慢性乙型重型肝炎分期辨证模式研究

Research on the model of syndrome differentiation based on different stages for patients with chronic severe hepatitis B

目的：探讨慢性乙型重型肝炎的证候学特点,以期总结出临床辨证的＂分期论治＂模式。方法：按诊断标准,收集慢性乙型重型肝炎患者400例（暴发期、平台期、坏证期和恢复期患者各100例）,进行临床症状体征、证素和辨证分型调查,并统计相应的表达频数和以及聚类分析。结果：①表达频数相对较高的症状体征有：尿黄96.25%,目黄95.25%,身黄94.00%,脘痞90.50%,口臭85.50%,神疲乏力80.75%,胸闷80.50%,是各期最为常见的表现。②血瘀（肝络瘀阻）证素高达98.00%-100%;湿热邪毒及其所导致的气机逆乱、脏腑功能失调比例很高;正气亏虚以气虚（73%-100%）和阴虚（18%-89%）、血虚（12%-86%）等为主。可见毒、瘀、虚贯穿了慢性乙型重型肝炎的整个过程,是决定本病进展和证候特点的基本证素。③病例集中在热毒壅肝、邪陷正脱、肝郁脾虚3型,而瘀血内阻、阴虚血热、脾肾阳虚等分布较少。结论：慢性乙型重型肝炎的证候学研究支持其＂分期论治＂模式,它具有符合传统、逻辑一致、临床实用和操作简便等优势。

Objective：To investigate the clinical characteristics of patients with chronic severe hepatitis B,and summarize the model of syndrome differentiation based on different stages.Methods：Four hundreds patients with chronic severe hepatitis B were collected,which involved 100 cases lying in active phase,platform phase,deterioration phase and recovery phase,respectively.The frequency and cluster analysis was made according to the investigation on clinical symptoms and signs,syndrome differentiation.Results：①The most frequent symptoms and signs were yellow urine（96.25%）,yellow sclera（95.25%）,yellow skin（94.00%）,stomach swelling（90.50%）,halitosis（85.50%）,fatigue（80.75%）,and chest distress（80.50%）;②The frequency of blood stasis syndrome was about 98.00%~100%,especially in liver-collateral obstruction syndrome.A higher proportion occurred in damp-heat toxin and its subsequent functional disorder.The deficiency of anti-pathogen energy mainly showed in deficiency of Qi（73%~100%）,Yin（18% ~89%）,and blood（12%~86%）,so the toxin,blood stasis and deficiency were the main syndromes during the whole stages of patients with chronic severe hepatitis B;③The higher proportion of syndromes were heat-toxin obstruct the liver,evil predominance and Qi deficiency,liver stagnation and spleen deficiency,while other syndromes showed lower frequency involving blood stasis,Yin deficiency and heat blood,and Yang deficiency of spleen and kidney.Conclusion：The research on syndromes of patients with chronic severe hepatitis B supports the model of syndrome differentiation based on different stages,which have the advantage of practical and operation values corresponding to tradition and logical thinking.