肝炎肝硬化患者舌象表现与MELD评分及其相关指标水平间相关性的探讨

Exploration on the correlation between tongue picture and MELD score and its related lab test results in patients with liver cirrhosis

目的:分析肝炎肝硬化患者的舌象与终末期肝病模型(MELD)及血清肌酐、胆红素、凝血酶原时间的国际标准化比值(INR)的相关性,为临床通过观察舌象以了解疾病的轻重提供依据。方法:运用本课题组统一制定的《肝炎肝硬化临床信息采集表》,进行全国多中心的横断面流行病学调查,收集肝炎肝硬化患者的舌象信息及实验室检查信息等,按照统一的标准公式计算MELD分值。分别按照是否出现某种舌象将773例患者分成两组,比较MELD评分在两组间的差异;选出MELD评分差异具有统计学意义的舌象,再分别比较该舌象分组下的肌酐、胆红素及INR水平各自的差异。运用SPSS 13.0进行频次、频率分析及Mann-Whitney秩和检验。结果:除瘦舌和舌下细小络脉之外,出现其他舌象表现者的MELD评分的秩均值高于未出现者,其中有统计学差异的是舌下络脉紫黑、舌下络脉迂曲、厚苔(P<0.05,P<0.01);胆红素水平的秩均值在出现上述3种舌象的组分别为417.60、430.89及432.42,与未出现组的369.62、379.56及362.06比较均具有统计学差异(P<0.05,P<0.01);INR水平的秩均值在出现上述3种舌象的组分别为421.15、451.91及422.01,与不出现组的367.61、376.00及367.77比较均具有统计学差异(P<0.05,P<0.01)。结论:肝炎肝硬化患者的舌象表现与MELD评分间存在着一定关联,其中舌下络脉迂曲、舌下络脉紫黑及厚苔的出现与胆红素水平及INR水平间有一定关联,初步提示肝炎肝硬化患者的舌象表现可以反映其病情的严重程度。

Objective： To analyze the correlation between tongue picture and model for end-stage liver disease （MELD） and its related lab test results including serum creatinine, bilirubin and international normalized ratio （INR） of prothrombin time and provide evidence for understanding the disease severity by observing the tongue picture in patients with liver cirrhosis. Methods： Tongue picture and lab tests information was filled in the unified ＇liver cirrhosis case survey form＇ formulated by research group by conducting nationwide multi-center cross-sectional epidemiological survey, MELD score was calculated by the unified standard formula. 773 cases were divided into two groups according to whether there exists some kind of tongue picture, comparing the difference of MELD score between the two groups; tongue picture with statistical significance was selected, comparing the difference of creatinine, bilirubin and INR level respectively under the groups divided by the above tongue picture; data was analyzed by methods of frequency and Mann-Whitney Rank test by SPSS. Results： Except of thin tongue and sublingualminute veins, MELD score in the group that some kind of tongue picture appeared is higher than that in the group the same tongue picture not appeared, and purple black sublingual veins, tortuous sublingual veins and thick coating had significant differences （P〈0.05, P〈0.01）; the average rank of bilirubin level in the appeared group of above three kinds of tongue picture was 417.60, 430.89, 432.42, and there was significant differences compared with 369.62, 379.56, 362.06 in the not appeared group （P〈0.05, P〈0.01）; the average rank of INR level in the appeared group of above three kinds of tongue picture was 421.15, 451.91, 422.01, and there was significant differences compared with 367.61,376.00, 367.77 in the not appeared group （P〈0.05, P〈0.01）. Conclusion： There was a certain correlation between tongue picture and MELD score in the patients with liver cirrhosis, and there also was a certain correlation between purple black sublingual veins, tortuous sublingual veins, thick coating and bilirubin and 1NR level, which initially showed that tongue picture could reflect the disease severity.