慢性乙型重型肝炎中医证候规律研究

Study on the TCM Syndromes of Chronic Severe Hepatitis B

目的:探讨浙江地区慢性乙型重型肝炎(CSHB)中医证候特点及分布规律,为建立规范的中医证候标准进行前期探索。方法:临床收集2009年5月-2010年1月在杭州市第六人民医院住院CSHB患者的一般情况、中医四诊信息及相关实验室指标,以国家"十一五"科技重大专项"慢性重型肝炎证候规律及中西医结合治疗方案研究"制定的辨证分型方案进行辨证,分析中医证型的分布规律及其与临床特征的关系。结果:(1)总计99例CSHB纳入研究,其中慢加急(亚急)性肝衰竭80例(80.08%);年龄15～72岁,平均(44.48±12.26)岁,男性74(74.75%)例;(2)中医证型以瘀热发黄27例(27.27%)、气虚瘀黄26例(26.26%)和湿热发黄21例(21.21%)3型较为常见,其次为阴虚瘀黄型16例(16.16%)、阳虚瘀黄型9例(9.09%);(3)各证型间性别和年龄分布未见统计学差异(P>0.05);(4)80例慢加急(亚急)性肝衰竭中,不同临床分期的证型分布有统计学差异(P<0.05),其中早期以气虚瘀黄型(43.6%)为主,中期以瘀热发黄型(27.3%)和湿热发黄型(22.7%)为主,晚期以阴虚瘀黄型(27.8%)为主;(5)实验室指标中,仅阴虚瘀黄型的国际标准化比值(INR)明显高于气虚瘀黄型(P<0.05);血清生化学指标胆红素、白蛋白等均与中医证型无关(P>0.05)。结论:瘀热发黄、气虚瘀黄和湿热发黄型是浙江地区CSHB的主要证型;在构成CSHB的主要人群慢加急(亚急)性肝衰竭中,早期以气虚瘀黄型为主,中期多以瘀热发黄、湿热发黄型为主,晚期以阴虚瘀黄型多见;阴虚瘀黄型患者的凝血功能明显较气虚瘀黄型差,但不能从临床常规实验室指标对证型进行明确区分。

Objective：To explore the distribution and characteristics of TCM syndromes of chronic severe hepatitis B （CSHB） , in order to provide dialectical evidence for future clinics. Methods：Collect the general conditions, four diagnostic information of TCM and related laboratory tests of patients with CSHB in Hangzhou Sixth Hospital between May 2009 to January 2010. Zheng differentiation - classification relied on the major science and technology projects of National 1 lth five -year plan -the TCM syndromes characteristics and conbined therapy of traditional Chinese medicine and western medicine of chronic severe hepatitis B, to analyze the relationship between the characteristics of TCM syndromes and the clinical feature. Results：（ 1 ）In total of 99 CSHB patients were included, which encompassed of 80（80.08% ） cases with acute -on- chronic liver failure. Our objects were 15 to 72 years old（ mean age 44.48 12.26）, 74 （74.75%） cases were male. （2）In terms of TCM syndromes, there were 27 （27.27%） cases with heat -stagnant jaundice syndrome, 26（26.26% ） cases with qi - deficiency related stagnant jaundice, 21 （21.21%） cases with damp - heat jaundice syndrome, 16（ 16.16% ） cases with yin deficiency related stagnant jaundice and 9（9.09% ） cases with yang deficiency related stagnant jaundice. （3）No differences were found among the TCM sydromes（ P 〉 0.05 ）. （4）In the 80 patients with acute - on - chronic liver failure, the distribution of TCM syndromes in the three chnical stages had statistically difference （P 〈0.05）, the predominant sydrome in early- , mid - , and end stage were qi -deficiency related stagnant jaundice （ 43.6% ）, heat - stagnant（ 27.3% ） and damp - heat jaundice syndrome（ 22.7% ）, yin deficiency related stagnant jaun-dice（ 27.8% ）, in turn. （5） In terms of laboratory results, none of the markers related to TCM sydromes except for the intematlonal normalized ratio（ INR）, the INR level in yin deficiency related stagnant jaundice was higher than that＇in eli - deficiency related stagnant jaundice （ P 〈 0.05 ）. Conclusion： Heat - stagtmnt jaundice syndrome, qi -defieieney relat- ed stagnant jaundice and damp - heat jaundice syndrome were the predominant types of TCM sydromes in CSHB in Zhe- jiang province. For the acute - on - chronic liver failure, the predominant sydrome in early -, mid -, and end stage were eli - deficiency related stagnant jaundice, heat - stagnant and damp - heat jaundice syndrome, yin deficiency related stagnant jaundice, in turn. The coagulation function in yin deficiency related stagnant jaundice worsen than that in qi- deficiency related stagnant jaundice, but it is difficult to differentiate the TCM sydromes relying on the routine laboratory markers in CSHB.