自身免疫性肝炎中医证型与临床特点的多中心回顾性研究

TCM syndromes and clinical characteristics of autoimmune hepatitis:A multicenter retrospective study

目的探讨自身免疫性肝炎中医证型分布情况及不同证型患者的临床表现和生化指标的特点。方法收集2016年6月-2022年12月河南中医药大学第一附属医院、河南省中医院、河南中医药大学第三附属医院收治的212例自身免疫性肝炎患者的病历资料,分析患者中医证型分布情况及不同证型患者症状、体征、肝功能、免疫球蛋白水平的差异。结果212例自身免疫性肝炎患者中,肝郁脾虚证101例占47.64%,肝肾阴虚证50例占23.58%,湿热中阻证44例占20.75%,瘀血阻络证17例占8.02%,肝郁脾虚证最常见。临床表现以乏力、肝区不适和纳差更常见;肝郁脾虚证患者出现肝区不适的比例明显高于肝肾阴虚证和湿热中阻证患者(P均<0.05);肝肾阴虚证和湿热中阻证患者出现腹胀的比例明显高于肝郁脾虚证患者(P均<0.05);湿热中阻证患者出现皮肤、黏膜黄染的比例明显高于肝郁脾虚证、肝肾阴虚证和瘀血阻络证患者(P均<0.05);湿热中阻证和瘀血阻络证患者的谷丙转氨酶(ALT)水平明显高于肝肾阴虚证患者(P均<0.05);湿热中阻证患者的总胆红素(TBil)、直接胆红素(DBil)水平明显高于肝肾阴虚证患者(P均<0.05);湿热中阻证患者的总胆汁酸(TBA)水平明显高于肝郁脾虚证患者(P<0.05);瘀血阻络证患者总蛋白(TP)水平明显低于肝郁脾虚证患者(P<0.05);湿热中阻证患者的IgG水平明显高于肝肾阴虚证和肝郁脾虚证患者(P均<0.05);肝郁脾虚证和瘀血阻络证患者IgG水平明显高于肝肾阴虚证患者(P均<0.05);所有证型患者IgM、IgE和IgA水平均在正常范围内;各组谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、间接胆红素(IBil)、白蛋白(ALB)、球蛋白(GLB)水平比较差异均无统计学意义(P均>0.05)。结论不同中医证型的自身免疫性肝炎患者临床表现及生化指标有其各自的特点,临床诊疗时可作参考。

Objective It is to explore the distribution of Chinese medicine syndrome of autoimmune hepatitis and the characteristics of clinical manifestations and biochemical indexes of patients with different syndromes.Methods The medical records of 212 autoimmune hepatitis patients treated in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Henan Provincial Hospital of Traditional Chinese Medicine,and the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine from June 2016 to December 2022 were collected,to analyze the distribution of Chinese medicine syndrome and the differences in symptoms,signs,liver function indicators and immune gloulin among different syndromes.Results Among 212 patients with autoimmune hepatitis,there were 101 cases of liver depression and spleen deficiency syndrome accounted for 47.64%,50 cases of liver kidney yin deficiency syndrome accounted for 23.58%,44 cases of dampness heat middle obstruction syndrome accounted for 20.75%,17 cases of blood stasis obstructing the collaterals syndrome accounted for 8.02%,and liver depression and spleen deficiency syndrome were the most common.The clinical manifestations were more common in fatigue,liver discomfort and poor appetite;the proportion of liver discomfort was significantly higher in the patients with syndrome of liver depression and spleen deficiency than those with syndrome of liver kidney yin deficiency and dampness heat middle obstruction(all P<0.05);the proportion of abdominal distension was significantly higher in the patients with syndrome of liver kidney yin deficiency and dampness heat middle obstruction than those with syndrome of liver depression and spleen deficiency(all P<0.05);the proportion of yellow coloration of the skin and mucous membranes was higher in the patients with dampness heat middle obstruction syndrome than those with liver depression and spleen-deficiency syndrome,liver kidney yin deficiency syndrome and blood stasis obstructing the collaterals syndrome(all P<0.05);the levels of ALT of patients with dampness heat middle obstruction syndrome and blood stasis obstructing the collaterals were significantly higher than those with liver kidney yin deficiency syndrome(all P<0.05);the levels of TBil and DBil of patients with dampness heat middle obstruction syndrome were significantly higher than those with liver kidney yin deficiency syndrome(P<0.05);the levels of TBA of patients with dampness heat middle obstruction syndrome were significantly higher than those with liver depression and spleen deficiency syndrome(P<0.05);the levels of TP of patients with blood stasis obstructing the collaterals syndrome were significantly lower than those with liver depression and spleen deficiency(P<0.05);the levels of IgG patients with dampness heat middle obstruction syndrome were significantly higher than those with liver depression and spleen deficiency syndrome and liver kidney yin deficiency syndrome(P<0.05);the levels of IgG of patients with liver depression and spleen deficiency syndrome and blood stasis obstructing the collaterals syndrome were higher than those with liver kidney yin deficiency syndrome(P<0.05);the levels of IgM,IgE,and IgA of all patients were within the normal range;there were no significant differences in AST,GGT,ALP,IBil,ALB and GLB among every group(all P>0.05).Conclusion The clinical manifestations and biochemical indexes of patients with different traditional Chinese medical syndrome have their own characteristics,which can be used for reference in clinical diagnosis and treatment.