1119例药物性肝损害患者中医证候规律分析  

Analysis on the Regularity of TCM Syndromes in Patients with 1119 Cases of Drug-Induced Liver Injury

作　　者：郭玉明[1] 张宁[1] 毕京峰[1] 王仲霞[1] 肖小河[1] 

机构地区：[1]中国人民解放军第三〇二医院,北京市西四环中路100号100039

出　　处：《中医杂志》2015年第7期575-578,共4页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(81330090)

摘　　要：目的分析药物性肝损害(DILI)中医证候规律,为辨证施治提供依据。方法收集1119例DILI病例资料,包括年龄、性别、疾病分型、中医临床症状体征(乏力、纳差、厌油、尿黄、身黄、恶心、腹胀、腹痛、发热、肝肿大、呕吐、皮肤瘙痒、皮疹等23项)。采用频数描述与Logistic回归分析方法,探讨肝细胞损伤型、胆汁淤积型及混合型DILI患者中医症状特征及其分布规律。结果 1119例DILI患者中肝细胞损伤型746例,胆汁淤积型233例,混合型140例,乏力、尿黄、纳差、目黄、身黄、恶心的出现频数较高,分别占60.14%、57.82%、42.72%、42.63%、27.61%、16.35%。Logistic回归分析显示,纳差、厌油、恶心、发热与肝细胞损伤型相关性较大;皮肤瘙痒与胆汁淤积型相关性较大;尿黄、身黄、纳差与混合型肝损伤相关性较大。结论肝细胞损伤型DILI多见肝郁脾虚、肝胃不和证,胆汁淤积型DILI多见肝胆湿热证,混合型DILI可能涉及肝郁脾虚、肝胃不和、肝胆湿热、下焦湿热等证型。Objective To analyze the syndrome regularity of drug-induced liver injury（ DILI） and to provide basis for treatment based on syndrome differentiation. Methods Collected clinical data of 1119 patients with DILI,including age,sex,disease type,clinical symptoms and signs of traditional Chinese medicine（ fatigue,poor appetite,sickness of oily food,yellow urine,yellowish discoloration of body,nausea,abdominal distension,abdominal pain,fever,hepatomegaly,vomiting,skin itching,skin rash and others,totally 23 items）. Adopted frequency description and Logistic regression analysis method to investigate TCM symptom characteristics and its distribution of liver cell damage pattern,cholestasis pattern and mixed pattern of the DILI patients. Results Among 1119 DILI patients,746 cases belong to liver cell damage pattern,233 cases belong to cholestasis pattern,and 140 cases belong to mixed pattern. Symptoms such as fatigue,yellow urine,poor appetite,yellow eyes,yellow body and nausea have higher frequency accounted for 60. 14%,57. 82%,42. 72%,42. 63%,27. 61%,16. 35%,respectively. Logistic regression analysis showed poor appetite,sickness of the oily food,nausea,and fever have greater correlation with the hepatocyte injury pattern; skin itching has greater correlation with cholestasis pattern; yellow urine,yellowish discoloration of body,and poor appetite have greater correlation with the mixed pattern of hepatic injury. Conclusion DILI of liver cell injury type mainly belong to liver stagnation and spleen deficiency pattern,liver-stomach disharmony pattern,and cholestasis type is frequently seen in liver-gallbladder damp-heat pattern; DILI of mixed type may involve the liver stagnation and spleen deficiency pattern,and lower-jiao damp-heat pattern,liver-stomach disharmony pattern,and damp heat in liver and gallbladder dampness heat in lower-jiao pattern.

关 键 词：药物性肝损害 中医证候 LOGISTIC回归分析 

分 类 号：R259[医药卫生—中西医结合]