原发性肝癌中医证型与凝血功能相关性研究

The correlation between syndrome types of primary hepatic carcinoma and coagulation function

目的研究原发性肝癌中医证型、并发症及生活质量与凝血功能之间的相关性。方法回顾性分析99例原发性肝癌患者,观察原发性肝癌患者的中医证型与临床分期分布情况,根据中医证型分为肝肾阴虚、湿热聚毒、肝郁脾虚、脾虚湿困、气滞血瘀5组,比较各组血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、血浆纤维蛋白原（FIB）、凝血酶时间（TT）、凝血酶原时间比值（PTR）、国际标准化比值（INR）的差异,并分别根据肝外转移、上消化道出血、门脉癌栓的有无,不同的腹腔积液量及不同的卡氏评分（KPS）分组,比较各组凝血功能指标的差异。结果原发性肝癌以肝郁脾虚组最为多见（31.31%）,其次是湿热聚毒组（25.25%）及气滞血瘀组（18.18%）。各中医证型组间PT,APTT比较差异有统计学意义（P〈0.05）。PT以脾虚湿困组升高最多,其次是湿热聚毒组与肝肾阴虚组,肝郁脾虚组升高最少。APTT以湿热聚毒组升高最多,其次是脾虚湿困组与肝肾阴虚组,肝郁脾虚组升高最少。肝外转移组的PTR,INR较无转移组明显升高（P〈0.05）。上消化道出血组PT,TT,PTR,INR较无出血组明显升高（P〈0.05）。门脉癌栓组与无门脉癌栓组之间各凝血指标比较差异均无统计学意义（P〉0.05）。不同程度腹腔积液组PT,APTT,PTR,INR比较差异有统计学意义（P〈0.05）,中量积液组、大量积液组PT较无积液组明显升高（P〈0.05）,中量积液组APTT,PTR较无积液组明显升高（P〈0.05）,少量积液组、中量积液组、大量积液组INR较无积液组明显升高（P〈0.05）。不同KPS评分组PT,APTT,FIB,PTR,INR比较差异均有统计学意义（P〈0.05）。0-30分组PT,APTT,PTR,INR升高最多,FIB减少最多。结论肝郁脾虚证为原发性肝癌最常见的证型;脾虚湿困证与湿热聚毒证凝血功能较差,肝郁脾虚证凝血功能较好;出现肝外转移、上消化道出血、腹腔积液等并发症的患者及卡氏评分0-30分的患者凝血功能较差。

Objective To study the correlation among syndrome types,complication and life quality of primary hepatic carcinoma and coagulation function. Methods 99 cases of primary hepatic carcinoma were retrospective analyzed,and the syndrome types and clinical stages distribution were recorded.According to Chinese medicine theory,there are 5 kinds of syndrome,including yin deficiency of both liver and kidney,dampness and heat accumulation,liver stagnation and spleen deficiency,dampnessretention due to spleen deficiency,qi stagnation and blood stasis. The prothrombin time（ PT）,activated partial thromboplastin time（ APTT）,plasma fibrinogen（ FIB）,thrombin time（ TT）,prothrombin time ratio（ PTR）,international normalized ratio（ INR） were analyzed. The differences of presence or absence of extrahepatic metastasis,upper gastrointestinal hemorrhage and portal vein tumor thrombus（ PVTT）,different abdominal cavity effusion quantity and KPS scores were analyzed in order to detect coagulation function among different groups. Results Liver stagnation and spleen deficiency is the most common syndrome in primary hepatic carcinoma（ 31. 31%）, followed by dampness and heat accumulation（ 25. 25%） and qi stagnation and blood stasis（ 18. 18%）. Among different groups,PT and APTT has significant difference（ P〈0. 05）. PT increased the highest in dampness retention due to spleen deficiency,followed by dampness and heat accumulation and yin deficiency of both liver and kidney,while increased the lowest in liver stagnation and spleen deficiency. APTT increased the highest in dampness and heat accumulation,followed by dampness retention due to spleen deficiency and yin deficiency of both liver and kidney,while increased the lowest in liver stagnation and spleen deficiency.Compared to the presence of extrahepatic metastasis group,PTR and INR increased significantly in absence group（ P〈0. 05）. PT,TT,PTR and INR of upper gastrointestinal hemorrhage group increased significantly than no hemorrhage group（ P〈0. 05）. There was no significantly difference of the coagulation indicators between portal vein tumor thrombus group and non- portal vein tumor thrombus group（ P〈0. 05）. Different seroperitoneum groups had significant differences in PT,APTT,PTR and INR（ P〈0. 05）. PT of median and large amount of seroperitoneum groups increased significantly than non-seroperitoneum group（ P〈0. 05）,APTT and PTR of median group increased significantly than the non-seroperitoneum group（ P〈0. 05）,INR of small,median and large amount of seroperitoneum groups had increased significantly than non-seroperitoneum group（ P〈0. 05）. PT,APTT,FIB,PTR and INR in different KPS scores had significantly difference（ P〈0. 05）. PT,APTT,PTR and INR of the group scores 0-30 increased highest while FIB decreased the most. Conclusion Liver stagnation and spleen deficiency is a common syndrome in primary hepatic carcinoma; dampness retention due to spleen deficiency and dampness and heat accumulation have bad coagulation,while liver stagnation and spleen deficiency has better. The patients with complications of extrahepatic metastasis,upper gastrointestinal hemorrhage,seroperitoneum and 0-30 in KPS scores have bad coagulation.