临床前代偿期肝硬化中医证候要素及其与肝组织分级分期评分的相关性研究  

Relationship between elements of TCM syndromes and its histological grading and staging scoring in patients with pre-clinical compensatory liver cirrhosis

作　　者：王岭[1] 李野平[1] 张均倡[1] 王新华[2] 熊倩[1] 李国焕[1] 李金菊[1] 俞家福[1] 张志魁[3] 付新录[3] 

机构地区：[1]广东省中医院珠海医院肝病科,广东珠海519015 [2]广州中医药大学 [3]广州金域医学检验中心

出　　处：《中西医结合肝病杂志》2012年第6期327-329,I0001,共4页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：国家自然科学基金课题(No.30672575;No.81072950);广东省自然科学基金课题(No.8151902501000004);广东省科技厅科技计划项目(No.2008B030301292)

摘　　要：目的:探究按临床诊断标准尚不够条件但根据肝硬化诊断的"金标准"可以确诊为肝硬化患者的中医证候要素及其与肝组织分级分期评分的相关性,以充实肝硬化的中医证候理论。方法:通过流行病学横断面调查的方法对25例研究对象的中医证候要素及其与肝脏大体形态学改变(腹腔镜或开腹手术直视下观察)、肝组织分级分期评分的相关性进行描述性分析。结果:①肝脏大体形态改变在各证候要素中具体分布为:瘀(76.0%)>郁(72.0%)>脾虚(60.0%)>湿(48.0%)>热(36.0%)>阴虚(4.0%)>阳虚(0%)=其他证候要素(0%)=无证可辨(0%);②肝脏组织炎症程度分级多分布在G1、G2,瘀以G1、G2为主(G1占52.6%,G2占31.6%),郁以G1为主(占61.1%);③肝脏纤维化程度分期主要为S4,部分未达到S4(即组织学诊断尚不能确立肝硬化);在证候要素瘀中S4占78.9%,在证候要素郁中S4占72.2%;④此期患者肝脏大体形态学改变80.0%为小结节。结论:本研究中,①临床前代偿期肝硬化患者的中医证候要素分布以瘀、郁为主,G1、G2为其主要的肝脏炎症程度分级评分,S4为其主要肝脏纤维化程度分期评分,亦见部分未达到S4,小结节为其主要大体形态改变;②此组患者肝组织学活检诊断肝硬化存在一定的漏诊率(28.0%)。Objective： To study the relationship between elements of TCM syndromes and its histological grading and stag- ing scoring in patients with pre-clinical compensatory liver cirrhosis. Methods： By clinical epidemiological survey, we used de- scriptive statistical methods to analyze elements of TCM syndromes and its morphological changes of Iiver surface and liver histo- logical grading and staging scoring that was got through laparotomy or laparoscopy in 25 patients with pre-clinical compensatory liver cirrhosis. Results： ①The concrete disposition of elements of TCM syndromes was stasis （76.0%） 〉 depression （72. 0% ） 〉 spleen deficiency （60. 0% ） 〉 dampness （48. 0% ） 〉 heat （36. 0% ） 〉 Yin-deficiency （4.0%） 〉 Yang-de- ficiency （0%） = other elements of TCM syndromes （0%） = no elements of TCM syndromes （0%） . ② Most of the grading scoring was G1 and G2. Stasis mostly was G1 and G2 （52. 6% G1, 31.6% G2）, depression mostly was G1 （61.1% G1 ） . ③Most of the staging scoring was $4 （some can＇t be diagnosed with histological data）, 78.9% of the staging scoring was $4 in ＂stasis＂, 72.2% of the staging scoring was S4 in ＂depression＂ . ④ Micronodular cirrhosis was shown in 80.0% patients. Conclusion： In this period of liver cirrhosis, ①The main elements of TCM syndromes are ＂stasis＂ and ＂depression＂ . Most grading scoring was G1 and G2. Most staging scoring is S4. Most of the patients with pre-clinical compensatory liver cirrho- sis is micronodular cirrhosis. ②There is some of missed diagnosis of liver cirrhosis in histological diagnosis （28.0%） .

关 键 词：肝硬化 中医证候 大体形态 组织病理 

分 类 号：R259[医药卫生—中西医结合]