180例乙肝相关性肝癌患者的中医体质分布、证侯类型及临床特点分析

Distribution of CM Constitutions, Syndrome Types, and Clinical Characteristics in 180 Patients with HBV Related Liver Cancer

目的分析乙肝相关性肝癌患者中医体质分布、证侯类型及临床特点。方法通过计算180例乙肝相关性肝癌患者《中医体质量表》得分情况,分析患者中医体质类型,根据患者临床症状判断中医证型,比较主要体质类型及不同中医证型患者白细胞、中性粒细胞百分比(neutrophil-lymphocyte ratio, NLR)、红细胞、血红蛋白、凝血酶原时间(prothrombin time, PT)、凝血酶原活动度(prothrombin time activity, PTA)、国际标准化比值(international normalized ratio, INR)的差异,并记录患者有无食管胃底静脉曲张破裂出血。结果乙肝相关性肝癌患者体质类型以偏颇体质为主,整体偏颇体质类型分布以阳虚质[47例(26.1%)]、阴虚质[18例(10.0%)]、湿热质[17例(9.4%)]为主。男性偏颇体质以阳虚质[28例(19.7%)]、湿热质[16例(11.3%)]为主,女性以阳虚质[19例(50.0%)]为主。阳虚质患者红细胞及血红蛋白水平低于平和体质患者(P<0.05)。中医证型以湿瘀互结[51例(28.3%)]、肝郁脾虚[44例(24.4%)]、湿热蕴结[36例(20.0%)]为主。肝郁脾虚组PTA低于气滞血瘀组(P<0.05)。乙肝相关性肝癌并食管胃底静脉曲张破裂出血患者(17例)体质以阳虚质[6例(35.3%)]为主,证型以肝郁脾虚[6例(35.3%)]及肝肾阴虚证[5例(29.4%)]为主。结论乙肝相关性肝癌患者的偏颇体质以阳虚质、阴虚质、湿热质为主;湿瘀互结、肝郁脾虚、湿热蕴结为常见中医证型。阳虚质为上消化道出血的主要体质类型,肝郁脾虚及肝肾阴虚为上消化道出血的常见中医证型。

Objective To analyze the distribution of Chinese medicine(CM) constitutions, syndrome types, and clinical characteristics of patients with hepatitis B virus(HBV) related liver cancer. Methods Types of CM constitutions were analyzed in 180 HBV related liver cancer by CM Constitutions Questionnaire. CM syndromes were judged by their clincal symptoms. White blood cell(WBC), neutrophil-lymphocyte ratio(NLR), red blood cell(RBC), hemoglobin(HB), prothrombin time(PT), prothrombin time activity(PTA), international normalized ratio(INR) were compared in patients with different CM constitutions. Whether there were esophageal and gastric variceal bleeding were also recorded. Results Unbalanced constitution was dominated in HBV related liver cancer patients, distributed mainly as yang deficiency [47(26.1%)], yin deficiency [18(10.0%)], and dampness-heat [17(9.4%)]. Yang deficiency [28(19.7%)] and dampness-heat [16(11.3%)] were main patterns of constitutions in male patients, while yang deficiency [19(50.0%)] was the main pattern of constitutions in female patients. Levels of RBC and HB in yang deficiency patients were lower than those in balanced constitution patients(P<0.05). Intermingled dampness and stasis syndrome [51(28.3%)], Gan stagnation Pi deficiency syndrome [44(24.4%)], damp and heat accumulation syndrome [36(20.0%)] were main CM syndrome types. Prothrombin activity was lower in patients with Gan stagnation Pi deficiency syndrome than in patients with qi stagnation blood stasis syndrome(P<0.05). Yang deficiency constitution was the main constitution type in primary liver cancer patients complicated with esophageal and gastric variceal bleeding. Gan stagnation Pi deficiency syndrome [6(35.3%)] and Gan-Shen yin deficiency syndrome [5(29.4%)] were main syndrome types. Conclusions Yang deficiency, yin deficiency, and dampness-heat were main constitutions of patients with HBV related liver cancer. Intermingled dampness and stasis syndrome, Gan stagnation Pi deficiency syndrome, and damp and heat accumulation syndrome were common CM syndrome types. Yang deficiency constitution was main constitution of upper digestive tract hemorrhage. Gan stagnation Pi deficiency syndrome and Gan-Shen yin deficiency syndrome were main syndrome types of upper digestive tract hemorrhage.