原发性胆汁性胆管炎患者中医证候特征与熊去氧胆酸应答不佳的相关性研究

Clinical study on the correlation between traditional Chinese medicine syndrome characteristics and inadequate response to UDCA in patients with primary biliary cholangitis

目的:探讨原发性胆汁性胆管炎(PBC)患者的中医证候特征与熊去氧胆酸(UDCA)应答不佳的相关性。方法:通过多中心横断面中医证候问卷调查,采集经UDCA治疗12个月以上的229例PBC患者的中医四诊信息,依据UDCA应答标准,分为UDCA应答组与UDCA应答不佳组,进行因子分析和聚类分析,获得PBC证素以及证型,分析中医证候特征与UDCA应答不佳的相关性。结果:①UDCA应答不佳组患者病位证素按照频数由高到低排列为肝>胆>脾>肾>胃;病性证素按照频数由高到低排列为:湿>热、血瘀>气滞>阳虚>气虚、血虚>阴虚、水停>精亏。UDCA应答不佳组患者中胆证素和湿证素频率比UDCA应答组的患者显著增加(P<0.01)。②UDCA应答不佳组患者证型按照频率由高到低排列为:肝胆湿热兼瘀血阻络证(16例)、肝郁脾虚证(14例)、脾气虚证(13例)、肝郁血瘀证(13例)、肝肾阴虚证(8例)、脾肾阳虚证(7例)、肾虚寒湿证(7例)、湿热中阻证(7例)。肝胆湿热兼瘀血阻络证型在UDCA应答不佳组患者中频率明显增加(P<0.05)。结论:肝胆证素、湿证素与UDCA应答不佳有一定相关性,肝胆湿热兼瘀血阻络证是UDCA应答不佳的主要证型。

Objective:To investigate the relationship between the characteristics of traditional Chinese medicine(TCM)and inadequate response to UDCA in patients with primary biliary cholangitis(PBC),so as to pretreat PBC patients with inadequate response to UDCA.Methods:A total of 229 cases with PBC treated by UDCA for more than 12 months took part in the multi-center cross-sectional questionnaire survey on TCM syndromes.According to the UDCA response criteria,all the patients were divided into UDCA response group and UDCA inadequate response group.By factor analysis and cluster analysis,we obtained the TCM syndrome elements and syndrome types and analysised the correlation between the characteristics of TCM and inadequate response to UDCA.Results:①In the group with inadequate response to UDCA,the disease-location syndrome elements frequency ranked from high to low as follows:liver>gallbladder>spleen>kidney>stomach;the disease-character syndrome elementsfrequancyranked from high to low as follows:dampness>heat,blood stasis >qi stagnation>Yang deficiency>Qi deficiency,blood deficiency>Yin deficiency,water stagnation>essence deficiency.The frequency of cholesterol and dampness syndromes inadeguate vesponse group was significantly higher than in UDCA response group(P<0.01).②The frequency of syndromes in UDCA inadequate response UDCA group was arranged from high to low as follows:dampness-heat of liver and gallbladder combined with blood stasis obstruction syndrome(16),liver depression and spleen deficiency syndrome(14),spleen deficiency syndrome(13),liver stagnation and blood stasis syndrome(13),liver and kidney yin deficiency syndrome(8),spleen-kidney Yang deficiency syndrome(7),kidney deficiency and cold-dampness syndrome(7),dampness-heat resistance syndrome(7).The frequency of PBC patients with Damp-heat of liver and gallbladder combined with blood stasis blocking collaterals syndrome was higher in UDCA inadeguate nesponse group.(P<0.05).Conclusion:Hepatobiliary syndrome element and dampness syndrome element are correlated with inadequate response to UDCA.Damp-heat of liver and gallbladder combined with blood stasis blocking collaterals syndrome is the main syndrome type with inadequate response to UDCA in primary biliary cholangitis patients.