艾灸联合柴胡疏肝散治疗慢性乙型肝炎肝纤维化

Moxibustion Combined with Chaihu Shugan Powder in the Treatment of Chronic Hepatitis B Liver Fibrosis

目的:分析临床参数联合中医症状构建模型预测艾灸联合柴胡疏肝散治疗慢性乙型肝纤维化患者是否有效。方法:回顾性纳入河南中医药大学第一附属医院慢性乙型肝炎肝纤维化患者135例,所有患者均于治疗前检测谷草转氨酶(aspartate aminotransferase,AST)、谷丙转氨酶(alanineaminotransferase,ALT)、总胆红素(total bilirubin,TBIL)、透明质酸(hyaluronic acid,HA)、Ⅲ型前胶原(procollagenⅢ,PCⅢ)、Ⅳ型胶原(collagen typeⅣ,Ⅳ-C)水平,肝脏超声测量门静脉直径、脾静脉直径、脾脏厚度、肝脏硬度值。所有患者均接受艾灸联合柴胡疏肝散连续治疗5个月,并重新检测患者的肝脏纤维化指标、超声评估患者疾病是否改善,并分为临床有效组患者和临床无效患者。收集临床有效患者和临床无效患者治疗前临床信息、超声检查信息以及患者中医症状信息,构建多元逻辑回归模型预测艾灸联合柴胡疏肝散临床治疗是否有效。结果:135例肝纤维化患者中临床疗效评估有效患者75例,无效患者60例;按照7:3比例随机分为训练组和测试组,以临床疗效是否有效作为研究目的,采用LASSO对训练组患者9个中医症状进行特征降维,构建中医得分,共纳入形寒肢冷和脉沉细两个中医症状。训练组中患者的临床参数包括生化指标、超声测量指标和中医得分构建多元逻辑回归评估患者接受艾灸联合柴胡疏肝散治疗后的临床有效性,并采用Nomogram可视化模型。训练组中联合模型的诊断效能高于中医得分与临床参数(AUC=0.67 vs 0.62 vs 0.62),测试组中采用联合模型评估艾灸联合柴胡疏肝散治疗慢性乙型肝纤维化的临床有效性的诊断效能高于中医得分、低于临床参数(AUC=0.67 vs 0.51 vs 0.70)。结论:临床参数联合中医症状构建模型可协助临床针对乙型肝炎肝纤维化患者制定治疗方案,辅助预测艾灸联合柴胡疏肝散的临床有效性。

Objective:To analyze the clinical parameters combined with TCM symptoms to build a model to predict whether moxibustion combined with Chaihu Shugan powder is effective in the treatment of patients with chronic hepatitis B liver fibrosis.Methods:A total of 135 patients with chronic hepatitis B liver fibrosis in The First Affiliated Hospital of Henan University of Chinese medicine were enrolled in this study.All patients were tested for liver biochemical indicators aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin(TBIL),hyaluronic acid(HA),procollagen III(PCIII)and type IV collagen(IV-C)were measured by liver ultrasound to measure the portal vein diameter,splenic vein diameter,spleen thickness,and liver stiffness.All patients received moxibustion combined with Chaihu Shugan Powder for continuous treatment for 5 months,and the liver fibrosis indicators of the patients were re-examined,and the ultrasound evaluated whether the patient′s disease was improved,and were divided into clinically effective patients and clinically ineffective patients.Clinical information of clinically effective and clinically ineffective patients before treatment,ultrasound examination information,and patient′s TCM symptoms information were collected to construct a multiple logistic regression model to predict whether moxibustion combined with Chaihu Shugan Powder is effective in clinical treatment.Results:Of 135 patients with liver fibrosis,75 patients were effective in clinical efficacy evaluation,60 were ineffective;According to the ratio of 7:3,the training group and the test group were randomly divided into two groups.The clinical efficacy was taken as the research objective.The 9 TCM symptoms in the training group were reduced by LASSO,and the scores of TCM were constructed.The symptoms of cold limbs and pulse sinking were included.The clinical parameters of the patients in the training group included biochemical indexes,ultrasonic measurement indexes and TCM scores to evaluate the clinical effectiveness of moxibustion combined with Chaihu Shugan powder,and the Nomogram visual model was used.The diagnostic efficacy of the combined model in the training group was higher than that of traditional Chinese medicine(AUC=0.67 vs 0.62 vs 0.62).The clinical efficacy of moxibustion combined with Chaihu Shugan Powder in the treatment of chronic hepatitis B fibrosis was higher than that of traditional Chinese medicine(AUC=0.67 vs 0.51 vs 0.70).Conclusion:The clinical parameters combined with TCM symptom model can help to formulate treatment plan for patients with hepatitis B liver fibrosis,and assist to predict the clinical efficacy of moxibustion combined with Chaihu Shugan Powder.