肝炎肝硬化患者促肾上腺皮质激素、糖皮质激素水平与中医证候要素的相关性探讨

目的比较代偿期与失代偿期肝炎肝硬化患者血清促肾上腺皮质激素(Adrenocorticotropic hormone,ACTH)、糖皮质激素(Glucocorticoid,GC)的水平,探讨其与中医常见病性类证候要素的相关性。方法研究制定《肝炎肝硬化临床信息采集表》,进行全国多中心的横断面流行病学调查,收集患者的一般情况、症状等信息,采集血液标本并统一检测指标;参照以往制定和发布的肝硬化诊疗共识和原则,结合文献回顾和临床调查结果,并经过专家两轮论证,形成《肝炎肝硬化常见证候要素辨识标准》,根据该标准,判定患者的常见病性类证候要素;分别分析代偿期与失代偿期患者间血清ACTH、GC水平的差异,以及代偿期和失代偿期血瘀、阴虚、湿热、气滞、气虚、阳虚、水停诸病性类证候要素的判定组与非判定组患者间ACTH、GC水平的差异。结果与代偿期比较,失代偿期患者的ACTH和GC水平均升高,其中GC差异有统计学意义(P0.05);在代偿期患者中,只有阳虚判定组患者的ACTH水平显著低于非判定组(P0.05);在失代偿期患者中,只有血瘀判定组患者的ACTH水平显著高于非判定组(P0.05);诸证候要素(除水停)判定组患者的GC水平显著高于非判定组(P0.05)。结论肝炎肝硬化患者的血清ACTH与GC水平反映了疾病的轻重,且初步提示与中医常见病性类证侯要素之间有一定相关性。

ACTH and GC levels in patients with hepatitis cirrhosis at two stages and their correlation with TCM pattern elements

Objective To compare the levels of serum adrencortical hormone ( Adrenocorticotropic hormone, ACTH) , and glucocorticoid ( Glucocorticoid, GC ) between patients of hepatitis cirrhosis at compensated and decompensated stages, and to evaluate their correlation with common TCM pattern elements.Methods Using a unified “hepatitis cirrhosis clinical information collection list”, which is formulated by this team, we conducted a national multi-center cross-sectional epidemiological survey, to collect the general condition of patients, their symptoms and other information.We also collected their blood samples for standardized laboratory tests. Previously published consensus and guidelines on diagnosis and treatment of hepatic cirrhosis were reviewed.With reference to literature review of clinical investigation, and finally we came up with a“common pattern element identification standard for hepatitis cirrhosis” after two rounds of expert consensus verification process.According to this standard, we can analyze the pattern elements and compare the differences between serum ACTH and GC levels during compensated and decompensated stages, as well as those between the pattern elements of blood stasis, yin deficiency, damp heat, qi stagnation, Qi deficiency, Yang deficiency, and water retention.Results Compared with patients at compensated stage, ACTH and GC levels in patients at decompensated stage were elevated, with significant difference in GC levels (P<0.05).In patients at decompensated stage, levels of ACTH in patients with Yang deficiency group was significantly lower than those in groups without it (P<0.05);In patients with blood stasis at decompensated stage, the level of ACTH was significantly higher than those in groups without it ( P<0.05) , but GC was higher than that of the other groups ( P<0.05) in terms of pattern elements ( except water retention).Conclusion ACTH and GC levels in patients with hepatitis cirrhosis could reflect the severity of disease, and may suggest a certain correlation with TCM pattern elements of class of common diseases.