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肝炎后肝硬化中医证候特点的临床调查研究
引用本文:张琴,刘平,陈慧芬,陈良,曹素华,刘莺,魏建军,方志红,吴定中.肝炎后肝硬化中医证候特点的临床调查研究[J].中西医结合学报,2003,1(2):108-112.
作者姓名:张琴  刘平  陈慧芬  陈良  曹素华  刘莺  魏建军  方志红  吴定中
作者单位:1. 上海市传染病医院中西医结合科,上海,200083
2. 上海中医药大学肝病研究所,上海,200032
3. 复旦大学上海医学院卫生统计教研室,上海,200030
摘    要:目的探讨肝炎后肝硬化中医证候特点。方法临床系统采集223例肝炎后肝硬化患者中医四诊信息和相关实验室指标,运用SAS6.1l软件进行系统聚类、主成分分析、逐步判别和方差分析等多元统计。结果多元分析提示3类证候特点:第1类为湿热内蕴、血瘀阻络、肝脾气虚的134例;第2类为气阴两虚,气虚重于阴虚,湿热内蕴,湿重于热,兼有血瘀的62例;第3类为气阴两虚,阴虚重于气虚、瘀热内蕴,兼有湿邪内停的27例。分析相关实验室指标在3类证候间的变化显示,邪实为主、兼有正虚的的第1类,其血天冬氨酸转移酶(AST)、丙氨酸转移酶(ALT)、γ-谷氨酰转移酶(GGT)活性显著高于正虚为主、兼有邪实的其它两类;阴虚为重的第3类,其血纤维结合蛋白(FN)、血浆凝血因子V(FV)、血浆凝血因子Ⅶ(FⅦ)、自蛋白(Alb)、血小板计数(PLT)、血小板压积(PCT)值均显著低于气虚重于阴虚的第2类及邪实为主的第1类。结论多元统计方法在较大程度上能体现出肝炎后肝硬化中医证候的特点及规律性,3类中医证候特点基本符合临床。证候分类与实验室指标结果提示,肝组织炎症是湿热内蕴的病理基础,肝功能障碍、肝实质损害程度是肝炎后肝硬化肝肾阴虚的病理学基础。

关 键 词:肝炎后肝硬化  中医证候  临床调查  中医药疗法
文章编号:1672-1977(2003)02-0108-05
修稿时间:2003年5月12日

Clinical investigation on characteristics of traditional Chinese medical syndrome of hepatocirrhosis
ZHANG Qin ,LIU Ping ,CHENG Hui-Fen ,CHEN Liang ,C AO Su-Hua ,lIU Ying ,WEI Jian-Jun ,FANG Zhi-Hong ,WU Ding-Zhong.Clinical investigation on characteristics of traditional Chinese medical syndrome of hepatocirrhosis[J].Journal of Chinese Integrative Medicine,2003,1(2):108-112.
Authors:ZHANG Qin  LIU Ping  CHENG Hui-Fen  CHEN Liang  C AO Su-Hua  lIU Ying  WEI Jian-Jun  FANG Zhi-Hong  WU Ding-Zhong
Institution:Department of Integrated Traditional Chinese and Western Medicine, Shanghai Municipal Infectious Disease Hospital, Shanghai 200083, China. zhangq1030@163.com
Abstract:OBJECTIVE: To explore the characteristics of traditional Chinese medical syndrome (TCM syndrome) of hepatocirrhosis. METHODS: Clinical information from the four diagnosis methods of traditional Chinese medicine (TCM) and related laboratorial indexes were systematically collected from 223 hepatocirrhosis cases, and the multi-statistical methods including systematic cluster analysis, principal component analysis, stepwise discrimination and variance analysis were made with the software SAS 6.11. RESULTS: Multi-analysis showed that there were 3 categories of syndrome characteristics. Type 1 (134 cases): damp heat, blood stasis, deficiency of liver and spleen Qi; Type 2 (62 cases): deficiency of both Qi and Yin with severe deficiency of Qi, heat with severe dampness, blood stasis; Type 3 (27 cases): deficiency of both Qi and Yin with severe deficiency of Yin, stasis and heat or dampness. Analysis of the changes of the related laboratorial indexes among the three types of syndrome showed that Type 1 mainly manifested asthenia syndrome with sthenia syndrome, and its indexes of AST, ALT, GGT levels were markedly higher than those of Type 2 and Type 3, both of which mainly showed sthenia syndrome with asthenia syndrome, and that Type 3 was in active inflammation, deficiency of both Qi and Yin (deficiency of Yin > deficiency of Qi), and its FN, Alb, FV, FVII, PLT, PCT levels were obviously reduced. CONCLUSION: The multi-statistical methods can reveal the characteristics and regularity of TCM syndrome of hepatocirrhosis, and the 3 categories of syndrome characteristics basically conform to clinical manifestations. The result of TCM syndrome distribution and laboratorial indexes infer that damp heat is the pathological basis of hepatocirrhosis, and the degree of liver function disorder and liver damage may be the pathological basis of deficiency of Yin of both liver and kidney.
Keywords:hepatocirrhosis  traditional Chinese medi cal syndrome  multi-analysis
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