活动期与静止期肝炎肝硬化患者常见病性类证候要素的分布比较及其与血清同型半胱氨酸水平的相关性探讨

Distribution of TCM syndrome elements at active stage and at stationary stage and their correlation with serum homocysteine level: a study of 715 patients with hepatitis cirrhosis

目的比较活动期与静止期肝炎肝硬化患者常见病性类证候要素的分布特点及其与血清同型半胱氨酸(Hcy)水平的相关性。方法运用本课题组统一制定的《肝炎肝硬化临床信息采集表》,进行全国多中心的横断面流行病学调查,收集患者的一般情况、症状等信息,采集血液标本并统一检测指标;依据课题组形成的专家共识《肝炎肝硬化常见证候要素辨识标准》,判定患者的病性类证候要素;比较肝炎肝硬化患者活动期与静止期常见病性类证候要素的分布与血清Hcy水平,探讨Hcy水平与常见病性类证候要素的相关性。结果 715例肝炎肝硬化患者的常见病性类证候要素在活动期的出现频率均高于静止期,其中血瘀、阴虚、气虚、阳虚、水停有统计学差异(P<0.05);活动期患者血清Hcy水平显著高于静止期患者(P<0.05);不分期与分期比较的结果均表明,判定具有阴虚、湿热、气滞、阳虚者的Hcy水平均低于非判定组,判定具有血瘀、气虚、水停者的Hcy水平均高于非判定组,其中静止期的气滞判定组患者的Hcy水平与非判定组比较有显著差异(P<0.05),活动期阴虚、气虚判定组患者的Hcy水平与非判定组比较有显著差异(P<0.05)。结论肝炎肝硬化患者活动期常见病性类证候要素的出现频率及血清Hcy水平高于静止期,表明肝炎肝硬化患者的血清Hcy水平可反映肝脏炎症活动及病情的程度;血清Hcy水平与常见中医病性类证候要素之间有一定的相关性,可为探讨肝炎肝硬化常见中医病性类证候要素的病理学基础及规范化研究提供一定依据。

Objective To explore the characteristics of distribution of TCM syndrome elements of disease nature between active stage and stationary stage of patients with hepatitis cirrhosis,and to study the correlation between the TCM syndrome elements and serum level of homocysteine（ Hcy）. Methods By using Information Collection Form of Hepatitis Cirrhosis drafted by our research team,a national multicenter and cross-sectional epidemiological survey was conducted to collect the general condition,symptoms,and blood samples from which the serum Hcy levels were obtained. In accordance with Standard of Hepatitis Cirrhosis Syndrome Elements Differentiation,the TCM syndrome elements of nature of the patients were determined. Then the correlation of the TCM syndrome elements and the serum levels of Hcy was investigated at active stage and stationary stage. Results Altogether 715 patients were included. The frequency of all syndrome elements in patients of active stage were higher than those in patients of stationary phase,in which the element of blood stasis,yin deficiency,qi deficiency,yang deficiency and water retention showed statistical differences（ P 0. 05）. The serum level of Hcy in patients of active stage was higher significantly than that of stationary stage（ P 0. 05）. The Hcy level of patients with yin deficiency pattern was lower than that of patients without yin deficiency pattern,the same as element of damp heat,qi stagnation and yang deficiency; however,the situations of element of blood stasis,qi deficiency and water retention were quite the reverse. In the patients of stationary stage,the serum levels of Hcy showed significant difference between qi stagnation group and non qi stagnation group（ P 0. 05）. In the patients of active stage,the levels of Hcy showed difference between yin deficiency group and non yin deficiency group,as well as the element of qi deficiency（ P 0. 05）. Conclusion The frequency of TCM syndrome elements and the serum Hcy level in patients of active stage higher than those of patients of stationary stage,reflected the degree of hepatic inflammation and severity of disease. That the correlation between the Hcy level and the TCM syndrome elements of nature could provide the evidence for pathological basis and standardization study of TCM syndrome elements in patients with hepatitis cirrhosis.