ABSTRACT
ObjectiveTo observe the effect of enema with Chinese medicine Changduqing combined with plasma exchange for treatment of endotoxemia in patients with acute-on-chronic liver failure.Methods A prospective randomized controlled trial was conducted, and 68 patients with acute-on-chronic hepatic failure who were hospitalized from January 2009 to June 2012 in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine were randomly divided into treatment and control groups, 34 cases in each group. The patients in control group were treated with plasma exchange combined with western medicine comprehensive treatment such as protecting liver, reducing enzyme, removing jaundice, and in cases with hepatitis B, antiviral therapy was added. The treatment in patients of treatment group was the same as that in the control group, but additionally Changduqing enema of TCM decoction was given(ingredients: radix et rhizoma ginseng 10 g, flos magnolia officinalis 6 g, radix et rhizoma rhei 6 g, fructus aurantii immaturus 6 g, radix paeoniae rubra 10 g),twice a day combined with 3-4 times of plasma exchange treatment, once every 72 hours. The course of treatment of both groups was 4 weeks. The changes of total bilirubin (TBil), alanine aminotransferase(ALT), albumin(ALB), prothrombin activity(PTA), endotoxin, the improvement of clinical symptoms and signs such as lacking in strength, poor appetite, abdominal distension, oliguria, bleeding tendency, hepatic encephalopathy, infection and ascites were observed before and after treatment, and the survival rate in 24 weeks of follow-up was also investigated.Results Before treatment, the comparisons of TBil,ALT, ALB and PTA between the two groups were of no statistically significant differences(allP>0.05); compared with those before treatment, the levels of TBil and ALT were obviously decreased, and PTA was markedly increased after treatment in both groups, the degree of change being more prominent in treatment group〔TBil(μmol/L): 89.6±52.3 vs. 124.6±64.4, ALT(U/L):52.4±32.1 vs. 98.3±42.5, PTA:(53.8±11.5)% vs.(41.2±10.2)%, allP0.05). After treatment, the endotoxin(kU/L) in both groups were decreased in inchoate, developing and fully-developed stages and the descent being more significant in treatment group(inchoate stage: 0.094±0.015 vs. 0.109±0.032, developingstage: 0.102±0.019 vs. 0.146±0.062, fully-developed stage: 0.124±0.022 vs. 0.196±0.074, allP<0.05). The 24-week survival rates of developing and fully-developed stages in patients of both groups were lower than the rate in patients of inchoate stage, and the rates of treatment group in inchoate and developing stages were remarkably higher than the rate in control group〔inchoate stage: 94.1%(16/17) vs. 83.3%(15/18), developed stage: 85.7%(12/14) vs. 42.9%(6/14),bothP<0.01〕.ConclusionEnema with TCM Changduqing combined with plasma exchange for treatment of patients with acute-on-chronic liver failure can remove bilirubin, ameliorate endotoxemia, elevate PTA level and increase the survival rate of patients in 24 weeks of follow-up.