原发性胆汁性肝硬化与慢性乙型病毒性肝炎文献证素比较研究

Comparative Study on Syndrome Factors of Primary Biliary Cirrhosis and Chronic Hepatitis B Based on Literature Survey

目的:通过原发性胆汁性肝硬化(PBC)与慢性乙型病毒性肝炎(CHB)的文献证素比较研究,探析PBC的证素分布特征及病机特点。方法:基于万方及中国知网文献数据库,结合人工筛选,获取2000年1月至2014年6月公开发表的非重复PBC中医研究文献,参照CHB证素研究方法建立PBC证素数据库。通过与CHB的对比显示PBC证素分布规律与特点。结果:①文献特征:纳入56篇文献,病例1368例,研究快速增加,高质量研究主要集中于三级甲等中医院。②证型分布特征:析出证型56个,依次为肝肾阴虚等10个高频证型,按照证素聚合后形成6大核心证素群依次为:血瘀、脾虚、阴虚、肾虚、湿热及肝郁,与CHB中湿热、肝郁、血瘀、毒、阴虚有所不同。③证素分布特征:PBC病位证素依次为肝、脾、胆、肾;CHB为肝、脾、肾、胆、络。PBC中胆为高频病位,胆络、肝络为特有病位。PBC中病性证素依次为气虚、血瘀、气郁、湿、热;CHB为气郁、湿、热、阴虚、血瘀、阳虚;与CHB相比,PBC中气虚、血瘀为高频证素,气郁、热、阴虚、阳虚为低频证素。结论:PBC中瘀、气虚(脾虚)等6大核心证素群值得重点关注;胆、肝络及胆络是特有病位,应在实践中丰富关于胆系的中医治法;气虚、血瘀是PBC绝对优势证素,早期使用补气活血治法可能有助于改善预后。结合前期研究,提出PBC三阶段演变假说,气虚血瘀为核心证型,毒损胆络是关键推动机制。

Objective:To explore the distribution characteristics of syndrome factors and pathogenesis features of primary biliary cirrhosis(PBC) through the comparative study of the literature syndrome factors of PBC and chronic hepatitis B(CHB). Methods:All the non-repetitive literatures of PBC published between January 2000 to June 2014 with TCM therapy were obtained from website of Wanfangdata and CNKI. The database of PBC syndrome factors was built with the same method of target CHB literature syndrome factors. The distribution rules and features of PBC syndrome factors were demonstrated by comparing with the CHB. Results:①Literature characteristics:total 56 articles with 1368 PBC cases were enrolled in this study,the publication number increased rapidly and nearly all the valuable research completed in TCM Third-class hospital.②Syndromes distribution features:total 56 types of syndrome were found,and the top 10 were respectively liver and kidney yin deficiency etc. Blood stasis,spleen deficiency,yin deficiency,kidney deficiency,damp heat and liver depression were the six important center syndrome factors.③Distribution feature of syndrome factors:the disease location factors of PBC were the liver,spleen,gallbladder and kidney while those of CHB were the liver,spleen,kidney,gallbladder and collaterals. The frequency of gallbladder in PBC was the higher location and bile collaterals and liver collaterals were special locations. The frequency sequence of disease nature factors of PBC was qi deficiency,blood stasis,qi stagnation,dampness and heat while that of CHB was qi depression,dampness,heat,yin deficiency,blood stasis and yang deficiency. Compared with CHB,qi deficiency and blood stasis in PBC were high-frequency syndrome factors while qi stagnation,heat,yin deficiency and yang deficiency were low-frequency syndrome factors. Conclusions:The six core factors such like blood stasis and qi deficiency(spleen deficiency) deserve more attention. Gallbladder,liver collateral and gallbladder collateral are unique disease locations,and should be enriched in practice.Considering qi deficiency and blood stasis are so important in PBC,the method of enhancing qi and activating blood circulation should be used earlier so as to improve prognosis. Based on the previous study,we proposed a three-stage hypothesis,qi deficiency and blood stasis as the core syndrome and toxin damaging the gallbladder collateral as the main promoting mechanism.