乙型肝炎肝硬化患者胆囊病变的中西医特征分析

Analysis of the Characteristics of Traditional Chinese Medicine and Western Medicine in Patients with Hepatitis B Cirrhosis and Gallbladder Diseases

目的:了解乙型肝炎肝硬化患者胆囊病变的流行病学特点和中医诊治现状。方法:选择2015年1月至2016年12月303例乙型肝炎肝硬化住院患者作为研究对象。采用回顾性调查研究方法,根据患者的病案信息,将调查所得资料进行分析。结果:乙型肝炎肝硬化患者胆壁增厚和胆壁水肿发生率在不同Child-Pugh分级中比较有统计学意义(P <0. 05),胆结石和胆息肉的发生率在不同Child-Pugh分级中无统计学意义(P> 0. 05);乙型肝炎肝硬化胆囊病变患者中医证候要素中以气虚、血瘀、气郁为主,气郁证、气虚证、肾虚证在不同Child-Pugh分级中比较有统计学意义(P <0. 05)。结论:乙型肝炎肝硬化患者发生胆囊炎的几率与肝脏功能情况呈正相关,而胆结石、胆息肉的发生率与Child-Pugh分级无明显相关性;乙型肝炎肝硬化合并胆囊病变病程早期的中医证候要素以气郁为主,而中晚期证候以虚损为主。由Child-Pugh A级到Child-Pugh B级是疾病虚实转换和复杂化的重要拐点,健脾护中治则应贯穿在治疗的始终。

Objective ：To investigate the epidemiologieal features, diagnosis, treatment of traditional Chinese medicine of gallbladder lesions in patients with hepatic B cirrhosis. Methods： Three hundred and three eases of hospitalized patients with hepatitis B cirrhosis were selected to be the study objects from January 2015 to December 2016. Retrospective research was used to analyze the patients＇ information. Results： There was statistical significance in the incidence of gallbladder wall thickening and edema in patients with hepatitis B cirrhosis according to different Child-Pugh classifications （P 〈 0.05 ）, and there was no significant difference in the incidence of gallstones and gallbladder polyps in different Child-Pugh classifications （ P 〉 0.05 ）. The main factors of TCM syndrome elements in patients with hepatitis B cirrhosis and gallbladder lesions were qi deficiency, blood stasis, qi stagnation. Qi stagnation syndrome, qi deficiency syndrome and kidney defteiency syndrome were statistically significant in different Child-Pugh classifications （ P 〈 0.05 ）. Conclusion： There was positive correlation between the incidence of cholecystitis and liver function in patients with hepatitis B cirrhosis, while there was no significant correlation between the incidence of both gallstones and gallbladder polyps and Child-Pugh classification. The TCM syndrome factors of hepatitis B cirrhosis complicated with gallbladder disease in the early stage were mainly qi stagnation, and it was weakness in the advanced stage. The course from Child-Pugh A to Child-Pugh B is an important turning point in the conversion of the disease, and the rules of tonifying spleen and protecting middle-jiao should be carried out throughout the treatment.