肝硬化黄疸中医证型研究

Study on Syndrome Types of TCM in Liver Cirrhotic Jaundice

目的:探讨肝硬化黄疸的中医证型与客观指标的关系。方法:将199例肝硬化黄疸患者辨证分为肝郁脾虑、气滞血瘀、热郁湿阻和肝肾亏虚4型。分别检测总胆红素(SB)、总胆汁酸(TBA)、白球蛋白的比值(A/G)和血清透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(ⅣC),并同步检测Child-Pugh分(?)的项目。结果:①热郁湿阻型、肝肾亏虚型SB、TBA均值均明显高于肝郁脾虚型,分别有显著差异;热郁湿阳(?)肾亏虚型A/G比值均明显低于肝郁脾虚型,且有显著差异;肝肾亏虚型A/G比值与气滞血瘀型比较有显著差异。(?)血瘀、热郁湿阻型、肝肾亏虚型3型血清HA值依次升高,与肝郁脾虚型比较均有显著差异;热郁湿阻型和肝肾亏虚型均明显高于肝(?)脾虚型,且分别有显著差异;气滞血瘀型、热郁湿阻型、肝肾亏虚型ⅣC值均高于肝郁脾虚型,前3型分别与(?)郁脾虚型比较,均有显著差异。③肝郁睥虚型以Child A级为主(73.86);气滞血瘀型以Child B级为多(45.23%);肝肾亏虚型以Child C级为多见(57.45％)。结论:血清SB、TBA、A/G和血清HA、PCⅢ、ⅣC以及Child-Pugh检测可作为肝硬化黄疸辨证分型的客观指标。

Objective: To explore syndrome types of TCM in liver cirrhotic jaundice. Methods: 199 patients of cir-rhotic jaundice were classified, according to syndrome differentiation of TCM into four types: liver-Qi stagnancy and spllen-deficiency type.Qi stagnancy and blood stasis type,heat-stagnancy and damp-block,and both liver and kidney deficiency type. Serum bilirubin, serum total bile acid, the ratio of albumin to globulin; Serum hyaluronic acid, procoliagen type Ⅲ , collagen type Ⅳ were detected; at the same time detected the items relating to classification of Child-Pugh. Re sult: ① Among the four types, heat stagnancy and damp block type and both liver and kidney deficiency types SB、TBA level were markedly higher than liver-Qi stagnancy and spleen-deficiency types, the difference between groups was significant; heat-stagnancy and damp-block type and both liver and kidney deficiency type's A/G ratio were respectively lower than liver-Qi stagnancy and spleen-damp type, the difference was signifcant. ②Qi-stagnancy and blood stasis type and both liver and kidney deficiency type's HA level was markedly higher than liver-Qi stagnancy and spleen-deficiency type's; and in turn both liver and kidney deficiency type>heat-stagnancy and damp block type>Qi-stagnancy and blood stasis type, the three types compared with liver-Qi stagnancy and spleen-deficiency type was significant difference; heat-stagnancy and damp-block type and both liver and kidhey deficiency type was significant ; Qi-stagnancy and blood stasis type、 heat-stagnancy and damp-block type and both liver and kidney deficiency type's ⅣC was higher than liver-Qi stagnancy and spleen-deficiency type's. The three types compared with liver-Qi stagnancy and spleen-deficiency type was significant difference respectively. ③Liver-Qi stagnancy and spleen-deficiency type's child A was the most in four groups, 73. 68% ; Qi-stagnancy and blood stasis type's child B was 45. 23%, both liver and kidney deficiency type's child C was 57. 45%. Conclusion: Serum SB, TBA, A/G; HA, PC Ⅲ , ⅣC: and Child-Pugh classification could serve as objective indexes for classifying syndrome type of TCM in cirrbotic jaundice.