肝硬化证型与生物学指标相关性研究

目的:为探讨慢性乙型肝炎后肝硬化中医辨证分型与生物学指标的相关性,为肝炎后肝硬化辨证分型的客观化、标准化研究提供一定依据。方法:对符合纳入标准的170例乙肝后肝硬化患者进行系统性调查,填表收集一般情况、病史、四诊信息进行辨证分型,同步检测肝功能(ALT、AST、AKP、GGT、Alb、PA、STB、CB、BA)、HA、PT、血脂(CHO、TG、HDL、LDL、Apo-A1)等现代医学检测指标等,建立信息数据库,了解该病种的证型分布特征。运用单因素方差分析统计方法,研究中医辨证分型与生物学指标的相关性。结果:证型分布以湿热蕴结证及肝肾阴虚证最为多见。AST在湿热蕴结组与脾肾阳虚组中较高,脾虚痰湿组中较低,且湿热蕴结组与脾虚痰湿组比较有显著性差异(P<0.05)。Alb均值,肝气郁结证>肝肾阴虚证>瘀血内阻证>湿热蕴结证>脾虚痰湿证>脾肾阳虚证(P<0.01),其中肝气郁结证、肝肾阴虚证、湿热蕴结证、瘀血内阻证与脾肾阳虚证相比,其差异有显著性(P<0.01)。PT均值,脾肾阳虚证>瘀血内阻证>脾虚痰湿证>肝气郁结证>肝肾阴虚证>湿热蕴结证(P<0.05),其中肝气郁结证、肝肾阴虚证与脾肾阳虚证相比,肝肾阴虚证与湿热蕴结证相比,有显著性差异(P<0.05)。STB、CB均值,脾肾阳虚证>湿热蕴结证>脾虚痰湿证>瘀血内阻证>肝肾阴虚证>肝气郁结证(P<0.01),其中肝气郁结证、肝肾阴虚证、脾虚痰湿证、瘀血内阻证与脾肾阳虚证相比,肝气郁结证、肝肾阴虚证、瘀血内阻证与湿热蕴结证相比,有显著性差异(P<0.05)。CB在肝气郁结证、肝肾阴虚证、瘀血内阻证与脾肾阳虚证相比,湿热蕴结证与肝气郁结证相比,其差异有显著性意义(P<0.05)。BA均值,湿热蕴结证>脾肾阳虚证>瘀血内阻证>脾虚痰湿证>肝肾阴虚证>肝气郁结证(P<0.05),两两比较中肝气郁结证、肝肾阴虚证、脾虚痰湿证、瘀血内阻证与湿热蕴结证相比,有显著性差异(P<0.05)。结论:脾肾阳虚证、脾虚痰湿证患者肝脏合成功能较差,Alb、PT可作为肝炎后肝硬化中医辨证分型的客观参考指标;胆汁酸可作为反映肝炎后肝硬化中医湿热蕴结证病机病理的一个客观指标;脾肾阳虚证与湿热蕴结证患者存在明显的胆红素代谢障碍。对处于肝炎后肝硬化疾病中期的患者,辨证分型与肝酶检测指标相结合有助于指导临床用药及判断预后;以虚证为主的肝肾阴虚证较以实证为主的湿热蕴结证其凝血功能相对较差,反映了其正虚的本质。

Study on the Relevance between Cirrhosis Syndrome Types of TCM and Biological Detection Indexes

Objective:Chromic hepatitis B liver cirrhosis differentiation of symptoms and signs for classification of syndrome and relevance of biological indicators were studied,so as to provide some reference for liver cirrhosis differentiation of symptoms and signs for classification of syndrome.Methods:170 liver cirrhosis patients chosen by adoption standards were investigated systematically.General states of health,case history,general state of health were collected for syndrome differentiation.Liver function(ALT,AST,AKP,GGT,Alb,PA,STB,CB,BA),HA,PT,lipid(CHO,TG,HDL,LDL,Apo-A1),and other indicators of modern medicine were detected simultaneously.Information database was established to understand the distribution characteristics of the disease.One-factor ANOVA was applied to investigate the relevance between the differentiation of symptoms and signs for classification of syndrome and objective index.Results:Endoretention of damp-heat and hepatic and renal yin deficiency are most common in syndrome types of TCM distribution.For endoretention of damp-heat and asdthenic splenonephro-yang,AST is higher.While for splenic asthenia phlegmatic hygrosis,AST is very low.The difference between endoretention of damp-heat and splenic asthenia phlegmatic hygrosis is significant(P<0.05).For mean of the Alb,stagnation of liver-QI > hepatic and renal yin deficiency> blood stasis resistance> endoretention of damp-heat> splenic asthenia phlegmatic hygrosis> asdthenic splenonephro-yang(P<0.01).For PT,Asdthenic splenonephro-yang> blood stasis resistance> splenic asthenia phlegmatic hygrosis> stagnation of liver-QI> hepatic and renal yin deficiency> endoretention of damp heat(P<0.05),in which,stagnation of liver-QI has significant difference with hepatic and renal yin deficiency and asdthenic splenonephro-yang,while hepatic and renal yin deficiency has significant difference with endoretention of damp-heat(P<0.05).For STB and CB,asdthenic splenonephro-yang> endoretention of damp heat> splenic asthenia phlegmatic hygrosis> blood stasis resistance> hepatic and renal yin deficiency> stagnation of liver-QI(P<0.01).Among them,stagnation of liver-QI,hepatic and renal yin deficiency and blood stasis resistance have significant difference with asdthenic splenonephro-yang,while endoretention of damp heat and stagnation of liver-QI have significant difference.For BA,endoretention of damp-heat> asdthenic splenonephro-yang >blood stasis resistance> splenic asthenia phlegmatic hygrosis> hepatic and renal yin deficiency> depression of liver-QI.Stagnation of liver-QI,hepatic and renal yin deficiency,splenic asthenia phlegmatic hygrosis,blood stasis resistance and endoretention of damp heat have significant difference(P<0.05).Conclusion:The asdthenic splenonephro-yang and splenic asthenia phlegmatic hygrosis patients have poor liver synthetic function.Alb and PT can be used as objective reference of differentiation of symptoms and signs for classification of syndrome.Bile acids can reflect posthepatitic cirrhosis endoretention of damp-heat as an objective index.Asdthenic splenonephro-yang and endoretention of damp-heat patients have obvious barriers in bilirubin dysbolism.For the posthepatitic cirrhosis patients in posthepatitic cirrhosis,the combination of differentiation of symptoms and signs for classification of syndrome and liver enzyme detect index could also guide clinical medication and judge prognosis.Hepatic and renal yin deficiency patients have weaker blood clotting function than endoretention of damp-heat patients,which shows the essence of asthenia of healthy energy.