慢性丙肝不同肝纤维化程度中医证候相关分析

Correlation analysis of traditional Chinese medicine syndromes for different liver fibrosis in chronic hepatitis C

关键词:  慢性丙型肝炎  证候  肝硬度  相关分析

Key words:  chronic hepatitis C  syndrome of traditional Chinese medicine  liver stiffness  correlation analysis

摘要:

[目的]探讨不同肝纤维化程度的慢性丙型肝炎（CHC）患者中医证候表现及中医证素特点。[方法]对452例CHC患者进行中医证候调查，同时行瞬时弹性成像检测获取肝硬度值（LSM），评估患者肝纤维化程度。以LSM 7.3~14.6 kPa为界分成3组：LSM<7.3 kPa为无或轻微纤维化组；LSM 7.3~14.6 kPa为明显纤维化组；LSM>14.6 kPa为严重纤维化组，用SPSS 19.0进行统计学分析。计量资料组间比较采用t检验、χ²检验；计数资料组间比较采用秩和检验；中医症状、体征采取聚类分析法。[结果]纳入本研究患者390例，其中LSM<7.3 kPa 244例；LSM 7.3~14.6 kPa 75例；LSM>14.6 kPa 71例。LSM<7.3 kPa的CHC中医证候主要为肝郁脾虚；LSM 7.3~14.6 kPa的CHC中医证候除肝郁脾虚外，尚有血瘀肾虚；LSM>14.6 kPa的CHC中医证候主要为气虚血瘀、肝肾阴虚。[结论]CHC轻度肝纤维化中医证候以肝郁脾虚为主；显著肝纤维化者中医证候以气虚血瘀及肝肾阴虚为主。

Abstract:

[Objective] To explore the traits of syndrome and key factors of traditional Chinese medicine (TCM) in the patients with chronic hepatitis C(CHC)whose fibrosis were different.[Methods] The 452 patients who have been diagnosed clinically chronic hepatitis C have been done syndrome differentiation of TCM, at the same time the patients have been examined to LSM by transient elastography which have been evaluated the extent of liver fibrosis. All of patients have been divided into three groups by LSM 7.3-14.6Kpa. The three groups respectively were no or mild fibrosis group which LSM were inferior to 7.3 kPa, the significant fibrosis group which LSM were between 7.3~14.6Ka and the severe fibrosis group which LSM were equal or greater than 14.6 kPa. The t test or variance analysis has been exerted in comparison of measurement data. The Chi-square test has been applied comparison of enumeration data. The symptoms and signs were analyzed by clustering method.[Results] There were 390 patients of CHC who were brought into the study, including 244 patients whose liver stiffness measurements are inferior to 7.3 kPa. In addition, the LSM of 75 patients were among 7.3~14.6 kPa, the LSM of 71 patients were equal or greater than 14.6 kPa. The TCM syndrome elements which LSM was below 7.3 kPa in CHC were mainly liver stagnation spleen deficiency. The syndrome element which LSM were within the scope of 7.3~14.6 kPa were liver stagnation and spleen deficiency in addition to blood stasis and kidney asthenia. The syndrome element which LSM reaching or exceeding 14.6 kPa was principally qi deficiency blood stasis, hepatic and renal Yin deficiency.[Conclusion] The TCM syndrome key factors patients with CHC whose liver fibrosis were mild were mainly liver stagnation spleen deficiency. The TCM syndrome key factors patients with CHC whose liver fibrosis were advanced were characterized by qi deficiency, blood stasis, hepatic and renal Yin deficiency.