自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征56例中医辨证规律的研究  

Study on Syndrome Differentiation of TCM in 56 Cases of Overlap Syndrome of Autoimmune Hepatitis and Primary Biliary Cholangitis

作　　者：肖倩 谭善忠[1,2] 蒋淑莲[1,2] 梁重峰 各廷秋[1,2] 陈小妹[1,2] XIAO Qian;TAN Shan-zhong;JIANG Shu-lian(Department of Integrated Traditional Chinese and Western Medicine,Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine,Nanjing Jiangsu,210003,China)

机构地区：[1]南京中医药大学附属南京医院中西医结合科,江苏南京210003 [2]南京市第二医院

出　　处：《中西医结合肝病杂志》2021年第4期320-323,共4页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：江苏省中医药领军人才项目(No.苏中医科[2018]4号);南京市卫生青年人才培养工程(No.QRX11096)。

摘　　要：目的:探讨自身免疫性肝炎(AIH)-原发性胆汁性胆管炎(PBC)重叠综合征的中医辨证规律。方法:收集2017年1月至2020年1月于南京中医药大学附属南京医院住院就诊的AIH-PBC重叠综合征患者56例,采用气血津液辨证结合脏腑辨证方法,将其分为肝郁脾虚证、肝肾阴虚证、湿热中阻证、湿热瘀血证和瘀血阻络证5类,探讨其与肝功能、免疫球蛋白、自身免疫性肝病相关抗体及肝组织病理的关系。结果:56例肝郁脾虚证患者病情较轻,湿热瘀血证为AIH-PBC重叠综合征最常见类型,湿热瘀血证患者的总胆红素(TBil)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)均升高明显,组间差异有统计学意义(P<0.01);各中医辨证分型中IgG与球蛋白(Glo)值均异常升高,IgA处于正常范围;IgM在湿热中阻证升高较其他证型组明显,但其差异无统计学意义(P>0.05)。结论:AIH-PBC重叠综合征的中医证型与病情程度和肝功能损害有一定相关性。Objective:To explore the method of TCM syndrome differentiation of autoimmune hepatitis(AIH)primary bile cholangitis(PBC)overlap syndrome.Methods:Collect the AIH PBC overlap syndrome in our hospital from January 2017 to January 2020.56 patients which were based on Qi and blood fluid combined with viscera and syndrome differentiation methods,were divided into five categories:liver stagnation and spleen deficiency syndrome,liver and kidney Yin deficiency syndrome,damp heat syndrome,damp heat stasis syndrome,and blood stasis obstruction syndrome,discuss the liver function,immune globulin,autoimmune liver disease related antibodies and the relationship between the liver tissue pathology.Results:56 patients with liver stagnation and spleen deficiency syndrome had mild disease.Damp heat stasis syndrome was the most common type of AIH-PBC overlap syndrome.The total bilirubin(TBil),glutamyl transpeptidase(GGT)and alkaline phosphatase(ALP)of the patients with damp heat stasis syndrome were significantly increased,and the differences between the groups were statistically significant(all P<0.01).The IgG and globulin(Glo)values in all TCM syndrome types were abnormally elevated,and IgA was in the normal range;IgM resistance increased significantly in damp heat group compared with other syndrome groups,but the difference was not statistically significant(P>0.05).Conclusion:AIH-PBC overlap syndrome has some correlation with TCM syndrome and disease severity and liver damage.

关 键 词：自身免疫性肝炎 原发性胆汁性胆管炎 重叠综合征 中医证型 客观指标 

分 类 号：R259[医药卫生—中西医结合]