乙型肝炎相关性慢加急性肝衰竭细菌感染临床特点及中医证候回顾性分析

Retrospective Study of Clinical Features and Traditional Chinese Medicine Syndrome Characteristics on HBV-ACLF Patients with Bacterial Infection

目的:通过对乙型肝炎相关性慢加急性肝衰竭(HBV-ACLF)患者进行回顾性研究,阐述HBV-ACLF并发细菌感染的临床特点、中医证候分布特征,从而为中医药诊治HBV-ACLF继发细菌感染提供相应的理论依据。方法:采用病例回顾性的流行病学调查研究方法,制定统一的慢加急性肝衰竭患者的信息采集表。按照纳入标准和排除标准收集了307例于湖南中医药大学第一附属医院肝病研究所住院的HBV-ACLF患者的临床资料,从中筛选出主要的中医症状体征及中医证候。然后按照有无合并细菌感染分为合并细菌感染组与未合并细菌感染组,比较两组的主要中医症状体征及中医证候的分布特征,从而得出HBV-ACLF并发细菌感染的中医证候分布特征。结果:与未合并细菌感染患者比,合并细菌感染患者腹胀、便溏、舌质紫暗、腹露青筋、皮下瘀斑瘀点、舌边齿痕明显增多;与合并细菌感染患者比,未合并细菌感染患者主要表现为身目鲜黄、舌苔黄腻、口干明显增多(P<0.05,P<0.01)。合并细菌感染患者主要表现以兼夹证候为主(93.6%),且多兼夹脾虚证(81.6%);而未合并细菌感染患者以单一证候为主(53.5%),且多为湿热证(51.9%);合并细菌感染患者的兼夹证候中又以虚实夹杂证为主(94.4%),且明显高于未合并细菌感染患者的虚实夹杂证(58.9%)。结论:HBV-ACLF未合并细菌感染患者以湿热症状体征为主,随着合并细菌感染后,脾虚血瘀症状体征逐渐加重;HBV-ACLF并细菌感染患者以脾虚血瘀兼夹证候为主,而未合并细菌感染患者以湿热单一证候为主。

Objective: Through the retrospective study of Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF) patients,the clinical features and the characteristics of traditional Chinese medicine(TCM)syndrome distribution of HBV-ACLF complicated with bacterial infection were preliminarily expounded,so as to provide the corresponding theoretical basis for the diagnosis and treatment of HBV-ACLF secondary bacterial infection.Method: A unified data collection form for patients with slow plus acute liver failure was designed by the retrospective epidemiological investigation method.The clinical data of 307 patients with HBV-ACLF who were hospitalized at the Hepatology Institute of the First Affiliated Hospital of Hunan University of Chinese Medicine were collected in strict accordance with the inclusion and exclusion standards,and the main symptoms and the TCM symptoms were screened.Then,according to whether or not there was a bacterial infection,the patients were divided into a combined bacterial infection group and a non-combined bacterial infection group.The distribution characteristics of the main symptoms and the TCM symptoms in two groups were compared,and the distribution characteristics of TCM symptoms of HBV-ACLF with bacterial infection were obtained.Result: Compared with patients with uncombined bacterial infection,patients with combined bacterial infection had significantly increased abdominal distension,puffiness,purple and dark tongue color,abdominal varicose tendons,subcutaneous stasis spots,and tooth marks on the side of the tongue.Compared with patients with combined bacterial infections,patients with uncombined bacterial infections mainly showed bright yellow head,yellow tongue coating,and significantly increased dry mouth(P<0.05,P<0.01).The main symptoms of patients with combined bacterial infections was the combination of syndrome(93.6%),and more spleen deficiency syndrome(81.6%),patients with uncombined bacterial infections mainly suffered from a single syndrome(53.5%),which was mostly dampheat syndrome(51.9%),patients of concurrent syndrome with combined bacterial infections mostly suffered from false and real syndrome(94.4%),which was significantly higher than those with uncombined bacterial infections(58.9%).Conclusion: The patients with HBV-ACLF without bacterial infection mainly suffered from damp-heat symptoms and signs.With the combination of bacterial infection,the symptoms and signs of spleen deficiency and blood stasis gradually worsened.HBV-ACLF patients with bacterial infection mainly suffered from spleen deficiency and blood stasis,while patients with unincorporated bacterial infection mainly suffered from the single damp-heat symptoms and signs.