【目的】观察联合牛角地黄解毒汤 （由犀角地黄汤加减组方而成） 的中西医结合治疗慢加急性肝衰竭 （acute-on-chronic liver failure，ACLF） 患者的临床疗效。 【方法】将60例毒热瘀结型ACLF患者随机分为试验组和对照组，每组各30例。对照组给予西医综合治疗 （包括病因治疗、护肝治疗以及对症支持治疗） ，试验组在对照组的基础上联合牛角地黄解毒汤治疗，疗程为4周。观察2组患者治疗前后肝功能指标及凝血功能指标的变化情况，并评价2组患者的临床疗效。 【结果】（1） 脱落情况方面，研究过程中，试验组脱落2例，对照组脱落3例，2组脱落病例均按无效病例统计。 （2） 疗效方面，治疗4周后，试验组的总有效率为80.00% （24/30） ，对照组为53.33% （16/30） ，组间比较 （χ2检验） ，试验组的疗效明显优于对照组 （P＜0.05） 。（3） 肝功能指标方面，治疗后，2组患者的谷丙转氨酶 （ALT） 、谷草转氨酶 （AST） 、总胆红素 （TBIL） 、直接胆红素 （DBIL） 等肝功能指标均较治疗前明显改善 （P＜0.05） ，且试验组的改善作用均明显优于对照组 （P＜0.05） 。 （4） 凝血功能指标方面，治疗后，2组患者的凝血酶原时间 （PT） 均较治疗前明显改善 （P＜0.05） ，且试验组的改善作用明显优于对照组 （P＜0.05） 。 【结论】联合牛角地黄解毒汤的中西医结合治疗毒热瘀结型ACLF患者疗效确切，能显著改善患者的肝脏功能及凝血功能，其疗效明显优于单纯西医综合治疗，具有较高的临床价值。

Objective To observe the clinical efficacy of the integrative Chinese and western medicine therapy with the utilization of Niujiao Dihuang Jiedu Decoction （derived from the modified Xijiao Dihuang Decoction） in the treatment of acute-on-chronic liver failure （ACLF） . Methods Sixty patients with ACLF of toxic-heat-stasis stagnation type were randomly divided into the trial group and the control group，with 30 patients in each group. The control group was given western medicine comprehensive treatment （including etiologic treatment，liver-protecting treatment and symptomatic and supportive treatment），while the trial group was treated with Niujiao Dihuang Jiedu Decoction on the basis of treatment for the control group，and the courses of treatment covered four weeks. The changes of liver function indicators and coagulation function indicators of the patients in the two groups before and after treatment were observed，and the clinical efficacy of the patients in the two groups after treatment was evaluated. Results （1） During the trial，there were two cases in the trial group and three cases in the control group dropped off，and the falling-off cases in the two groups were counted as invalid cases. （2） After four weeks of treatment，the total effective rate of the trial group was 80.00% （24/30） and that of the control group was 53.33% （16/30），and the intergroup comparison （by chi-square test） showed that the therapeutic efficacy of the trialgroup was significantly superior to that of the control group （P＜0.05） . （3） After treatment， liver function indicators such as alanine transaminase （ALT），aspartate transaminase （AST），total bilirubin （TBIL），and direct bilirubin （DBIL） in the two groups were significantly improved compared with those before treatment （P＜0.05） ，and the improvement of liver function indicators in the trial group was significantly superior to that in the control group （P＜0.05） . （4） After treatment，the prothrombin time （PT） of patients in the two groups was significantly improved when compared with that before treatment （P＜0.05），and the improvement of PT in the trial group was significantly superior to that in the control group （P＜0.05） . Conclusion The integrative Chinese and western medicine therapy with the utilization of Niujiao Dihuang Jiedu Decoction is effective in treating ACLF patients with toxic-heat-stasis stagnation type，which can significantly improve the liver function and coagulation function of the patients. The therapeutic efficacy of the integrative therapy is significantly superior to that of the western medicine comprehensive treatment alone，which has high clinical value.

R259.753

广东省中医药局科研项目 （编号：20201303）；深圳市“医疗卫生三名工程”资助项目 （编号：SZZYSM202311014）；深圳市宝安区属公立医院高质量发展项目 （编号：YNXM2024072）；深圳市宝安区医学会科研课题 （编号：BAYXH2024022）