肝硬化的形态学变化及其与中医证候要素关系的探讨  

Exploration for the relationship between morphologic changes and elements of TCM pattern in the patients with liver cirrhosis diagnosed with morphologic diagnosis

作　　者：王岭[1] 张均倡[1] 张朴[2] 蒋晓松[1] 李春涛[1] 李野平[1] 

机构地区：[1]广东省中医院珠海医院消化内科,广东珠海519015 [2]广东省珠海市妇幼保健院

出　　处：《中西医结合肝病杂志》2006年第1期4-7,共4页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：广东省自然科学基金资助(No.05010894)

摘　　要：目的:以肝硬化形态学病理诊断的金标准为基础,对其确诊的肝硬化患者,进行形态学改变与中医证候关系的探讨,为中医证候的研究及辨证施治提供依据。方法:通过腹腔镜或开腹手术的方法,直接对肝脏进行肝硬化形态学诊断(小结节型、大结节型、大小结节混合型、橘皮样变);同时收集临床资料进行中医证候诊断(主证、证候要素)。结果:本组腹腔镜确诊的肝硬化患者中,①临床诊断符合率为45.16%;②中医主证中肝气郁结占19.35%(主要见于小结节型)、脾虚湿盛占12.90%、湿热内蕴占32.26%(可见于各型)、肝肾阴虚占9.68%、脾肾阳虚为0、血瘀证占25.81%(主要见于大结节型);③中医证候要素中,郁、瘀各型中均多见,湿、热稍少,但也可见于各型中,虚证主要出现于久病者(尤其是阳虚、阴虚),更相对集中于大结节型、大小结节混合型。结论:①橘皮样变、小结节型的早期肝硬化患者临床诊断漏诊率较高;②“瘀”提示病情可能已进入肝硬化的阶段(开始有形态学改变);“郁”可能与疾病本身的心理负担有关,也可能是肝硬化病理状态的反映;“湿”、“热”与疾病的活动、进展有关;“虚证”表明疾病已久;③治疗上应注重疏肝健脾、活血化瘀,日久应兼顾肝肾之阴或脾肾之阳。Ohiective：According to morphologic diagnosis of liver cirrhosis （gold criteria）, to explore the. relationships between morphologie changes and elements of TCM pattern （ZHENG） in 31 patients with liver cirrhosis diagnosed with the gold criteria, to provide information on studying TCM pattern and on identifying TCM pattern and determining treatment. Methods： By laparoscopy or abdominal operation, the morphologic changes in the 31 cases were directly observed which were 4 types （rnicronodular cirrhosis [MieroNC], macronodular cirrhosis [ MaeroNC], mixed macronodular and micronodular cirrhosis [MixedNC] and incomplete septal eirrhosis [ISC] ） . TCM pattern （binding depression of liver Qi [BDLQ], spleen vacuity with damp exuberance [SVDE], damp heat brewing internally [DHBI], live-kidney Yin vacuity [LKYV], spleen-kidney Yang vacuity [SKYV], blood stasis [BS] and elements of the pattern [ depression, dampness, heat, stasis, spleen vacuity, Yang vacuity, Yin vacuity] ） were confirmed with the clinic materials.Results： In the 31 eases, ①The coincidence rate of morphologic diagnosis and clinic diagnosis was 45.16%. ②Among the patterns, BDLQ was 19.35% （major in MieroNC）, SVDE 12.90%, DHBI 32.26% （seen in all types）, LKYV 9.68%, SKYV 0, and BS 25.81% （major in MacroNC） . ③Among the elements of the pattern, depression or Stasis was common in all types, dampness or heat also was seen in all types （but less than depression or stasis）, vacuities （especially Yang vacuity and Yin vacuity） werc seen in the enduring ones and their morphologic changes mainly was MaeroNC and MixedNC. Conclusion. ①Rate of missed diagnosis of early liver cirrhosis （especially MieroNC and ISC） was relatively high with clinic criteria. ②Stasis was a mention that patients with chronic liver disease might had the morphologie changes of liver cirrhosis. Depression migth be deal with the psychic factor of chronic liver disease, also might be a presentation of liver eirrhosis. Dampness or heat was de

关 键 词：中医证候 肝硬化 形态学诊断 

分 类 号：R575.2[医药卫生—消化系统] R259[医药卫生—内科学]