从肝脏储备功能与有效血流量探讨乙肝肝硬化中医证型特点

Study on Traditional Chinese Medicine Syndrome Characteristics of Hepatitis B Cirrhosis from Liver Reserve Function and Effective Blood Flow

目的:探讨乙肝肝硬化患者中医证型分布与肝脏储备功能以及有效肝血流量之间的关系,从肝脏功能代谢角度探讨乙肝肝硬化患者中医证型的特征表现。方法:选取2018年9月至2019年12月上海中医药大学附属曙光医院收治的乙肝肝硬化患者163例作为研究对象,基于四诊信息及“以方测证”归纳中医证型,分析不同中医证型间的吲哚菁绿15 min滞留率(ICG-R15)、有效肝血流量(EHBF)、Alb、MELD评分、Child-pugh评分等的组间差异,并进行分析。结果:乙肝肝硬化中医证型以肝肾阴虚证为主,占48.46%。不同中医证型间ICG-R15、EHBF、Alb、PA、PT、Child-pugh分级差异有统计学意义。ICG-R15、Child-pugh分值呈现肝郁脾虚证/肝胆湿热证>肝肾阴虚证>瘀血阻络证>脾肾阳虚证的趋势;EHBF呈现肝胆湿热证>肝郁脾虚证>瘀血阻络证>肝肾阴虚证>脾肾阳虚证的趋势。EHBF在肝肾阴虚证中呈现随Child-pugh分级降低而下降的趋势(P=0.008)。结论:乙肝肝硬化患者的肝脏储备功能及肝有效血流量与中医证型的演变分期具有一致性。肝肾阴虚证的有效血流量具有随肝脏储备功能下降而减少的趋势。

Objective:To investigate the relationship between the distribution of traditional Chinese medicine(TCM)syndromes in patients with hepatitis B cirrhosis and liver reserve function and effective liver blood flow,and to explore the characteristics of TCM syndromes in patients with hepatitis B cirrhosis from the perspective of liver function metabolism.Methods:A total of 163 patients with hepatitis B cirrhosis admitted to Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine were selected as the research objects.Based on the information of the four diagnostics and the“syndrome testing with prescriptions”,the TCM syndrome types were summarized,and the indocyanine green 15-min retention rate(ICG-R15),effective liver blood flow(EHBF),Alb,and MELD scores among different TCM syndrome types were analyzed.Differences between groups such as Child-pugh score,etc.,were analyzed.Results:The TCM syndromes of hepatitis B and cirrhosis were mainly liver and kidney yin deficiency,accounting for 48.46%.There are significant differences in ICG-R15,EHBF,Alb,PA,PT,and Child-pugh classifications among different TCM syndrome types.ICG-R15 and Child-pugh scores showed the trend of liver depression and spleen deficiency syndrome/liver and gallbladder damp-heat syndrome>liver and kidney yin deficiency syndrome>blood stagnation syndrome>spleen and kidney yang deficiency syndrome;EHBF showed the trend of liver and gallbladder damp-heat syndrome>liver stagnation and spleen deficiency syndrome>blood stasis obstructing collaterals>liver and kidney yin deficiency>spleen and kidney yang deficiency.EHBF in the syndrome of liver and kidney yin deficiency showed a downward trend with the decrease of Child-pugh grade(P=0.008).Conclusion:The liver reserve function and hepatic effective blood flow of patients with hepatitis B cirrhosis are consistent with the evolutionary stages of TCM syndromes.The effective blood flow of liver and kidney yin deficiency has a tendency to decrease with the decrease of liver reserve function.