乙型肝炎肝硬化中医证型、证素分布特点文献研究

Literature Study on Chracteristics of Traditional Chinese Medicine Syndrome Types and Syndrome Elements Distribution of Hepatitis B Virus-Related Hepatocirrhosis

目的通过文献回顾分析,探讨乙型肝炎肝硬化中医证型、证素分布特点。方法检索1963年1月1日至2018年12月31日中国期刊全文数据库、中文科技期刊数据库、万方数据库出版平台、中国中医药数据库及MEDLINE、EMBASE、Web of knowledge、Cochrane library数据库,纳入乙型肝炎肝硬化的临床研究文献,对纳入文献中患者的中医证型、证素进特点进行分析。结果共纳入文献81篇,乙型肝炎肝硬化患者11912例,其中有明确肝硬化分期代偿期1780例,失代偿期2942例。中医证型不含兼夹证前5位为湿热内蕴、肝肾阴虚、瘀血阻络、肝郁脾虚、肝郁气滞,累积占比为58.23%;含兼夹证前5位证型依次为湿热内蕴、肝郁脾虚、瘀血阻络、肝肾阴虚、肝郁气滞,累积占比为72.49%;病位证素以肝、脾为主,累积频率为75.53%,病性证素以湿、气滞、气虚、热、血瘀为主,累积频率为86.85%。代偿期主要中医证型为湿热内蕴、肝郁气滞、瘀血阻络,失代偿期主要为湿热内蕴、脾肾阳虚、肝肾阴虚。失代偿期复合证8种、复杂证19种,较代偿期复合证3种、复杂证7种明显增多。结论乙型肝炎肝炎肝硬化核心病机为肝郁脾虚,湿瘀热互结,随病情进展,证型、证素构成逐渐复杂。

Objective To explore the characteristics of traditional Chinese medicine(TCM)syndromes and syndrome elements distribution of hepatitis B virus(HBV)-related hepatocirrhosis by literature review.Methods Chinese Journal Full-text Database,Chinese Sci-tech Periodical Database,Wanfang Database Publishing Platform,China Traditional Chinese Medicine Database and MEDLINE,EMBASE,Web of knowledge,Cochrane library database were searched from January 1,1963 to December 31,2018,and the clinical research literature on HBV-related hepatocirrhosis were included.The characteristics of TCM syndromes and syndrome elements of patients included in the literature were analyzed.Results A total of 81 papers were included.There were 11?912 patients with HBV-related hepatocirrhosis,including 1780 patients with compensated stage and 2942 patients with decompensation stage.The top 5 TCM syndromes without accompanied symptoms were internal accumulation of damp heat,yin deficiency of liver and kidney,blood stasis obstructing the collaterals,liver depression and spleen deficiency,liver depression and qi stagnation,accounting 58.23%in total.Taken accompanied symptoms into consideration,the top 5 was internal accumulation of damp heat,liver depression and spleen deficiency,blood stasis obstructing the collaterals,yin deficiency of liver and kidney and liver depression and qi stagnation,accounting 72.49%in total.The syndrome elements of disease location were the liver and the spleen,with a total frequency of 75.53%.The syndrome elements of the disease nature were dampness,qi stagnation,qi deficiency,heat,blood stasis,accounting 86.85%in total frequency.The major TCM syndromes in compensated stage were internal accumulation of damp heat,liver depression and qi stagnation,blood stasis obstructing the collaterals.The syndromes in decompensated stage were internal accumulation of damp heat,yang deficiency of the spleen and kidney,yin deficiency of the liver and kidney.There were 8 compound syndromes and 19 complex syndromes in the decompensated stage,which were significantly increased than 3 compound syndromes and 7 complex syndromes in the compensated stage.Conclusion The core pathogenesis of HBV-related hepatocirrhosis is liver depression and spleen deficiency and intermingled damp,blood stasis,and heat.The syndromes and syndrome elements are becoming complex.