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熊去氧胆酸联合中药对原发性胆汁性胆管炎患者生化反应的影响:一项真实世界队列研究

[Effect of ursodeoxycholic acid with traditional Chinese medicine on biochemical response in patients with primary biliary cholangitis: a real-world cohort study].

作者信息

Chen J L, Yang X, Zhang Q, Sun L, Liu Y, Zhu B B, Wang X B

机构信息

Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.

Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China.

出版信息

Zhonghua Gan Zang Bing Za Zhi. 2018 Dec 20;26(12):909-915. doi: 10.3760/cma.j.issn.1007-3418.2018.12.007.

Abstract

To examine the effects of ursodeoxycholic acid combined with Traditional Chinese Medicine on biochemical response in patients with primary biliary cholangitis. According to the method of receiving treatment, 197 patients with primary biliary cholangitis were divided into Traditional Chinese Medicine plus Western medicine group (93 cases, 47.2%) and Western medicine group (104 cases, 52.8%). From the baseline date, the combined group was treated with ursodeoxycholic acid plus traditional Chinese medicine decoction or Chinese patent medicine for at least one month and the Western medicine group simply took ursodeoxycholic acid . Additionally, Traditional Chinese medicine decoction prescriptions were mainly Xiaoyaosan and Yinchenhao. Chinese patent medicine were restricted to Biejia Ruangan tablets, Fuzheng Huayu capsules, Jiuweigantai capsules and Yinzhihuang capsules, which were used to treat liver fibrosis and cholestasis. The primary efficacy endpoint was defined as ALP level < 1.67 × ULN and ≥ 15% decrease in ALP with baseline level and TBIL≤ULN after 12 months of treatment. The overall biochemical response rate of patients was 35.0% (69/197). The response rate of TCM+ Western medicine group was 43.0% (40/93), and that of Western medicine group was 27.9% (29/104). The difference between the two groups was statistically significant ((2) = 4.936, < 0.05). Further analysis showed that the Chinese and Western medicine group was superior to the Western medicine group alone in reducing γ-glutamyltransferase (GGT) and TBiL [the median decline were GGT: 160.1 U/L and 111.3 U/L ( = -2.474, < 0.05), TBiL: 5.2 umol/l and 3.1 umol/l ( = -2.125, < 0.05)]. UDCA combined with TCM therapy can remarkably improve the biochemical response rate in patients with PBC and distinctly decrease the TBIL and GGT levels than UDCA monotherapy.

摘要

探讨熊去氧胆酸联合中药对原发性胆汁性胆管炎患者生化反应的影响。根据治疗方法,将197例原发性胆汁性胆管炎患者分为中西医结合组(93例,47.2%)和西医组(104例,52.8%)。从基线日期开始,联合组接受熊去氧胆酸加中药汤剂或中成药治疗至少1个月,西医组单纯服用熊去氧胆酸。此外,中药汤剂处方主要为逍遥散和茵陈蒿汤。中成药限于鳖甲软肝片、扶正化瘀胶囊、九味肝泰胶囊和茵栀黄胶囊,用于治疗肝纤维化和胆汁淤积。主要疗效终点定义为治疗12个月后碱性磷酸酶(ALP)水平<1.67×ULN且较基线水平下降≥15%,总胆红素(TBIL)≤ULN。患者的总体生化反应率为35.0%(69/197)。中西医结合组的反应率为43.0%(40/93),西医组为27.9%(29/104)。两组之间的差异具有统计学意义((2)=4.936,<0.05)。进一步分析表明,中西医结合组在降低γ-谷氨酰转移酶(GGT)和总胆红素方面优于单纯西医组[GGT的中位数下降分别为160.1 U/L和111.3 U/L(=-2.474,<0.05),总胆红素:5.2 μmol/l和3.1 μmol/l(=-2.125,<0.05)]。熊去氧胆酸联合中药治疗可显著提高原发性胆汁性胆管炎患者的生化反应率,且与熊去氧胆酸单药治疗相比,可明显降低总胆红素和GGT水平。

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