding[J].Journal of Traditional Chinese Medicine,2022,63(15):1456-1462.
于浩,侯艺鑫,江宇泳等.健脾化湿方加减对乙型肝炎肝硬化合并食道胃底静脉曲张出血患者1年内再出血及内毒素、细胞因子的影响[J].中医杂志,2022,63(15):1456-1462. DOI： 10.13288/j.11-2166/r.2022.15.011.

YU Hao,HOU Yixin,JIANG Yuyong,et al.Effect of Modified Jianpi Huashi Formula （健脾化湿方） on Rebleeding Rate within One Year and the Levels of Endotoxin and Cytokines in Patients with HBV-related Liver Cirrhosis and Esophageal Variceal Bleeding[J].Journal of Traditional Chinese Medicine,2022,63(15):1456-1462. DOI： 10.13288/j.11-2166/r.2022.15.011.

摘要

目的

探讨基于健脾化湿方的随证加减方案对乙型肝炎肝硬化合并食道胃底静脉曲张破裂出血（EGVB）患者1年内再出血、内毒素及细胞因子水平的影响。

方法

将乙型肝炎肝硬化合并EGVB患者110例随机分为中西医结合治疗组和西医对照组各55例，两组均采用西医综合治疗方案进行治疗，活动出血停止1周后，中西医结合治疗组加用健脾化湿方，西医对照组加用卡维地洛片，两组疗程均为12周，治疗结束后随访36周。记录两组患者一般资料情况及生化指标包括肝功能［丙氨酸氨基转移酶（ALT）、门冬氨酸氨基转移酶（AST）、总胆红素（TBIL）、谷氨酰基转移酶（GGT）、白蛋白（AlB）］、电解质及肾功能、［钠（NA）、肌酐（Cr）］、血糖（GlU）、血常规［白细胞（WBC）、粒淋比（NLR）、血红蛋白（HGB）、血小板（PLT）］、凝血功能［凝血酶原时间（PT）、国际标准化比值（INR）］。将指标进行Cox单因素分析，筛选出具有统计学意义的单因素变量，纳入单因素变量进行Cox多因素分析，确定影响EGVB发生1年内再出血的影响因素。并检测两组治疗前后及随访时血清内毒素、细胞因子［内皮素-1（ET-1）、肿瘤坏死因子（TNF-α）、一氧化氮（NO）］水平。

结果

单因素分析结果显示，TBIL、GGT、GLU、WBC、INR、PT、NA及中药治疗差异具有统计学意义（

＜0.05或

＜0.01）。多因素分析结果显示，TBIL、GLU、INR、中药治疗是EGVB发生1年内再出血的独立影响因素，其中中药治疗是EGVB再出血的保护因素（

＜0.05或

＜0.01）。两组治疗后及随访时与治疗前比较ET-1、TNF-α、NO及内毒素水平均明显降低（

＜0.05或

＜0.01）；两组随访时与治疗后比较，ET-1、TNF-α、NO及内毒素水平均明显下降（

＜0.01）；治疗后及随访时，中西医结合治疗组ET-1、TNF-α、NO及内毒素水平较西医对照组明显降低（

＜0.01）。

结论

基于健脾化湿方的随证加减方案能够降低乙肝肝硬化合并EGVB患者1年内再出血发生率，且具有降低细胞因子及内毒素水平的作用。

Abstract

Objective

To investigate the effect of modified

Jianpi Huashi Formula

（健脾化湿方， JHF） on rebleeding， endotoxin and cytokine levels in patients with HBV-related liver cirrhosis and esophageal variceal bleeding （EGVB） within one year.

Methods

A randomized controlled study was conducted in 110 patients with HBV-related liver cirrhosis and EGVB， who were randomly divided into the integrated traditional Chinese medicine and western medicine group （55 cases） and the western medicine control group （55 cases）. Both groups received comprehensive western medicine treatment， and one week after the bleeding stopped， the integrated treatment group was added with JHF， while the control group received carvedilol tablets additionally， both for 12 weeks with follow-up of 36 weeks. General information and biochemical parameters related to liver function， including alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， total bilirubin （TBIL）， glutamyltransferase （GGT） and albumin （AlB）， electrolytes and renal function indicators inlcuding sodium （NA）， creatinine （Cr） and glucose （GlU）， blood routine indicators including white blood cell （WBC）， neutrophil-to-lymphocyte ratio （NLR）， hemoglobin （HGB）， platelets （PLT）， and coagulation function indicators including prothrombin time （PT） and international normalized ratio （INR）. Univariate Cox analysis was performed to select the variables that were statistically significant， and those selected factors were then used for multivariate Cox analysis to determine the influencing factors of the occurrence of EGVB rebleeding within 1 year. The changes of serum endotoxin and cytokines including endothelin-1 （ET-1）， tumor necrosis factor （TNF-α）， and nitric oxide （NO） before and after treatment and during follow-up were analyzed.

Results

Univariate analysis showed that there were significant differences in TBIL ， GGT， GLU， WBC， INR， PT， NA and treatment with traditional Chinese medicine （TCM）. Multivariate analysis showed that TBIL， GLU， INR and TCM treatment were the independent influencing factors of EGVB rebleeding within 1 year， of which TCM treatment was the protective factor （

＜0.05 or

＜0.01）. The ET-1， TNF-α， NO and endotoxin levels in both groups significantly decreased after treatment and during follow-up （

＜0.01）， and more decreases were found during follow-up than after treatment （

＜0.01）， as well as in the integrated group than in the control group measured after treatment and during follow-up （

＜0.01）.

Conclusion

The modified JHF can reduce the rebleeding rate within 1 year in patients with HBV-related liver cirrhosis and EGVB， and can reduce the levels of cytokines and endotoxin.

关键词

Keywords

references

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Effect of Modified Jianpi Huashi Formula （健脾化湿方） on Rebleeding Rate within One Year and the Levels of Endotoxin and Cytokines in Patients with HBV-related Liver Cirrhosis and Esophageal Variceal Bleeding

DOI：10.13288/j.11-2166/r.2022.15.011

摘要

Abstract

关键词

Keywords

references