酒精性肝硬化中医证型与肝功能的关系研究

Study on Relationships between Traditional Chinese Medicine Syndromes and Liver Function in Patients with Alcoholic Liver Cirrhosis

目的分析酒精性肝硬化(Alcoholic Cirrhosis,AC)患者中医证型与肝功能相关指标之间的关系,探析不同中医证型AC患者的病机特点。方法回顾2008年至2018年在广州中医药大学第一附属医院住院治疗的AC患者的一般资料、中医证型及各项实验室检查结果等数据,运用Epidata和Excel整理和管理提取数据,对提取后的数据进行证型规范和中药规范后,采用SPSS 19.0软件进行统计分析中医证型与客观指标之间的相关性。结果纳入有效病例数193例,平均年龄58.59±10.95岁,平均每日饮酒量339.60±205.05g,平均饮酒年限28.50±11.75年,平均饮酒度数为45.43±8.17%。193例AC患者中,不同证型间的白蛋白、前白蛋白、凝血酶原时间、活化部分凝血酶时间、总胆红素、直接胆红素、间接胆红素、总胆汁酸、谷草转氨酶、谷氨酰转肽酶、甲胎蛋白均具有统计学差异(P<0.05)。不同证型间的谷丙转氨酶、碱性磷酸酶不具有统计学差异(P>0.05)。结论本研究发现肝气郁结证AC患者的白蛋白和前白蛋白水平明显高于其他证型者(P<0.05),而凝血酶原时间、活化部分凝血酶时间方面则明显低于其他证型(P<0.05),脾肾阳虚证和瘀血阻络证AC患者的白蛋白和前白蛋白水平明显低于其他证型者(P<0.05)。瘀血阻络证AC患者胆红素水平明显高于其他证型(P<0.05)。而不同证型的AC患者肝细胞损害情况总体差异不大,但瘀血阻络证AC患者的谷草转氨酶中位数水平最高。本研究揭示AC早期病机多为肝郁气滞、湿热蕴结,晚期转化为瘀血、阳虚证型的特点。

Objective To analyze the relationship between traditional Chinese medicine(TCM)syndromes and functionrelated indicators in patients with alcoholic cirrhosis(AC),and to explore the characteristics of pathology and pathogenesis of AC patients with different TCM syndromes.Methods The general data,TCM syndromes and laboratory examination results of AC patients hospitalized in the first affiliated Hospital of Guangzhou University of Chinese Medicine from 2008 to 2018 were reviewed.Epidata and Excel were used to sort and manage the extracted data.After standardizing the syndromes and Chinese materia medica,SPSS 19.0 software was used to analyze the correlation between TCM syndrome type and objective index.Results There were 193 effective cases,the average age was 58.59±10.95 years old,the average daily alcohol consumption was 339.60±205.05 g,the average drinking years was 28.50±11.75 years,and the average alcohol consumption was 45.43±8.17%.There were significant differences in albumin,prealbumin,prothrombin time,activated partial thrombin time,total bilirubin,direct bilirubin,indirect bilirubin,total bile acid,glutamic oxaloacetic transaminase,glutamyl transpeptidase and alpha-fetoprotein among different syndrome types of AC(P<0.05).There was no statistical difference in glutamic pyruvic transaminase and alkaline phosphatase among different syndrome types(P>0.05).Conclusion This study found that the level of albumin and prealbumin in AC patients with liver qi stagnation syndrome significantly higher than other syndromes(P<0.05),and their level in AC patients with spleen-kidney yang deficiency syndrome and blood stasis syndrome significantly lower than other syndromes(P<0.05).The bilirubin level in AC patients with blood stasis syndrome was significantly higher than that of other syndromes(P<0.05).The overall difference of hepatocyte damage in different syndrome types of AC patients is not significant,but the median level of glutamyl transpeptidase in AC patients with blood stasis syndrome was the highest.This study reveals that the early pathogenesis of AC is liver depression and qi stagnation,damp-heat accumulation,and the late transformation into blood stasis and yang deficiency syndrome.