康艳艳+王运其+李朝晖

[摘要] 目的 觀察舒清丸治疗肝病残留黄疸的临床效果。 方法 选择2015年3月～2017年3月河北中医肝病医院（以下简称“我院”）收治的100例符合肝病残留黄疸诊断标准的患者，随机分为两组，治疗组50例（肝炎41例，肝硬化9例），对照组50例（肝炎38例，肝硬化12例）。治疗组应用舒清丸治疗，对照组应用茵栀黄颗粒治疗，30 d为1个疗程，根据病情治疗1～2个疗程。观察两组治疗前后总胆红素水平，比较两组治疗有效率，同时监测各组治疗期间的不良反应。 结果 治疗后两组患者总胆红素水平均有所降低（P < 0.05）；治疗后60 d，治疗组总胆红素水平低于对照组（P < 0.05）。治疗组总有效率优于对照组（P < 0.05）。亚组间总有效率比较：治疗组中硬化组、肝炎组的总有效率分别高于对照组（P < 0.05），同组内肝炎组总有效率优于硬化组（P < 0.05）。治疗期间治疗组有2例患者出现轻微的肠胃不适，停药后肠胃不适症状缓解，未见其他严重不良反应。 结论 舒清丸可以显著降低肝病残留黄疸的胆红素水平，而且不良反应较少，值得在临床推广。

[关键词] 舒清丸；肝病；残留黄疸；疗效

[中图分类号] R256.4 [文献标识码] A [文章编号] 1673-7210（2017）12（c）-0125-04

[Abstract] Objective To observe the clinical effect of Shuqing Pills in treating residual jaundice of liver disease. Methods From March 2015 to March 2017， 100 patients diagnosed residual jaundice of liver disease in Hebei TCM Liver Disease Hospital were selected， they were randomly divided into two groups， with 50 cases in the treatment group （including 41 cases of hepatitis， 9 cases of liver cirrhosis） and 50 cases in the control group （including 38 cases of hepatitis， 12 cases of liver cirrhosis）. The treatment group was treated with Shuqing Pills， the control group was treated with Yinzhihuang Granules. 30 days is one course of treatment， 1-2 courses of treatment according to the disease. The total bilirubin levels were observed before and after treatment， the total effective rate of the two groups were compared， Meanwhile， adverse reactions during the treatment were monitored. Results After treatment， the total bilirubin levels of the two groups were decreased （P < 0.05）； sixty days after treatment， the total bilirubin level of the treatment group was lower than that of the control group （P < 0.05）. The total effective rate of the treatment group was better than that of the control group （P < 0.05）. The total effective comparison in the subgroups： the rates of the cirrhosis subgroup and the hepatitis subgroup in the treatment group were better than those in the control group respectively （P < 0.05）； besides， the rates of the hepatitis subgroup were better than those of the cirrhosis subgroup in the same group （P < 0.05）. In the treatment group， two patients experienced mild gastrointestinal distress， and the gastrointestinal symptoms were relieved after discontinuation， and no other serious adverse reactions were observed. Conclusion Shuqing Pills can significantly reduce the level of bilirubin in patients with residual jaundice of liver disease， and less adverse reactions， which is worthy of clinical application.endprint

[Key words] Shuqing Pill； Liver disease； Residual jaundice； Curative effect

残留黄疸多出现于急慢性肝病的治疗后期，常规的保肝治疗效果欠佳，现代医学缺乏理想的治疗方法，是临床治疗难点之一。中医认为黄疸的病因是以湿热为本，湿浊阻滞，肝失疏泄，气机不畅，胆汁排泄失司，瘀阻血脉，胆汁外溢，日久影响脾胃功能，运化失司，致痰浊内生而郁热，湿热与痰瘀互结肝胆络脉，黏腻难解。遵循张仲景的“观其脉症，犯何逆，随证治之”古训，故单纯清热利湿的治疗思路难以实施。目前临床常用的退黄药物有茵栀黄颗粒、熊去氧胆酸胶囊、腺苷蛋氨酸等，但可选择的种类有限。对于残留黄疸的治疗，近几年临床的治疗热点主要集中在苯巴比妥、复方丹参滴丸、大黄蟅虫丸等非常规退黄药物上，大多沿用了中医的活血化瘀、改善微循环的基本思路，有一定疗效，但不太满意[1-4]。……