研究疾病:
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难治性肝硬化腹水
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研究疾病代码:
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Target disease:
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Refractory cirrhotic ascite
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Target disease code:
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研究类型:
Study type:
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干预性研究
Interventional study
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研究设计:
Study design:
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随机平行对照
randomized controlled trial(parallel group design)
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研究所处阶段:
Study phase:
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探索性研究/预试验
Pilot clinical trial
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研究目的:
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明确真武汤结合西药可提高难治性肝硬化腹水的临床治疗疗效。
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Objectives of Study:
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Zhenwu decoction combined with western medicine can improve the clinical therapeutic effect of refractory cirrhosis ascites
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药物成份或治疗方案详述:
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Description for medicine or protocol of treatment in detail:
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纳入标准:
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1. 西医标准参考中华医学会肝病学分会肝硬化及相关并发症诊疗指南(2017版):
(1)失代偿性肝硬化(Child-Pugh分级B/C级)。
(2)有明显肝功能异常及失代偿征象,如血清白蛋白<35g/L;或明显黄疸,胆红素>35μmol/L;或ALT和AST升高;或凝血酶原活动度<60%;患者出现腹水。
(3)影像学诊断,B超见肝表面明显凹凸不平,锯齿状或波浪状,肝边缘变钝,肝实质回声不均、增强,呈结节状,门静脉和脾门静脉内径增宽,肝内血管走向欠清,腹腔内可见液性暗区。
(4)较大利尿剂药物(螺内160mg/d和呋塞米80mg/d)治疗至少1周或间断治疗性放腹水(4000-5000ml/次)联合白蛋白(20-40g/次/天)治疗2周腹水无治疗应答反应;出现难控制的利尿药物相关并发症或不良反应。
2. 中医标准参考2017肝硬化腹水中医诊疗庄洁共识意见,符合中医“鼓胀”诊断标准,即腹部胀满、小便短小、甚至腹大如鼓、皮色苍黄、脉络暴露为主要表现。证型符合脾肾阳虚证。主症:①腹大胀满,形如蛙腹;②腹胀早轻暮色重;③形肢寒冷;次症:①面色白;②肢体浮肿;③腰膝酸软;④腹中冷痛。诊断:具备主症2项加次症2项,或主症第1项加次症3项。
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Inclusion criteria
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1. Western medicine standard reference guidelines for diagnosis and treatment of cirrhosis and related complications of hepatology branch of the Chinese medical association (2017 edition):
(1) decompensated cirrhosis (child-pugh grade B/C).
(2) obvious signs of abnormal liver function and decompensation, such as serum albumin <35g/L; Or obvious jaundice, bilirubin >35 micron /L; Or elevated ALT and AST;Or prothrombin activity <60%; The patient has ascites.
(3) imaging diagnosis showed that the liver surface was obviously uneven, zigzag or wavy, the liver edge became blunt, the echo of liver parenchyma was uneven and enhanced, and it was nodular, the inner diameter of portal vein and splenic portal vein was widened, the blood vessels in the liver were not clear, and the liquid dark area was visible in the abdominal cavity.
(4) large diuretic drugs (160mg/d in whelk and 80mg/d in furfurmi) were treated for at least 1 week or intermittent therapeutic ascites (4000-5000ml/ time) combined with albumin (20-40g/ time/day) for ascites for 2 weeks without any response to treatment;Difficult to control diuretic drug - related complications or adverse reactions.
2. TCM standard reference 2017 cirrhosis ascites medical diagnosis and treatment Zhuangjie consensus opinion, in line with the Chinese medicine "bulging" diagnostic criteria, that is, abdominal fullness, short urine, and even abdomen as a drum, skin color pale, vein exposure as the main performance. The syndrome type conforms to the syndrome of spleen and kidney yang deficiency.
Main symptoms: (1) abdominal fullness, shape like frog belly; (2) abdominal distension early light weight; (3) limb cold;
secondary symptoms: (1) complexion white; (2) limb edema; (3) waist and knees soft; (4) cold pain in the abdomen.
Diagnosis: 2 cases with major symptoms plus 2 minor cases, or 1 case with major symptoms plus 3 minor symptoms.
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排除标准:
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排除标准凡不符合纳入标准任何一条者;合并心血管、肺、肾、神经系统严重疾病及血液系统严重原发疾病者以及精神病、肿瘤(肝脏肿瘤只排除并发血性腹水者)患者;肾功能不全者;血糖难以控制的糖尿病患者;妊娠及哺乳期妇女。肝硬化并发上消化道出血、肝性脑病、肝肾综合征患者。
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Exclusion criteria:
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Exclusion criteria are those that do not meet any of the inclusion criteria; patients with severe cardiovascular, pulmonary, renal, or neurological diseases and severe primary hematological diseases, as well as patients with mental illness, tumors (hepatic tumors only exclude concurrent ascites); renal insufficiency Diabetes patients with uncontrolled blood sugar; pregnant and lactating women. Liver cirrhosis complicated with upper gastrointestinal bleeding, hepatic encephalopathy, and patients with hepatorenal syndrome.
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研究实施时间:
Study execute time:
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从From
2019-10-01
至To
2021-09-30
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征募观察对象时间:
Recruiting time:
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从From
2019-10-01
至To
2021-09-30
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