108例肝炎肝硬化患者瞬时弹性成像检测值变化规律及与病性类证候要素的相关性

Change Rules of FibroScan Detection Value and Its Correlation with Traditional Chinese Medicine Syndrome Elements in 108 Patients with Hepatitis Cirrhosis

目的分析肝炎肝硬化患者瞬时弹性成像(FibroScan,简称FS值)在不同疾病分期、分级中的变化规律及其与病性类证候要素的相关性。方法纳入肝炎肝硬化患者108例,其中代偿期69例,失代偿期39例。制定证候要素辨识标准,判定每位患者的病性类证候要素;同时采集患者信息,对患者进行ChildPugh评分,并根据评分进行分级,以及终末期肝病模型(MELD)评分,检测FS值。比较不同分期及不同Child-Pugh分级患者的FS值,并分析患者FS值与病性类证候要素的相关性。结果代偿期患者FS值明显低于失代偿期患者(P <0. 01);患者FS值与Child-Pugh得分、Child-Pugh分级及MELD评分之间呈正相关(P <0. 01)。代偿期患者常见证候要素为阴虚(45例)、气滞(43例)、阳虚(39例);失代偿期常见证候要素为水停(34例)、阴虚(30例)、血瘀(29例),其中血瘀、阳虚、气虚、水停分布两期比较差异有统计学意义(P <0. 05)。代偿期患者血瘀、阴虚、湿热、阳虚、水停患者FS值均高于未出现相应证素者;气滞患者FS值低于未出现者(P <0. 05)。失代偿期患者中气滞患者FS值低于未出现者,血瘀、阴虚、湿热、气虚、阳虚、水停患者FS值均高于未出现相应证素者,其中是否出现血瘀、水停、阳虚比较差异有统计学意义(P <0. 05)。结论肝炎肝硬化患者FS检测值随着病情的加重而呈上升趋势;中医证候要素与患者FS检测值有一定相关性,出现血瘀、水停、阳虚时病情较重。

Objective To analyze the change rules of FibroScan detection value( FS value) of patients with hepatitis cirrhosis in different disease stages and levels,and its correlation with traditional Chinese medicine( TCM) disease syndrome elements. Methods A total of 108 patients with hepatitis cirrhosis were included,of which 69 were compensated and 39 were decompensated. The syndrome identification criteria were developed,and the disease syndrome elements of each patient were determined. The patient information was collected,and Child-Pugh scores on patients were performed. Then grade according to scores,and model for end-stage liver disease( MELD) scores were evaluated. FS value was detected. The FS values of patients with different stages and different Child-Pugh grades were compared,and the correlation between FS values and disease syndrome elements were analyzed. Results FS value in patients with compensated liver cirrhosis was significantly lower than that in patients with decompensation( P <0. 01). There was a positive correlation between FS value and Child-Pugh score,Child-Pugh grade as well as MELD score( P < 0. 01). The distribution of common syndrome elements in compensatory hepatitis cirrhosis patients was as follows: yin deficiency( 45 cases),qi stagnation( 43 cases),and yang deficiency( 39 cases). The distribution of common syndromes in patients with liver cirrhosis in decompensated stage was as follows: water retention( 34 cases),yin deficiency( 30 cases),and blood stasis( 29 cases). The distribution frequency of blood stasis,yang deficiency,qi deficiency and water retention was significantly different between the two groups( P < 0. 05). In the patients with liver cirrhosis at compensatory stage,the FS values of the patients with blood stasis,yin deficiency,damp-heat,yang deficiency and water retention were higher than those of non-appearance patients without above syndromes. The FS value of patients with qi stagnation was lower than that of patients without qi stagnation( P < 0. 05). In the decompensated patients,the FS value of patients with qi stagnation syndrome was lower than that of patients without qi stagnation. The FS values of patients with blood stasis,yin deficiency,damp-heat,qi deficiency,yang deficiency,and water retention were higher than those of patients without above syndromes. Among them,the comparison of whether or not blood stasis,water retention,and yang deficiency were statistically significant( P < 0. 05). Conclusion The FS detection value of patients with hepatitis and cirrhosis increase with the aggravation of the disease. There is a certain correlation between TCM syndrome elements and the FS detection value of the patients with liver cirrhosis. The patients with blood stasis,water retention,yang deficiency syndrome are more serious.