【目的】 研究解毒化瘀颗粒（由茵陈、大黄、白花蛇舌草、赤芍、郁金、石菖蒲等中药组成）治疗肝衰竭的临床疗效及 其对内质网应激和炎症反应的影响。【方法】 将2022年5月至2024年5月玉林市中医医院肝病科收治的102例肝衰竭毒热瘀结 证患者按随机数字表法随机分为对照组和研究组，每组各51例。对照组给予抗炎护肝、肠道微生态调节、抗病毒感染、降 酶及退黄疸等西医综合治疗，研究组在对照组的基础上加用解毒化瘀颗粒治疗，疗程为8周。观察2组患者治疗前后中医证候 积分、生化指标、炎症因子、内质网应激指标的变化情况，并比较2组患者的临床疗效和不良反应发生情况。【结果】（1）疗 效方面，治疗8周后，研究组的总有效率为86.27%（44/51），对照组为68.63%（35/51），组间比较（χ2 检验），研究组的疗效明 显优于对照组（P < 0.05）。（2）中医证候积分方面，治疗后，2组患者的中医证候积分均较治疗前明显降低（P < 0.01），且研究 组的降低幅度明显优于对照组（P < 0.05）。（3）生化指标方面，治疗后，2组患者的总胆红素（TBIL）、总胆汁酸（TBA）、丙氨酸 氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）水平均较治疗前明显降低（P < 0.05），且研究组的降低幅度均明显优于对照 组（P < 0.05或P < 0.01）。（4）炎症因子方面，治疗后，2组患者的血清白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、转化生长 因子β（TGF-β）、C反应蛋白（CRP）水平均较治疗前明显降低（P < 0.05），且研究组的降低幅度均明显优于对照组（P < 0.01）。（5）内 质网应激指标方面，治疗后，2组的内质网相关基因葡萄糖调节蛋白78（GRP78）、CCAAT增强子结合蛋白同源蛋白（CHOP）和门 冬氨酸特异性半胱氨酸蛋白酶12（caspase-12）水平均较治疗前明显降低（P < 0.05），且研究组的降低幅度均明显优于对照组 （P < 0.01）。（6）不良反应方面，研究组的不良反应发生率为15.69%（8/51），对照组为17.65%（9/51），组间比较，差异无统计 学意义（P > 0.05）。【结论】 在西医综合治疗的基础上应用解毒化瘀颗粒治疗肝衰竭毒热瘀结证患者临床疗效确切，可有效缓 解临床症状，改善肝功能，有助于缓解内质网应激和炎症反应。

Objective To investigate the clinical efficacy of Jiedu Huayu Granules （mainly composed of the Chinese herbal medicines of Artemisiae Scopariae Herba， Rhei Radix et Rhizoma， Hedyotis Diffusae Herba， Paeoniae Radix Rubra，Curcumae Radix and Acori Tatarinowii Rhizoma）in the treatment of liver failure（LF）and to observe their effects on endoplasmic reticulum stress and inflammatory response. Methods From May 2022 to May 2024，a total of 102 patients with LF of toxin-heat-stasis stagnation syndrome were collected from Hepatology Department of Yulin Traditional Chinese Medicine Hospital，and were divided into the control group and the study group by using a table of random numbers，with 51 cases in each group. The two groups were given comprehensive western medicine treatment for inhibiting inflammatory response and protecting liver， regulating intestinal microecology， counteracting viral infection， decreasing transaminase level and treating jaundice. Additionally， the study group was treated with Jiedu Huayu Granules. The course of treatment for the two groups covered eight weeks. Before and after treatment，the two groups were observed in the changes of traditional Chinese medicine （TCM） syndrome scores， biochemical indicators， inflammatory factors and endoplasmic reticulum stress indicators. After treatment， the clinical efficacy and the incidence of adverse reactions of the two groups of patients were compared. Results（1）After eight weeks of treatment，the total effective rate of the study group was 86.27%（44/51）and that of the control group was 68.63%（35/51），and the intergroup comparison（tested by chisquare test）showed that the efficacy of the study group was significantly superior to that of the control group（P < 0.05）.（2）After treatment，the TCM syndrome scores in both groups were significantly decreased compared with those before treatment（P < 0.01），and the decrease in the study group was significantly superior to that in the control group（P < 0.05）.（3）After treatment， the serum levels of biochemical indicators of total bilirubin （TBIL），total bile acid（TBA），alanine transaminase（ALT），and aspartate transaminase（AST）in the two groups were significantly decreased compared with those before treatment（P < 0.05），and the decrease in the study group was significantly superior to that in the control group（P < 0.05 or P < 0.01）.（4）After treatment，the serum levels of inflammatory factors of interleukin 6（IL-6），tumor necrosis factor α（TNF -α），transforming growth factor β（TGF-β），and C-reactive protein（CRP）in the two groups were significantly decreased compared with those before treatment（P < 0.05），and the decrease in the study group was significantly superior to that in the control group（P < 0.01）.（5）After treatment，the levels of endoplasmic reticulum response indicators such as glucose - regulated protein 78（GRP78），CCAAT enhancer-binding protein homologous protein（CHOP），and cysteine aspartic acid specific protease 12（caspase-12）in the two groups were significantly decreased compared with those before treatment（P < 0.05），and the decrease in the study group were significantly superior to those in the control group（P < 0.01）.（6）The incidence of adverse reactions in the study group was 15.69%（8/51）and that in the control group was 17.65%（9 / 51）， and the comparison between the two groups showed that the difference was not statistically significant（P > 0.05）. Conclusion The combined use of Jiedu Huayu Granules with comprehensive western medicine treatment exerts certain efficacy in treating patients with LF of toxin-heat-stasis stagnation syndrome. The combined therapy is effective on relieving clinical symptoms and improving liver function， and is helpful for relieving endoplasmic reticulum stress and inflammatory response.

R259.753

广西自然科学基金资助项目（编号：桂科计字[2023]26号）；国家中医药管理局第七批全国老中医药专家学术经验继承工作项目 （编号：国中医药人教函[2022]76号）；玉林市科学研究与技术开发计划项目（编号：玉市科202235032）