乙型肝炎病毒相关慢加急性肝衰竭湿热瘀黄证与气虚瘀黄证的临床特征分析  

Clinical characteristics of damp heat stasis syndrome and Qi deficiency stasis syndrome in hepatitis B virus related acute on chronic liver failure

作　　者：周超 张宁 何婷婷 王葽 张晶晶 付双楠 王宣 宫嫚 李筠 ZHOU Chao;ZHANG Ning;HE Ting-ting;GONG Man(Department of Hepatology,The fifth medical center of PLA generul hospital,Beijing,100039,China)

机构地区：[1]解放军总医院第五医学中心肝病医学部中医肝病科,北京100039

出　　处：《中西医结合肝病杂志》2021年第4期308-311,共4页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：国家科技重大专项(No.2012ZX10005-005,No.2018ZX10725506-002)。

摘　　要：目的:探讨乙型肝炎病毒相关慢加急性肝衰竭湿热瘀黄证与气虚瘀黄证人群临床特征的差异性。方法:比较两种证型人群在人口学特征、实验室指标、并发症及炎性细胞因子方面的差异,通过多因素回归分析寻找与证型相关的独立因素。结果:乙型肝炎病毒相关慢加急性肝衰竭气虚瘀黄证人群的平均年龄大于湿热瘀黄证人群(P=0.002);湿热瘀黄证患者的血清谷丙转移酶、谷草转移酶、谷氨酰胺转肽酶中位数水平高于气虚瘀黄证患者(P<0.01或P<0.05);气虚瘀黄证患者血清球蛋白、血红蛋白含量、红细胞计数、血小板计数显著低于湿热瘀黄证患者(P<0.01或P<0.05);气虚瘀黄证患者合并有腹水、低钠血症、自发性细菌性腹膜炎的比例显著高于湿热瘀黄证患者(P<0.01或P<0.05),且血清IL-4水平高于湿热瘀黄证(P=0.030);Logistics回归分析结果显示与湿热瘀黄证相比,年龄大、低水平的球蛋白及血红蛋白患者更倾向于气虚瘀黄证。结论:乙型肝炎病毒相关慢加急性肝衰竭湿热瘀黄证、气虚瘀黄证患者在年龄、实验室指标、临床并发症等方面存在差异,患者年龄、血红蛋白及球蛋白水平有助于证型判断。Objective:To explore the clinical difference between damp heat stasis jaundice and qi deficiency stasis jaundice in patients with hepatitis B virus-associated acute on chronic liver failure(HBV ACLF)and find out the dependent factors related to the different syndrome.Methods:We performed an analysis of the“Study on HBV ACLF treated with integrated Traditional Chinese Medicine and western medicine”.Compared the demographic characteristics,laboratory indicators,complications,and serum cytokines in HBV ACLF patients with qi deficiency stasis jaundice and these with damp heat stasis jaundice.Through the Logistics multivariate analysis,identified the dependent factors associated with the different syndrome.Results:The average age of HBV ACLF patients with qi deficiency stasis jaundice was elder than those with damp heat stasis jaundice.The serum ALT,AST,and GGT levels of HBV ACLF patients with damp heat stasis jaundice were significantly higher than those with qi deficiency stasis jaundice(P<0.001),as well as globulin,platelet count,hemoglobin,and red blood cell count.The presence of ascites,hyponatremia,and spontaneous bacterial peritonitis(SBP)in HBV ACLF patients with qi deficiency stasis jaundice increased than those with damp heat stasis jaundice.The serum IL-4 level of HBV ACLF patients with qi deficiency stasis jaundice was significantly higher than those with damp heat stasis jaundice(P<0.001).Older,lower levels of globulin and hemoglobin were dependently associated with qi deficiency stasis jaundice.Conclusion:HBV ACLF patients with damp heat stasis jaundice or qideficiency stasis jaundice showed different characteristics in terms of onset age,some laboratory indicators,and complications.Especially,age and levels of hemoglobin and globulin were beneficial to judge the syndrome.

关 键 词：慢加急性肝衰竭 乙型肝炎病毒 湿热瘀黄证 气虚瘀黄证 

分 类 号：R575.3[医药卫生—消化系统]