HBV慢性感染伴慢性失眠症患者的中医证候特点及其病机分析  

Analysis of TCM Syndromes and Pathogenesis of Chronic Hepatitis B Virus Infection with Chronic Insomnia

作　　者：余钦 赵沙沙 赵智豪 岳小强 陈建国[4] 凌昌全 YU Qin;ZHAO Sha-sha;ZHAO Zhi-hao;YUE Xiao-qiang;CHEN Jian-guo;LING Chang-quan(Graduate School,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Department of Traditional Chinese Medicine,The Second Military Medical University,200433,China;Department of Traditional Chinese Medicine,Changzheng Hospital,The Second Military Medical University,Shanghai 200003,China;Qidong Institute of Liver Cancer Prevention and Rreatment/Qidong People's Hospital,Qidong Jiangsu 226200,China;Department of Traditional Chinese Medicine,Changhai Hospital,The Second Military Medical University,Shanghai 200433,China)

机构地区：[1]上海中医药大学研究生院,上海201203 [2]海军军医大学中医系,上海200433 [3]海军军医大学附属长征医院中医科,上海200003 [4]启东市肝癌防治研究所/启东市人民医院,江苏启东226200 [5]海军军医大学附属长海医院中医科,上海200433

出　　处：《中医药导报》2020年第9期85-88,96,共5页Guiding Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家重大专项(2018ZX10732-202-001-004);国家自然科学基金面上项目(81573653);上海市卫计委中医优势病种培育项目(ZYBZ-2017028);上海市卫计委中医药重大临床研究[ZY(2018-2020)-CCCX-4003]。

摘　　要：目的:探讨慢性乙型肝炎病毒(hepatitis B virus,HBV)感染患者中慢性失眠症的患病情况,并分析其中医证候和病机特点。方法:收集启东地区"肝癌早诊早治"队列中HBV慢性感染患者的中医证候信息,并发失眠患者进一步采集其失眠相关信息,探讨该人群失眠的中医证候特点。结果:慢性失眠症在调查的HBV感染患者中患病率为7.71%,在肝炎后肝硬化患者中为17.37%。慢性失眠症患者的中医证型以湿热蕴结证和瘀血阻络证最为常见,且这两个证型在伴有肝炎后肝硬化患者中较非肝硬化患者更为常见。湿热蕴结证患者的失眠特点为易醒、多梦、睡眠时间短;瘀血阻络证患者失眠特点为易醒、多梦、失眠病史长、入睡困难。在HBV感染并发失眠患者中,瘀血阻络证与湿热蕴结证多相兼为病。结论:失眠为HBV感染患者常见病症,随病程进展患病率增高;其病机与肝胆湿热、热扰心神和瘀血阻络、神窍失用有关,两者常相兼为病,且具有一定自身特点。Objective:To discuss the TCM syndromes and pathogenesis in patients of chronic hepatitis B virus(HBV)infection complicated with insomnia.Methods:TCM syndrome information of patients with HBV infection in Qidong area was collected by using TCM four-diagnosis symptom questionnaire,and insomnia related information was further collected in patients with concurrent insomnia,to explore the characteristics,pathogenesis and the relationship between insomnia and disease process.Results:The prevalence of insomnia was 7.71%in patients with HBV infection and 17.37%in patients with post-hepatitis cirrhosis.Damp-heat accumulation syndrome and blood stasis blocking collaterals are the most common TCM syndromes in insomnia patients,and these two syndromes are more common in patients with post-hepatitis cirrhosis than in patients without cirrhosis.The insomnia of the patients with the syndrome of hot and humid accumulation is characterized by easy waking,more dreams and short sleep time.The characteristics of insomnia in patients with blood stasis syndrome are easy to wake up,many dreams,long history of insomnia and difficulty in falling asleep.In the patients with HBV complicated insomnia,the proportion of stasis of blood obstruction syndrome and damp-heat accumulation syndrome is very high.Conclusion:Insomnia is a common disease in patients with HBV infection,and the incidence rate increases with the progress of the disease.Its pathogenesis involves heat disturbance of mind caused by dampness and heat accumulation and mental disorder caused by blood stasis,which have their own characteristics and often lead to the disease simultaneously.

关 键 词：慢性乙型病毒性肝炎 乙型肝炎病毒 慢性失眠症 中医证候 病机 横断面研究 

分 类 号：R256.49[医药卫生—中医内科学]