肝硬化中医证型与Child-Pugh分类相关性的研究

Study on Correlation between the Syndrome Type of TCM and the Classification of Child-Pugh in Patients with Cirrhosis

目的:从中医角度探讨肝硬化证型与Child-Pugh分类之间的关系,以便正确评估不同证型肝硬化患者肝贮备功能,建立肝硬化辨证分型的客观指标。方法:将110例确诊为肝硬化病人按中医辨证分6个证型组,同步检测Child-Pugh分类要求检测的项目。结果:肝硬化中医证型不同,Child分类不同。肝郁脾虚型以Child A级为多(占80％);气滞血瘀型以Child B级为多(占46.67％);脾肾阳虚和肝肾阴虚型以Child C级为多(分别占56.25％和54.54％)。研究还发现随着中医病理发展,中医证型也由肝郁脾虚迢渐向湿热蕴结以至脾肾阳虚和肝肾阴虚发展,而Child分级也由A级向C级变化。结论:可将Child分级评分作为肝硬化辨证分型诊断的客观依据之一。

Aim: In order to accuratelly evaluate the hepatic reseruve of cirrhosis patients with different syndrome types and set up the objective index of differentiating various syndrome types of cirrhosis. Method: 110 cases of cirrhosis were separated into six groups of syndrome type and detected the items relating to classification of Child-Pugh at the same time. Result: Different syndrome type of cirrhosis had different grade of Child-Pugh classification. Among them about 80% of the type with stagnation of liver Qi and deficiency of spleen belong to grade A of Child-Pugh classification, 46. 67% of the type with stagnancy of Qi and blood stasis belong to grade B, 56. 25% of the type with insufficiency of both spleen and kidney belong to grade C, 54. 54% of the type with deficiency of liver-Yin and kidney-Yin belong to grade C, too. Along with the development of cirrhosis, the syndrome type of TCM were developing gradually from stagnation of liver Qi and deficiency of spleen towards accumulation of damp-heat in the body, towards insufficiency of both spleen and kidney, towards deficiency of liver-Yin and kidney Yin, and the Child-Pugh grade were changing from A towards C. Conclusion:Child-Pugh classification is one of objective basis for diagnosing cirrhosis and differentiating its syndrome type of TCM.