基于精神医学量表评估肝硬化患者的心理状态及其与中医证候的关系

目的:分析不同中医证候肝硬化患者精神心理状态的差异,探讨肝硬化患者不同精神心理状态与中医证候之间的关系,为临床心理干预提供依据。方法:采用他评量表的方式,对符合研究要求的肝硬化患者填写汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)和匹兹堡睡眠质量指数(PSQI),并计算评分,进行精神心理状态的评估;同时采集患者的中医四诊信息并进行辨证分型(分为肝气郁结、脾虚湿盛、湿热蕴结、肝肾阴虚、脾肾阳虚、瘀血阻络6个证型),比较不同中医证候肝硬化患者的精神心理状态差异。结果:共有208例肝硬化患者纳入研究。结果显示,各证型HAMA评分依次为肝气郁结湿热蕴结肝肾阴虚瘀血阻络脾虚湿盛脾肾阳虚,肝气郁结型最高,与脾虚湿盛、肝肾阴虚、脾肾阳虚、瘀血阻络相比,差异均有统计学意义(P0.05);HAMD评分依次为肝气郁结湿热蕴结肝肾阴虚瘀血阻络脾虚湿盛脾肾阳虚,肝气郁结型最高,与其他5型相比差异均具有统计学意义(P0.05);PSQI评分依次为:肝气郁结肝肾阴虚脾肾阳虚湿热蕴结瘀血阻络脾虚湿盛,肝气郁结型最高,与湿热蕴结型、脾虚湿盛型相比差异有统计学意义(P0.05)。肝硬化Child-Pugh C级患者的HAMA、HAMD、PSQI评分均高于Child-Pugh A级患者(P0.05,P0.01)。结论:肝硬化患者的焦虑、抑郁、睡眠障碍与中医肝气郁结的病机关系密切,且随着肝硬化程度的加重而加重。

Evaluation on Mental State of Patients with Liver Cirrhosis and Its Relationship with TCM Syndromes Based on Psychiatric Scale

  Objective:To analyze the differences on mental state of liver cirrhosis patients with different TCM syndromes,explore the relationship between different mental state and TCM syndromes, and provide evidence for clinical psychological intervention.   Methods: By others-rating scale,the patients with liver cirrhosis who met the research requirements were required to fill in the Hamilton anxiety scale (HAMA),Hamilton depression scale (HAMD) and Pittsburgh sleep quality index (PSQI),the scores were calculated to assess the psychological and mental state. Meanwhile,the TCM four diagnostic information of patients were collected and conducted the syndrome differentiation and classification(which classified into 6 patterns including liver qi stagnation,intense dampness due to spleen deficiency,accumulated dampness-heat,yin deficiency of liver and kidney,yang deficiency of spleen and kidney and static blood blocking collaterals),and the differences on psychological and mental state of liver cirrhosis patients with different TCM syndromes were compared.   Results: A total of 208 patients with liver cirrhosis were included in this study. The results showed that,the HAMA score of different syndrome patterns from high to low in turn followed as liver qi stagnation,accumulated dampness-heat,yin deficiency of liver and kidney,static blood blocking collaterals,intense dampness due to spleen deficiency and yang deficiency of spleen and kidney. The HAMA score of syndrome of liver qi stagnation was the highest,compared with the syndrome of intense dampness due to spleen deficiency,yin deficiency of liver and kidney,yang deficiency of spleen and kidney and static blood blocking collaterals,the difference on the HAMA score was statistically significant(P<0.05).The HAMD score of different syndrome patterns from high to low in turn followed as liver qi stagnation,accumulated dampness-heat,yin deficiency of liver and kidney,static blood blocking collaterals,intense dampness due to spleen deficiency and yang deficiency of spleen and kidney. The HAMD score of syndrome of liver qi stagnation was the highest,and there was statistically significant difference on the HAMD score between the syndrome of liver qi stagnation and the other 5 patterns(P<0.05).The PSQI score of different syndrome patterns from high to low in turn followed as liver qi stagnation,yin deficiency of liver and kidney,yang deficiency of spleen and kidney,accumulated dampness-heat,static blood blocking collaterals and intense dampness due to spleen deficiency. The PSQI score of syndrome of liver qi stagnation was the highest,compared with the syndrome of accumulated dampness-heat and intense dampness due to spleen deficiency,the difference on the PSQI score was statistically significant(P<0.05).The scores of HAMA, HAMD and PSQI in patients with Child-Pugh C were all higher than those in patients with Child-Pugh A (P<0.05, P<0.01).   Conclusion: The symptoms of anxiety, depression and sleep disorders in patients with liver cirrhosis are closely related to the pathogenesis of liver qi stagnation,and these symptoms would worsen with the aggravation of liver cirrhosis.