乙肝后肝硬化中医证型与腹部超声形态学特征的相关性研究

Correlation study on TCM syndrome types and morphological characteristics of abdomen ultrasound of post-hepatitis B cirrhosis

目的探讨乙肝后肝硬化中医证型与腹部超声形态学特征的相关性,探求对乙肝后肝硬化辨证分型有价值的超声检查指标,为病情评估及预后判断开拓新思路。方法对符合乙肝后肝硬化标准的135例患者,进行规范中医辨证和超声检查。记录肝、脾外形及实质回声、胆壁双边征、胆囊内透声、结石等声像特征,测量肝右叶最大斜径和前后径、肝左叶上下径和前后径、脾厚径、脾长径、胆囊壁厚度、腹水深度。使用SPSS 17.0统计软件包,计量资料采用平均数±标准差表示,2组间比较采用2组独立样本t检验;计数资料用率、构成比表示,2组间比较采用χ2检验。结果瘀血阻络证与肝气郁结、湿热蕴结、水湿内阻证相比较,肝左叶上下径缩小趋势更明显,脾脏增大较肝气郁结、湿热蕴结证更加显著。肝肾阴虚、脾肾阳虚、瘀血阻络证更容易出现肝叶形态比例失调、肝被膜锯齿状、弥漫性回声增高、胆囊壁增厚的表现。肝左叶上下径缩小可能是瘀血阻络证的特征,而肝叶形态比例失调、被膜锯齿状、弥漫性回声增高可能是肝肾阴虚、脾肾阳虚、瘀血阻络证的特点。胆囊壁增厚可能是水湿内阻、脾肾阳虚、瘀血阻络证的特征,胆囊腔内回声不均和胆壁毛糙可能是湿热蕴结证的提示指征。结论乙肝后肝硬化腹部超声形态学特征与中医证型具有一定的相关性,其特点与中医关于肝硬化病机演变特点的传统认识相符合。

Objective To investigate characteristics of abdomen ultrasound indexes to syndrome differentiation and the correlation between TCM syndrome types and morphological of post-hepatitis B cirrhosis, and seek the valuable ultrasonic classification of post-hepatitis B cirrhosis for opening new ideas in disease assessment and prognosis. Methods The patients （n = 135） were given syndrome differentiation and ultrasonic examination. The ultrasonic characteristics of liver and spleen were recorded, including shape, parenchyma echoes, signs of bilateral gallbladder wall, and transmission sound and stone ultrasound inside gallbladder. The maximum oblique and anteroposterior diameters of right liver lobe, vertical and anteroposterior diameters of left liver lobe, thick and length diameters of spleen, thickness of gallbladder wall and depth of ascites were detected. SPSS 17.0 statistical package was used. The quantitative data was expressed with mean _ standard deviation and independent samples were compared by using t-test between two groups. The enumeration data was expressed with rate and constituent ratioand two groups were compared by using x2 test. Results Compared with syndromes of liver qi depression, damp-heat accumulation and water-dampness obstructing in the interior, the decreasing trend of vertical diameter of left liver lobe was more significant in syndrome of static blood obstructing collaterals, and splenomegalia was more significant compared with syndromes of liver qi depression and damp-heat accumulation. The disorder of liver lobe morphological percentage, jagged liver tegument, increased diffuse echoes and thickened gallbladder wall were commonly observed in syndromes of liver- kidney yin deficiency, spleen-kidney yang deficiency and static blood obstructing collaterals. The decrease of vertical diameter of left liver lobe might be one of characteristics of syndrome of static blood obstructing collaterals, while imbalance of liver lobe morphological percentage, jagged liver capsule and increased diffuse echoes might related to syndromes of liver-kidney yin deficiency, spleen-kidney yang deficiency and static blood obstructing collaterals. The thickened gallbladder wall might be one of characteristics of syndromes of water-dampness obstructing in the interior, spleen-kidney yang deficiency and static blood obstructing collaterals. The inhomogeneous echoes inside gallbladder and rough gallbladder wall might be an indication sign of damp-heat accumulation syndrome. Conclusion The morphological characteristics of abdomen ultrasound is correlated to TCM syndrome types of post-hepatitis B cirrhosis, which is consistent with the traditional cognition of TCM on pathogenesis development of cirrhosis.