实脾饮治疗乙肝后肝硬化腹水脾虚水停证临床观察

Clinical Observation on Shipi Decoction in Treating Hepatitis B-Related Cirrhotic Ascites with Spleen Deficiency and Water Retention Syndrome

摘要: 目的：探讨实脾饮联合西医常规治疗乙肝后肝硬化腹水脾虚水停证的临床疗效。方法：纳入符合标准的乙肝后肝硬化腹水脾虚水停证患者100例，采用随机数字表法 + 密封信封随机隐藏分为观察组和对照组，各50例。对照组给予恩替卡韦胶囊抗病毒以及呋塞米片和螺内酯片利尿，观察组在对照组的基础上加用实脾饮，疗程24周。比较两组患者治疗后临床总有效率、中医证候积分、肝功能、细胞免疫功能的差异。结果：观察组临床总有效率为91.49%，显著高于对照组的73.91%；两组中医证候积分均下降，观察组腹胀、乏力、纳差等症状改善更显著(P < 0.05)；两组肝功能指标均较治疗前改善，并且观察组TBiL、ALT、AST降低更明显，ALB提升更显著(P < 0.01)；两组细胞免疫功能指标CD3⁺、CD4⁺水平显著升高，CD8⁺水平显著降低，并且免疫功能改善优于对照组(P < 0.05)。结论：实脾饮联合西医常规治疗乙肝后肝硬化腹水脾虚水停证，可有效改善临床症状、修复肝功能、调节免疫功能，提升临床治疗效果。中西医结合方案较单纯西医治疗显示出潜在的协同增效作用，值得临床推广应用。

Abstract: Objective: To explore the clinical efficacy of Shipi Decoction combined with conventional Western medicine in the treatment of hepatitis B-related cirrhotic ascites with spleen deficiency and water retention syndrome. Methods: A total of 100 patients diagnosed with hepatitis B-related cirrhotic ascites conforming to spleen deficiency and water retention syndrome were enrolled. The random number table method combined with sealed envelope random concealment was adopted to divide the subjects into an observation group and a control group, with 50 cases in each group. The control group received entecavir capsules for antiviral therapy plus furosemide tablets and spironolactone tablets for diuresis. On the basis of the treatment for the control group, the observation group was additionally administered Shipi Decoction, with a treatment course of 24 weeks. The overall clinical effectiveness rate, traditional Chinese medicine syndrome scores, liver function parameters, and cellular immune function indicators were compared between the two groups after treatment. Results: The overall clinical effectiveness rate of the observation group was 91.49%, which was markedly higher than 73.91% of the control group. The TCM syndrome scores of both groups declined, and the improvements in abdominal distension, fatigue, poor appetite, and other symptoms were more prominent in the observation group (P < 0.05). Liver function indicators of both groups were improved compared with baseline; the observation group presented more significant reductions in total bilirubin, alanine transaminase, and aspartate transaminase, as well as a more remarkable elevation of albumin (P < 0.01). Levels of CD3⁺ and CD4⁺ were significantly elevated while CD8⁺ levels were obviously decreased in both groups, and the improvement of immune function in the observation group was superior to that in the control group (P < 0.05).Conclusion: For patients with hepatitis B-related cirrhotic ascites of spleen deficiency and water retention syndrome, Shipi Decoction combined with routine Western medicine can effectively relieve clinical symptoms, restore liver function, regulate cellular immune function, and improve overall therapeutic efficacy. The integrated Chinese and Western medicine regimen exerts potential synergistic effects compared with Western monotherapy, which is worthy of clinical popularization and application.