不同时期肝硬化患者中医证候与肝脏纤维增生程度的相关性研究

A Correlative study on TCM syndrome differentiation types and the degree of hepatic fiber proliferation in different periods of cirrhosis

目的:研究不同时期肝硬化中医证候与肝脏纤维增生程度的相关性。方法:将肝硬化患者按肝脏代偿情况分为临床前代偿期、临床代偿期、失代偿期3组,利用腹腔镜或开腹手术直视观察肝脏大体形态学改变,获取肝组织并制成玻片,运用体视学软件测定肝纤维组织占比,采用描述性统计分析方法对其与肝硬化各中医证型之间相关性进行研究。结果:(1)各组患者肝纤维组织占比依次从临床失代偿期组(26.23±18.14)、临床代偿期组(17.96±11.38)、临床前代偿期组(17.64±10.26)逐渐减少,临床失代偿期组与其他两组比较;差异有显著性意义P<0.05。(2)不同证型的肝硬化患者肝纤维占比依次减少:脾肾阳虚证(42.23±00.00)>肝肾阴虚证(36.71±0.18)>湿热蕴结证(26.17±10.82)>瘀血内阻证(19.20±10.63)>肝气郁结证(15.23±8.18)>水湿内阻证(6.81±4.47),组问比较差异有显著性意义,P<0.05。结论:(1)肝纤维占比可作为肝纤维化程度的量化指标;(2)肝硬化的中医证候与肝脏纤维增生程度有一定内在联系。

Objetcive：To explore the correlation between TCM syndrome differentiation types and the degree of hepatic fiber proliferation in different periods of cirrhosis. Methods： Basing on the standard of the morphologic diagnosis of cirrhosis, the patients with cirrhosis were divided into pre-clinical group （CPPG） ,compensated period of clinical group （CPCG） and decompensated period group （DPG）. By the way of laparo- scope or laparotomy, liver tissues were available and made of pathological section. TCM syndrome differentiation types were analyzed through descriptive statistical methods and the ratio of the area of hepatic fiber proliferation which was measured through stereological software. Results ： （1）In different periods of cirrhosis, the ratio of the area of hepatic fiber proliferation from large to small：＂ DPG＂ （26.23 ± 18.14）, ＂CPCG＂ （ 17.96 ± 11.38） ,＂ CPPG＂ （ 17.64 ± 10.26）. （2）With regard to TCM syndrome differentiation types of the patients with cirrhosis, the ratio of the area of hepatic fiber proliferation from large to small as follows：＂ asdthenic splenonephro-yang（ASN-yang） ＂（42.23 ± 00.00） 〉 ＂hepatic and re- nal yin deficiency （HRYD）＂ （36.71 ± 0. 18 ） 〉 ＂endoretention of damp heat （ERDH）＂ （26.17 ± 10.82） 〉 ＂obstruction of collaterals by blood stasis （OCBS）＂ （ 19.20 ± 10.63） 〉 ＂depression of liver-QI （DOL-QI）＂ （ 15.23 ± 8.18） 〉 ＂stagnation of fluid-dampness （SFD）＂ （6.81 ±4.47）. Conclusion ：（1）The ratio of the area of hepatic fiber proliferation can be made for the measurement index of the clinical degree of hepatic cirrhosis. （2）There is a certaint internal link between TCM syndrome differentiation types and the degree of hepatic fiber proliferation.