慢性乙型肝炎患者证候学调查与分期辨证模式探讨

Chronic hepatitis B stages dialectical mode of governance research

目的探讨慢性乙型肝炎的证候学特点,以期总结出该病临床辨证的"分期辨证"模式。方法按诊断标准,收集慢性乙型肝炎患者400例,并分为四组:抗病毒治疗前(A组)、核苷类似物治疗(B组)、干扰素治疗(C组)、抗病毒治疗结束(D组);每组各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以及聚类分析。结果 (1)干扰素治疗的慢性乙型肝炎患者(C组)的临床症状、体征表达频数明显高于核苷类似物治疗组(B组)以及抗病毒治疗后组(D组),而比较相近甚至高于抗病毒治疗前组(A组),可见慢性乙型病毒性肝炎在不同的时期其证候学表现不同;(2)活动期相对高频的证素有:湿热(68%～92%),气郁(72%～76%),气虚(53%～65%),尤其以干扰素的副反应为甚;(3)所有病例主要集中在肝郁脾虚和湿热中阻两型,疾病活动期(A组、C组)以湿热中阻较多,病情稳定期(B组、D组)以肝郁脾虚为主。结论慢性乙型肝炎的证候学研究支持其"分期辨证"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 study the syndrome of chronic hepatitis B study characteristics,with a view to summarize the clinical syndromes of ＂stages theory of governance＂ model.Methods According to the diagnostic criteria,400 cases of patients with chronic hepatitis B were collected and were divided into four groups：the patients before anti-viral treatment group（group A,n=100）,the treatment with nucleoside analogues group（group B,n=100）,with interferon therapy group（group C,n=100）,finishied anti-viral treatment group（group D,n=100）.Study the clinical symptoms and signs,the securities hormone and syndrome differentiation and gather statistics of expression of the corresponding frequency and,as well as cluster analysis.Results（1）The symptoms and signs of expression frequency of chronic hepatitis B patients of group C were more than that of group B and group D,were similar to or more than group A.To sum up,Syndrome of the patients with chronic hepatitis B were different in different phase.（2）active stage of the evidence of the relatively high frequency is known as：hot and humid（68%~92%）,Qiyu（72%~76%）,qixu（53%~65%）,especially the side effects of interferon particularly at night;（3）All cases are mainly concentrated in the liver depression and spleen damp heat resistance in two types,active disease（group A,group C）to hot and humid in the resistance mainly in stable condition period（group B,group D）with liver depression mainly spleen.Conclusion The syndrome of chronic hepatitis B studies to support their ＂stage theory of governance＂ model,which has in line with tradition,logic,consistent,practical and clinical advantages of easy operation.