肝衰竭患者中医证型与西医肝衰竭分期之间的关系观察  

Relation of TCM syndrome type in traditional Chinese medicine with liver failure staging in Western medicine in patients with liver failure

作　　者：冯明洋 丁叶舟 赵青青 赵钢德[1] 娄世珂 郑超 孙学华 刘柯慧[1] 林兰意 谢青[1] 郑岚 王晖[1] FENG Mingyang;DING Yezhou;ZHAO Qingqing;ZHAO Gangde;LOU Shike;ZHENG Chao;SUN Xuehua;LIU Kehui;LIN Lanyi;XIE Qing;ZHENG Lan;WANG HUI(Department of Infectious Diseases,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Traditional Chinese Medicine,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Hepatology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200135,China)

机构地区：[1]上海交通大学医学院附属瑞金医院感染科,上海200025 [2]上海中医药大学附属曙光医院肝病科,上海200025 [3]上海交通大学医学院附属瑞金医院中医科,上海200135

出　　处：《诊断学理论与实践》2021年第4期391-395,共5页Journal of Diagnostics Concepts & Practice

基　　金：上海市加强公共卫生体系建设三年行动计划(GWV-3.1);上海市中医药事业发展三年行动计划[ZY(2018-2020)-CCCX-2003-01];重大疑难疾病中西医临床协作试点项目[ZY(2018-2020)-FXTW-2004]。

摘　　要：目的:探讨肝衰竭患者中医证型与西医肝衰竭分期之间的关系,以及不同中医证型患者的实验室检查指标及预后特点,为中西医结合治疗肝衰竭提供参考。方法:收集165例肝衰竭住院患者的基本信息,观察患者的西医肝衰竭前期、早期、中期及晚期各期中的中医证型分布情况,分析中医证型与患者的临床转归、血清学指标间的关系。结果:165例肝衰竭患者中,肝衰竭前期26例,早期87例,中期31例,晚期21例;165例肝衰竭患者的中医证型可大致归纳为肝郁脾虚、湿热蕴结、肝肾阴虚、瘀血阻络4个,其中以肝郁脾虚型最多,共81例(占49.09%),病因以乙型肝炎病毒(HBV)感染为主要原因,占70%(65%合并肝硬化);肝衰竭前期多见于瘀血阻络型(14/26,53.84%),早期肝衰竭多见于肝郁脾虚型(49/87,56.32%),肝衰竭中期也见于肝郁脾虚型(12/31,38.71%)和湿热蕴结型(12/31,38.71%),晚期肝衰竭多见于湿热蕴结型(11/21,52.38%)。肝郁脾虚型患者占所有患者的49.1%,占比最高且预后最佳,临床好转率超过80%;肝肾阴虚型患者的预后最差,临床恶化比例占50%。湿热蕴结型患者的丙氨酸氨基转移酶(alanine transaminase,ALT)[(655.0±143.4)IU/L]和天冬氨酸氨基转移酶(aspartate transaminase,AST)[(504.0±117.7)IU/L]显著高于其他证型(P<0.05),且凝血酶原时间(prothrombin time,PT)[(21.57±0.95)s]显著延长(P<0.05);肝肾阴虚型患者的总胆红素(total bilirubin,TBil)[(307.5±33.00)μmol/L]显著高于其他证型(P<0.05)。结论:肝衰竭各分期的患者中中医证型分布没有差异,肝郁脾虚型所占比例最高;肝郁脾虚型肝衰竭患者的预后最好,肝肾阴虚型患者预后最差,湿热蕴结型患者的肝功能生化指标异常较其他证型更为显著。Objective:To explore the relation of TCM(Triditional Chinese medicine syndrome)type in traditional Chinese medicine with liver failure staging in Western medicine in the patients with liver failure,and analyze the corresponding laboratory indicators and prognostic characteristics of the patients with different TCM syndrome type,and provide reference to treat liver failure through integrated traditional Chinese medicine and Western medicine.Methods:A total of 165 patients with liver failure were enrolled.Basic information of the patients was collected and the patients were divided into prophase,early stage,middle stage and late stage according to the severity of liver failure.The distribution of TCM syndrome types and their clinical manifestations,serological indicators and prognosis were analyzed.Results:In 165 inpatients with liver failure,there were four syndrome types,including liver depression and spleen deficiency,damp-heat accumulation,liver and kidney Yin deficiency,blood stasis and collateral obstruction.Among them,81 cases belonged to the type of liver depression and spleen deficiency(49.09%).Hepatitis B virus(HBV)infection was the main cause for liv-er failure,accounting for 70%(65%combined with cirrhosis).In all patients with liver failure,there were 26 cases in the prophase,87 cases in the early stage,31 cases in the middle stage and 21 cases in the late stage.In the prophase stage of liver failure,53.84%cases showed liver depression and spleen deficiency(14/26).56.32%cases had liver de-pression and spleen deficiency(49/87)In the early stage of liver failure,and 38.71%cases in the middle stage of liver failure showed liver depression and spleen deficiency(12/31)and 38.71%cases had damp-heat accumulation(12/31).52.38%patients with advanced liver failure belonged to in damp-heat accumulation type(11/21).The type of liver depression and spleen deficiency had the best prognosis,and the clinical improvement rate was more than 80%.While the type of liver and kidney Yin deficiency had the worst prognosis,and

关 键 词：肝衰竭 中医证型 疾病分期 临床预后 

分 类 号：R541.7[医药卫生—心血管疾病]