肝脏剪切波速度与中医证型的相关性研究

Correlative Study between Virtual Touch Tissue Quantification and Traditional Chinese Medicine Syndromes of Fatty Liver

目的探讨声触诊组织量化技术(VTQ)测量肝脏剪切波速度(SWV)与中医各证型的相关性。方法2011年12月—2012年8月对185例脂肪肝患者根据超声检查分为轻度组69例、中度组86例和重度组30例,根据中医诊断标准分为痰湿蕴结证、痰瘀互结证、肝郁气滞证、脾虚湿蕴证、湿热蕴伏证5种中医证型。应用VTQ测量所有患者的肝脏SWV,并分析其与中医各证型的相关性。结果 (1)不同程度脂肪肝中各中医证型构成比的比较,差异有统计学意义(χ2=99.304,P=0.000)。各中医证型中不同程度脂肪肝构成比的比较,差异有统计学意义(χ2=79.558,P=0.000)。(2)不同程度脂肪肝间、各证型与肝脏SWV之间的关系:①185例患者中,轻度组的肝脏SWV为(1.01±0.06)m/s、中度组为(1.57±0.65)m/s、重度组为(0.81±0.07)m/s,3组比较,差异有统计学意义(F=40.14,P=0.00)。其中中度组的肝脏SWV较轻度组和重度组高,且差异均有统计学意义(q=-7.225、-6.373,P=0.00、0.00);轻度组的肝脏SWV较重度组高,且差异有统计学意义(q=-13.599,P=0.03)。②185例患者中,痰湿蕴结证、脾虚湿蕴证、肝郁气滞证、湿热蕴伏证、痰瘀互结证的肝脏SWV测值分别为(1.45±0.67)m/s、(1.20±0.46)m/s、(1.17±0.45)m/s、(1.14±0.48)m/s、(0.92±0.14)m/s,5种证型比较,差异有统计学意义(F=4.49,P=0.00)。其中痰湿蕴结证较其余4种证型的肝脏SWV均高,且差异有统计学意义(q=-6.35、2.41、2.33、2.97,P=0.00、0.02、0.02、0.00)。③以痰湿蕴结证、痰瘀互结证、肝郁气滞证、脾虚湿蕴证、湿热蕴伏证为顺序,对不同证型患者的肝脏SWV进行Spearman等级相关分析,结果显示,不同证型与肝脏SWV呈负相关(r=-0.256,P=0.000)。结论肝脏SWV与中医各证型具有一定的相关性,为中医证型客观诊断指标提供了可靠依据,有利于推动中西医结合和中医中药诊断的客观发展。

Objective To investigate the relationship between virtual touch tissue quantification（VTQ） measuring the liver shear wave speed（SWV） and traditional Chinese medicine（TCM） syndromes of fatty liver.Methods 185 fatty liver patients from December 2011 to August 2012 were divided into mild group,moderate group and severe group according to the results of ultrasound.The patients were also divided into phlegm accumulation,phlegm and stasis,liver qi stagnation,spleen deficiency and wet accumulation and damp and heat accumulation.SWV of all the patients was measured by VTQ and its correlation with TCM syndromes was analyzed.Results（1） The TCM syndromes between patients with different levels of fatty liver showed statistically significant difference（χ2 = 99.304,P = 0.000）,and the levels of fatty liver between patients with different TCM syndromes also showed statistically significant differences（χ2 = 79.558,P = 0.000）.（2） The relationship between different levels of fatty liver,TCM syndromes and liver SWV： ①Among the 185 patients,the liver SWVs in mild group,moderate group and severe group were（1.01 ± 0.06） m / s,（1.57 ± 0.65） m / s and（0.81 ± 0.07） m / s respectively,and the differences were statistically significant（F = 40.14,P = 0.00）.The liver SWV in moderate group was significantly higher than that of the mild group and severe group（q =-7.225,-6.373,P = 0.00,0.00）.The liver SWV in mild group was significantly higher than that of the severe group（q =-13.599,P = 0.03）.②The liver SWVs of patients with TCM syndromes of phlegm accumulation,phlegm and stasis,liver qi stagnation,spleen deficiency and wet accumulation and damp and heat accumulation were（1.45 ±0.67） m/s,（1.20 ±0.46） m/s,（1.17 ±0.45） m/s,（1.14 ±0.48） m/s and（0.92 ±0.14） m/s respectively,and the differences were statistically significant（F = 4.49,P = 0.00）.The liver SWV in patients with phlegm accumulation was significantly higher than the other four TCM syndromes（q =-6.35,2.41,2.33,2.97,P = 0.00,0.02,0.02,0.00）.③ Spearman correlation analysis showed that the TCM syndromes were negatively correlated with liver SWV（r =-0.256,P = 0.000）.Conclusion The SWV and the TCM syndrome types of the fatty liver have certain relevance,which provides a reliable basis for TCM diagnosis and will help promote the development of a combination of Chinese and western medicines and TCM diagnosis.