原发性胆汁性胆管炎中医证型与证素分布特点文献分析

Distribution features of TCM syndrome types and syndrome elements of primary biliary cholangitis:a literature review

目的通过文献研究,探索原发性胆汁性胆管炎(PBC)证候类型及证候要素分布规律,为探索PBC证候内涵和规律提供依据。方法计算机系统检索中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、重庆维普中文期刊数据库(CQVIP)、万方数据库以及外文生物医学文献数据库(Pub Med)建库至2017年8月31日PBC有关文献,采用Note Express2.0软件进行PBC证候文献筛选,应用统计软件SPSS19.0进行统计分析。结果最终纳入文献11篇,报道病例总数849例,经规范后PBC证型19种,与PBC相关的证候要素18个。从证候出现频次以及病例构成比两个角度进行统计分析,得到PBC核心证候类型依次为:肝肾阴虚证、肝郁脾虚证;病位证素主要为:肝、脾、肾;病性证素主要为:气虚、湿、阴虚、气滞、血瘀、热。临床症状期证型主要为:肝郁脾虚证、肝肾阴虚证、脾胃气虚证,病位证素主要为:肝、脾,病性证素主要为:气虚、气滞、阴虚、湿阻。肝硬化失代偿期证型主要为:肝肾阴虚证、肝肾亏虚证、湿阻血瘀证,而病位证素主要为:肝、肾,病性证素主要为:阴虚、湿阻、血瘀、精亏。结论初步概括了PBC常见证型及证素的分布规律,为形成PBC中医辨证分型标准奠定基础。

Objective To investigate the distribution features of traditional Chinese medicine（TCM） syndromes types and syndrome elements of primary biliary cholangitis（PBC） via literature research,and to provide a basis for further research on PBC syndromes and features.Methods CNKI,CBM,CQVIP,Wanfang Data,and Pub Med were searched for articles on PBC published up to August 31,2017.Note Express2.0 was used for the screening of articles on PBC syndromes,and SPSS19.0 was used for statistical analysis.Results A total of 11 articles with 849 cases were included,and 19 PBC syndrome types and 18 syndrome elements were identified.A statistical analysis was performed from the aspects of the frequency of syndromes and the constituent ratio of cases,and the results showed that the core syndrome types of PBC were liver-kidney yin deficiency syndrome and the syndrome of stagnation of liver qi and spleen deficiency; major syndrome elements of disease location were the liver,the spleen,and the kidney; major syndrome elements reflecting the nature of disease included qi deficiency,dampness,yin deficiency,qi stagnation,blood stasis,and heat.Major syndrome types in the clinical symptom stage included stagnation of liver qi and spleen deficiency,liver-kidney yin deficiency,and deficiency of spleen qi and stomach qi,and major syndrome elements reflecting the nature of disease included qi deficiency,qi stagnation,yin deficiency,and dampness.Major syndrome types of decompensated cirrhosis included liver-kidney yin deficiency,deficiency of liver and kidney,and dampness and blood stasis; major syndrome elements of disease location were the liver and the kidney; major syndrome elements reflecting the nature of disease included yin deficiency,dampness,blood stasis,and deficiency of essence.Conclusion Distribution features of common syndrome types and syndrome elements of PBC summarized in this article lay a foundation for the development of the standards for TCM syndrome differentiation of PBC.