肝豆状核变性患者中医证型的临床客观指标研究

Clinical Objective Indices in Patients with Different Traditional Chinese Medicine Syndrome Types of Hepatolenticular Degeneration

目的分析不同中医证型肝豆状核变性(hepatolenticular degeneration,HLD)患者临床客观指标的差异,为HLD辨证分型客观化提供依据。方法回顾性分析2012年1月至2014年6月期间185例未经驱铜治疗的HLD患者的临床客观指标和中医证型,并比较不同中医证型患者客观指标的差异。结果不同证型HLD患者的发病年龄,病程,血尿酸水平,角膜K-F环阳性率,肝脏超声影像学表现,以及肾脏损伤、腹水和胆囊疾患发生率比较,差异均具有统计学意义(P<0.05),不同证型HLD患者的临床客观指标呈现不同的特征性变化。如肝肾不足证者发病最低,病程最短,血尿酸水平最高,角膜K-F环阳性率最低,肝脏超声主要呈现星光点征,肾脏损伤发生率最低。结论 HLD患者的年龄、病程、血尿酸水平、角膜K-F环、腹部彩色超声影像学表现对中医辨证分型具有一定参考价值。

Objective To analyze the differences in clinical objective indices between patients with different traditional Chinese medicine （TCM） syndrome types of hepatolenticular degeneration （HLD）, and to provide a basis for objective syndrome differentiation and typing of HLD. Methods The clinical objective indices and TCM syndrome types of 185 HLD patients who did not receive decoppering treatment from January 2012 to June 2014 were analyzed retrospectively, and the objective indices were compared between patients with different TCM syndrome types of HLD. Results The patients with different TCM syndrome types of HLD had significant differences in age of onset, course of disease, level of serum uric acid, positive rate of corneal Kayser-Fleischer ring （K-F ring）, imaging findings on liver ultrasound, and incidence rates of renal injury, ascites, and gallbladder diseases （all P〈0.05）. These patients also had characteristic changes in clinical objective indices; for example, the patients with deficiency of liver and kidney had the youngest age of onset, the shortest course of disease, the highest level of serum uric acid, the lowest positive rate of corneal K-F ring, and the lowest incidence rate of renal injury, as well as a spotted pattern on liver ultrasound. Conclusion The age, course of disease, level of serum uric acid, corneal K-F ring, and imaging findings on abdominal ultrasound in HLD patients have certain values in TCM syndrome differentiation.