74例原发性胆汁性肝硬化患者中医证型及临床特征分析

The analysis of TCM syndrome and clinical features for 74 cases patients with primary biliary cirrhosis

目的:探讨原发性胆汁性肝硬化(PBC)患者的中医证型分布及临床特征,以提高对PBC的诊断与治疗水平。方法:收集上海中医药大学附属曙光医院肝病科住院的74例PBC患者临床资料,进行回顾性分析。结果:74例患者中肝肾亏虚型36例(49%)、湿滞血瘀型20例(27%)、肝郁脾虚型18例(24%);主要症状及体征出现例数及频率分别为:口干30例(40%)、乏力74例(100%)、皮肤瘙痒24例(32%)、纳差67例(91%)、尿黄49例(66%)、脾大68例(91%);AMA/AMA-M2阳性率达77.03%;GGT、TBil、DBil、Alb、TC、TG等生化指标在不同证型中比较,差异无显著性意义(P>0.05)。结论:PBC患者的中医证型主要有肝郁脾虚型,湿滞血瘀型,肝肾亏虚型。湿滞血瘀型患者以尿黄最为常见,湿滞血瘀型患者AMA-M2、AMA、ANA阳性率明显偏高。脾大、乏力、纳差在各证型患者出现的频率均较高,皮肤瘙痒常见。肝郁脾虚型患者平均总胆汁酸较低。

Objective：To discuss TCM syndrome distribution and clinical features of the primary biliary cirrhosis（PBC）patients in order to improve the levels of diagnosis and treatment. Methods：Seventy-four cases of hospitalized PBC patients were collected and analyzed retrospectively. Results：There were 36 cases of liver and kidney deficiency（49%）,20 cases of wet stagnation and blood stasis（27%）,18 cases of liver depression and spleen deficiency（24%）. The number of cases and frequency for the main clinical symptoms and physical signs were30 cases of dry mouth（40%）,74 cases of weakness（100%）,24 cases of skin pruritus（32%）,67 cases of poor appetite（91%）,49 cases of urine yellow（66%）,68 cases of splenauxe（91%）. The positive rate of AMA/AMA-M2 was 77.03%. There were no statistical significance of GGT,TBil,DBil,Alb,TC,TG and other biochemical indicators in different syndromes（P〉 0.05）. Conclusion：The parimary TCM syndromes of PBC patients were liver depression and spleen deficiency,wet stagnation and blood stasis,and liver and kidney deficiency. The urine yellow was the most common symptom in the syndrome of wet stagnation and blood stasis,and the patients of this syndrome had a higher positive rate of AMA-M2,AMA,ANA. But there were higher frequency rates of splenauxe,weakness,poor appetite in all the syndromes,and the skin pruritus was common symptom. The average of total bile acid was lower in the syndrome of liver depression and spleen deficiency.