基于中医辅助诊疗仪的慢性乙型肝炎患者中医证型分布及临床诊断特征研究

Distribution of TCM syndrome types in chronic hepatitis B patients and its clinical diagnostic features based on auxiliary diagnosis and treatment instrument of traditional Chinese medicine

目的观察慢性乙型肝炎患者中医证型的分布特点及临床诊断特征。方法纳入124例慢性乙型肝炎患者,应用中医辅助诊疗仪采集面色、舌脉和脉象信息,参照中医诊断标准辨证分型。检测临床主要诊断指标(生化指标、病毒学指标和病理分级)并分析其与中医证型的关系。结果 124例慢性乙型肝炎患者中,湿热中阻型占比最高(32.3%),其余依次为肝郁脾虚型(30.6%)、脾肾阳虚型(16.9%)、瘀血阻络型(13.7%)、肝肾阴虚型(6.5%)。不同中医证型间ALT、HBsAg、Fibroscan硬度值和Metavir分级水平具有显著性差异(P<0.05)。湿热中阻证型患者的ALT和HBsAg水平明显高于其他证型(P<0.05,P<0.01),血瘀阻络证型患者的Fibroscan硬度值明显高于其他证型(P<0.01),且Metavir分级以F4期为主。结论慢性乙型肝炎患者的中医证型以湿热中阻、肝郁脾虚为主,不同证型的ALT、HBsAg和病理分级水平存在一定的差异。

Objective To observe the distribution of TCM syndrome types in chronic hepatitis B( CHB) patients and its clinical diagnostic features. Methods 124 CHB patients were included. The information of complexion,tongue and pulse in patients were collected by auxiliary diagnosis and treatment instrument of traditional Chinese medicine. According to the TCM diagnostic criteria,the syndrome differentiation and patterns classification were performed. The main clinical diagnostic indexes( biochemical indicators,virological indicators and pathological grades) were detected,and the relationship with TCM syndrome types were analyzed. Results Among the 124 CHB patients,the proportion of syndrome of dampness-heat obstructing middle jiao was the highest( 32.3%),followed by syndrome of stagnation of liver qi and spleen deficiency( 30.6%),syndrome of yang deficiency of spleen and kidney( 16.9%),syndrome of static blood blocking collaterals( 13.7%) and syndrome of yin deficiency of liver and kidney( 6.5%) in turn. There were significant differences on the levels of ALT,HBsAg,Fibroscan hardness value and Metavir grades between the different TCM syndrome types( P<0.05). The levels of ALT and HBsAg in patients with syndrome of dampness-heat obstructing middle jiao were obviously higher than those in patients with other types( P<0.05,P<0.01). The Fibroscan hardness value in patients with syndrome of static blood blocking collaterals was obviously higher than that in patients with other types( P < 0.01),and the Metavir grades in the syndrome of static blood blocking collaterals was mainly in F4 stage. Conclusion The syndrome of dampness-heat obstructing middle jiao and syndrome of stagnation of liver qi and spleen deficiency were the main TCM syndrome types in patients with chronic hepatitis B. There were certain differences on the levels of ALT,HBsAg and Metavir grades between the different TCM syndrome types