基于队列研究及双层频权剪叉算法的乙肝肝硬化/肝细胞癌肝郁脾虚证特征证候和客观指标相关性研究

Correlation Study of Characteristic Symptoms and Objective Indicators of Hepatitis B Liver Cirrhosis and Liver Cancer with Liver Depression and Spleen Deficiency Syndrome Based on Cohort Study and Double-Layer Frequency-weighted Scissors Algorithm

目的探索乙肝肝硬化代偿期、失代偿期及肝细胞癌患者肝郁脾虚证的特征证候和客观指标相关性,为临床相关辨证论治提供参考。方法选取2013年1月-2020年12月来自不同地区医院的乙肝肝硬化/肝细胞癌患者1263例,采用双层频权剪叉算法构建乙肝肝硬化/肝细胞癌肝郁脾虚证辨证标准,在此基础上以肝郁脾虚证为因变量,采用Logistic回归分析计算特征证候及相关实验室指标。结果饮酒史患者更偏向肝郁脾虚证(P<0.05);乙肝肝硬化代偿期、失代偿期及肝细胞癌肝郁脾虚证共有特征证候为烦躁易怒、脘闷善太息、口干,疾病后期脾虚证愈发明显。乙肝肝硬化不同阶段丙氨酸氨基转移酶、血红蛋白、红细胞、活化部分凝血活酶时间、D-二聚体等生化指标差异无统计学意义(P>0.05),但有进展为肝细胞癌的可能;代偿期患者甲胎蛋白水平升高(P<0.05),进展为肝细胞癌的概率增大。结论将队列研究、双层频权剪叉算法运用到乙肝肝硬化/肝细胞癌中医辨证中,可提高辨证准确率、指导用药及积极判断预后。

Objective To explore the correlation between the characteristic symptoms and objective indicators of hepatitis B liver cirrhosis in the compensatory phase,decompensated phase,and liver cancer with liver stagnation and spleen deficiency syndrome.To provide reference for clinical syndrome differentiation and treatment.Methods Totally 1263 patients with hepatitis B cirrhosis and liver cancer from different regional hospitals from January 2013 to December 2020 were selected,and the double-layer frequency-weighted scissor algorithm was used to construct the syndrome differentiation standard of liver depression and spleen deficiency syndrome of hepatitis B liver cirrhosis and liver cancer.On this basis,the syndrome of liver depression and spleen deficiency was adopted as the dependent variable,and Logistic regression analysis was used to calculate the characteristic symptoms and related laboratory indicators.Results Patients with drinking history preferred liver depression and spleen deficiency syndrome(P<0.05).The common characteristic symptoms of hepatitis B liver cirrhosis in the compensatory phase,decompensated phase,and liver cancer with liver stagnation and spleen deficiency syndrome were irritability,nausea,dry mouth,and the syndrome of spleen deficiency became more obvious in the later stage of the disease.There was no statistical significance in ALT,HGB,RBC,APTT,DD and other biochemical indicators in different stages of hepatitis B liver cirrhosis(P>0.05),but there was the possibility of progression to hepatocellular carcinoma;AFP increased in compensated patients(P<0.05),and the probability of progression to hepatocellular carcinoma increased.Conclusion The application of cohort study and double-layer frequency weighted scissor algorithm to TCM syndrome differentiation of hepatitis B cirrhosis/hepatocellular carcinoma can improve the accuracy of syndrome differentiation,guide medication and positively judge prognosis.