青海地区慢乙肝中医体质类型与中医证候分布的临床特征分析

Clinical Characteristics Analysis of T.C.M Constitution Type and T.C.M Syndrome Distribution of Chronic Hepatitis B in Qinghai Province

目的:探究青海地区慢乙肝(CHB)患者中医体质类型与中医证候分布的临床特征,为临床诊疗提供理论依据。方法:根据青海省中医院肝病科优势病种诊疗方案,选取2021年10月至2022年12月于我院门诊及住院治疗的352例慢乙肝患者,由至少2位副主任医师确定患者的中医体质类型及中医证候,采用皮尔逊卡方检验及列联系数或Fisher确切概率法分析不同中医体质类型与中医证候分布及相关因素之间的关联性。结果:352例慢乙肝患者中医体质以气虚质为主,占29.26%,其中在142例单纯慢性乙型肝炎患者中出现频率较高的中医体质类型依次为气虚质(27.46%)、平和质(23.24%)、气郁质(20.42%);在65例乙型肝炎肝硬化代偿期患者中出现频率较高的中医体质类型依次为气虚质(36.92%)、气郁质(23.08%)、湿热质(16.92%);在145例乙型肝炎肝硬化失代偿期患者中出现频率较高的中医体质类型依次为气虚质(27.59%)、痰湿质(18.62%)、湿热质(13.79%)。中医证候以肝郁脾虚证为主,主要见于气虚质。中医体质类型与中医证候分布及性别、年龄、民族、家族史、CHB疾病诊断类型有关(P<0.01),与病程无关(P>0.05)。中医证候类型分布与CHB疾病诊断类型存在关联性,P=0.000(P<0.01),且列联系数为0.552。结论:青海地区慢乙肝患者中医体质类型以偏颇体质为常见,主要为气虚质,男性多于女性,中医证候主要为肝郁脾虚证,中医体质类型与中医证候分布之间存在相关性。

Objective To explore the clinical characteristics of TCM physique type and TCM syndrome distribution of patients with chronic hepatitis B(CHB)in Qinghai,and provide theoretical basis for clinical diagnosis and treatment.Methods According to the diagnosis and treatment scheme of dominant diseases in the hepatology department of Qinghai Provincial Hospital of TCM,352 patients with chronic hepatitis B who were treated in our hospital from October 2021 to December 2022 were selected.At least two deputy chief physicians determined the patients TCM constitution types and TCM syndromes.Pearson Chi square test and contingency coefficient or Fisher exact probability method were used to analyze the correlation between different TCM constitution types and TCM syndrome distribution and related factors.Results The TCM constitution of 352 patients with chronic hepatitis B was dominated by qi deficiency,accounting for 29.26%.Among 142 patients with chronic hepatitis B,the TCM constitution types with higher frequency were qi deficiency,peace and qi stagnation,accounting for 27.46%,23.24%,and 20.42%respectively;Among 65 patients with compensatory phase of hepatitis B cirrhosis,the most frequently occurring types of TCM constitution were Qi deficiency constitution,Qi depression constitution,and damp heat constitution,accounting for 36.92%,23.08%,and 16.92%,respectively;Among 145 patients with decompensated hepatitis B cirrhosis,the most frequently occurring TCM constitution types were Qi deficiency constitution,phlegm dampness constitution,and damp heat constitution,accounting for 27.59%,18.62%,and 13.79%,respectively.The TCM syndrome is mainly characterized by liver depression and spleen deficiency,mainly seen in qi deficiency.The type of TCM constitution is related to the distribution of TCM syndromes,as well as gender,age,ethnicity,family history,and diagnostic type of CHB disease(P<0.01),but not to the course of the disease(P>0.05).There is a correlation between the distribution of TCM syndrome types and the diagnostic types of CHB disease,with P=0.000(P<0.01)and a correlation number of 0.552.Conclusion Bias constitution is the common constitution type of chronic hepatitis B patients in Qinghai,mainly qi deficiency,with more men than women.The TCM syndrome is mainly liver stagnation and spleen deficiency.There is a correlation between TCM constitution type and TCM syndrome distribution.