74例慢性乙型重型肝炎中医证候特点分析

Characteristics of TCM syndromes in 74 patients with chronic severe hepatitis B

目的探讨慢性乙型重型肝炎(chronic severe hepatitisB,CSHB)中医证候规律,明确辨证分型与相关实验室指标及并发症之间的相关性。方法收集2009年7月—2010年3月在首都医科大学附属北京佑安医院住院的CSHB患者辨证分型、相关实验室指标及并发症情况,以国家"十一五"传染病重大专项"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,分析中医辨证分型与实验室指标及并发症之间的关系。结果①纳入的74例CSHB患者中医辨证分型以气虚瘀黄证(25.7%)、阳虚瘀黄证(16.2%)、湿热发黄证(27.0%)和瘀热发黄证(21.6%)较为常见,阴虚瘀黄证(9.5%)较少见。②5型在TBIL、PT、中性粒细胞百分比(NEUT%)及HGB等指标的差异均无统计学意义,但若将5型合并为虚证和实证统计分析,则虚证组NEUT%高于实证组,2组间差异有统计学意义。③5型在腹水、肝性脑病、自发性细菌性腹膜炎、电解质紊乱及肝肾综合征等并发症的发病率方面差异均无统计学意义,但若将5型合并为虚证和实证进行统计分析,则虚证组腹水发病率高于实证组,2组间差异有统计学意义。结论按5型进行辨证,相关实验室指标与并发症无明显差异;若分为虚证和实证,实验室指标与并发症发病率有一定差异。CSHB的中医辨证与实验室指标和并发症之间具有一定的相关性,临床应该首重虚实辨证。

Objective To investigate the regular pattern of traditional Chinese medicine （TCM） syndromes of chronic severe he patitis B （CSHB）, and to explore the correlations between syndrome differentiation and the related laboratory markers and the in cidence of complications. Methods Patterns of syndrome differentiation, the related laboratory markers and the incidence of thecomplications in CSHB patients hospitalized in Beijing You＇an Hospital, Capital Medical Univemity from Jul. 2009 to Mar. 2010 were retrospectively studied. Syndrome differentiation was made according to syndrome differentiation classification protocol formu- lated by the study on CSHB TCM syndrome law and integrated TCM and western medicine treatment protocol supported by the Major and Special Programs of National ＂Eleventh Five-Year Plan＂ Period and the correlations between the patterns of syndrome differentiation and the related laboratory markers and the incidence of complications were analyzed. Results Of 74 CSHB patients, the common CSHB TCM syndromes were Qi-deficiency jaundice （25.7%）, Yang-deficiency jaundice （16.2%）, hygropyretic jaundice （27.0%） and blood stasis-heat jaundice （21.6%）. Yin-deficiency jaundice （9.5%） was seldom found. Laboratory markers such TBIL, PT, NEUT% and HGB were not significantly different among the patients with the 5 patterns of TCM syndromes. However, NEUT% of the deficient syndrome group was higher than that of the excessive syndrome group, and the difference between the two groups was significant. The incidence rates of ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, electrolyte disturbance and hepatorenal syndrome were not significantly different among the patients with the 5 patterns of TCM syndromes. However, the incidence of ascites in the deficient syndrome group was higher than that in the excessive syndrome group, and the difference between the two groups was significant. Conclusions The laboratory markers and the incidence of complications are not significantly different among the patients with the 5 patterns of TCM syndromes. However, they are significantly different between the deficient syndrome group and the excessive syndrome group. CSHB TCM syndrome differentiation is correlated with laboratory markers and the incidence of complications, and the differentiation of deficient syndromes and excessive syndromes should be paid much attention to in clinical practice.