基于中医五行“相侮”理论探讨肝豆状核变性患者脾切除术后肝功能的变化

Research on the changes of liver function in patients with hepatolenticular degeneration after splenectomy based on the theory of ‘mutual insult’ in five elements

目的:观察脾脏切除对肝豆状核变性(HLD)患者肝功能的影响,尝试探讨HLD患者脾切除术后肝功能变化的中医理论依据。方法:回顾性分析2014年1月—2018年12月安徽中医药大学第一附属医院363例HLD患者的临床资料,均为重度脾功能亢进患者,均有脾切除手术指征,根据是否行脾切除治疗,分为非手术组(185例)和手术组(178例)。分析比较两组患者不同时间谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)的变化情况。结果:非手术组患者治疗第14天ALT、AST水平低于本组治疗前(P<0.05)。手术组患者术后第3天时ALT、AST、TBIL及IBIL水平显著高于术前(P<0.05),随后逐渐降低;当至术后第14天时ALT、AST、TBIL及IBIL水平均显著低于术前(P<0.05)。两组比较,手术组术后第3天ALT、AST、TBIL及IBIL水平均显著高于非手术组(P<0.05),术后第14天ALT、AST、TBIL及IBIL水平均显著低于非手术组(P<0.05)。结论:脾脏切除可以改善肝豆状核变性患者的肝脏功能,其内在中医理论依据可能与中医五行相侮“土亢侮木”有关。

Objective: To observe the effects of splenectomy on liver function in patients with HLD, and discuss the theoretical basis of TCM for the changes of liver function. Methods: The clinical data of 363 HLD patients in the Department of General Surgery of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2014 to December 2018 were collected and retrospectively, all patients had severe hypersplenism and indications of splenectomy. Divided into non-operation group(185 cases) and operation group(178 cases) according to whether to accept splenectomy. Comparing the changes of alanine transaminase(ALT), aspartate transaminase(AST), total bilirubin(TBIL), direct bilirubin(DBIL) and indirect bilirubin(IBIL) in the two groups. Results: In the non-operation group, the levels of ALT and AST on the 14th day were lower than those before treatment(P<0.05);In the operation group, the levels of ALT, AST, TBIL and IBIL on the 3rd day were significantly higher than those before operation(P<0.05), and then decreased gradually;The levels of ALT, AST, TBIL and TBIL on the 14th day were significantly lower than those before operation(P<0.05). Compared with the non-operation group, the levels of ALT, AST, TBIL and IBIL in the operation group were significantly higher on the 3rd day(P<0.05) and were significantly lower on the 14th day(P<0.05). Conclusion: Splenectomy can improve the liver function of patients with hepatolenticular degeneration, its internal theoretical basis may be the ‘earth Counter-restriction wood’ in counter-restriction among five elements.