原发性干燥综合征并肝损害13例临床特征及中医证型分析

Clinical features and TCM syndrome types of 13 cases of primary Sj gren’s syndrome combined with liver damage

目的:分析原发性干燥综合征并肝损害临床特征及中医证型状况,为早期改善患者预后提供参考。方法:选择2018年9月至2022年1月广州中医药大学东莞医院风湿科诊治的原发性干燥综合征患者72例作为研究对象,调查、记录患者的电子病历系统,随访患者的预后,重点记录临床特征及中医证型。结果:72例患者中肝损害13例,占比18.1%,女性13例,临床上首发主要症状以口干、眼干为主。肝损害以GGT、ALP升高为主,ALT、AST升高不明显,13例患者均出现抗核抗体(ANA)阳性,中医分型判定为肝郁脾虚型6例、脾肾不足型4例、气阴两虚型2例、阴虚津亏型1例。13例患者经过中西医结合治疗后都顺利出院,2~3周后复查肝功能恢复至正常。结论:临床医师应对原发性干燥综合征肝损害、自身免疫性肝病的异同有充分认识,分析各种实验室检查结果,及早明确诊断、分析中医证型并给予相应治疗方案。

Objective:To explore the clinical features and TCM syndrome types of primary Sj gren’s syndrome combined with liver damage,aiming to provide reference for early improvement of patients’prognosis.Methods:Seventy-two cases of patients with primary Sj gren’s syndrome who were diagnosed and treated in the Department of Rheumatology,Dongguan Hospital,Guangdong University of Traditional Chinese Medicine from September 2018 to January 2022 were selected as the research subjects,and the electronic medical records of all patients were investigated and recorded.The prognosis of all patients were collected in follow-up,and clinical characteristics and TCM syndrome types of all patients were collected and recorded.Results:In the 72 patients,there were 13 patients(including 12 cases of female and 1 case of male)were diagnosed with liver damage,accounting for 18.1%.The main clinical symptoms were dry mouth and dry eyes.The liver damage was mainly characterized with increasing levels of GGT and ALP,but the levels of ALT and AST were not significantly increased.Antinuclear antibodies(ANA)were all positive in the 13 patients.According to the TCM classification,there were 6 cases of liver stagnation and spleen deficiency type,4 cases of kidney deficiency type,2 cases of Qi and Yin deficiency type,and 1 case of Yin and Jin(fluid)deficiency type.All 13 patients were successfully discharged after treating with integrated traditional Chinese and Western medicine,and their liver function returned to normal level in following reexamination after 2-3 weeks’treatment.Conclusion:Clinicians should clearly understand the similarities and differences between liver damage caused by primary Sj gren’s syndrome and autoimmune liver disease,and could correctly analyze various laboratory test results and make early diagnosis to perform TCM syndrome type analysis and make the appropriate treatment plan.