肝硬化患者中医辨证分型与凝血功能及激素水平的相关性分析

Correlation analysis of TCM syndrome differentiation and coagulation function and hormone levels in patients with liver cirrhosis

目的:分析肝硬化患者中医辨证分型与凝血功能及垂体甲状腺轴激素水平的相关性。方法:选取我院于2018年4月~2022年2月收治的肝硬化患者200例,观察中医证候转化规律,分析凝血功能指标、垂体甲状腺轴激素水平及Child-pugh分级的水平。结果:不同证型肝硬化患者Child-pugh分级分布、凝血四项、垂体甲状腺轴激素水平比较,有统计学意义(P<0.05);Child-A级以水湿内停证为主,Child-B级以脾肾阳虚证为主,其次为瘀血阻络证和肝气郁结证,而Child-C级则以肝肾阴虚证为主,其次是湿热内蕴证。肝肾阴虚证和瘀血阻络证患者凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)水平最高,而水湿内停证纤维蛋白原(FIB)水平最高,差异均有统计学意义(P<0.05);肝肾阴虚证、瘀血阻络证、肝气郁结证患者三碘甲状腺原氨酸(T3)水平最高,肝气郁结证甲状腺素(T4)、游离T3(FT3)、游离T4(FT4)、促甲状腺激素(TSH)水平最高,而脾肾阳虚证患者垂体甲状腺轴激素水平最低,差异均有统计学意义(P<0.05)。结论:凝血功能指标、垂体甲状腺轴激素水平及Child-pugh分级与肝硬化患者中医辨证分型有一定相关性,可作为辨证施治的依据。

Objective:The objective of this study was to analyze the correlation between Traditional Chinese Medicine(TCM)evidence-based staging and coagulation function and pituitary thyroid axis hormone levels in patients with liver cirrhosis.Methods:Two hundred patients with liver cirrhosis who visited the hospital between April 2018 to February 2022 were selected for the study.The transformation pattern of TCM evidence was observed,and the levels of coagulation function indexes,pituitary thyroid axis hormone levels,and Child-pugh classification were analyzed.Results:Statistical significance(P<0.05)was observed when comparing the distribution of Child-pugh grading,the four coagulation items,and pituitary thyroid axis hormone levels in patients with different types of cirrhosis.Child-A grade was dominated by Water and Dampness Internal Stagnation evidence,Child-B grade was dominated by Spleen and Kidney Yang Deficiency evidence,followed by Blood Stasis and Blood Blockage evidence and Liver Qi Stagnation evidence,while Child-C grade was dominated by Liver and Kidney Yin Deficiency evidence,followed by Dampness and heat within the body.The levels of prothrombin time(PT),prothrombin time(TT),and activated partial thromboplastin time(APTT)were the highest in patients with Liver and Kidney Yin Deficiency and Blood Stasis and Blockage,while fibrinogen(FIB)levels were the highest in patients with Water and Dampness Internal Stagnation,with statistically significant differences(P<0.05).The highest levels of thyroxine(T4),free T3(FT3),free T4(FT4),and thyroid-stimulating hormone(TSH)were found in patients with liver and kidney yin deficiency,and the lowest levels of pituitary thyroid axis hormones in patients with spleen and kidney yang deficiency,all with statistically significant differences(P<0.05).Conclusion:The coagulation function index,pituitary thyroid axis hormone level,and Child-pugh classification have a correlation with the TCM classification of cirrhotic patients.This correlation can serve as a basis for dialectical treatment.