急性药物性肝损伤患者中医证候要素分布特征探讨  

Discussion on distribution characteristics of syndrome elements of traditional Chinese medicine in patients with acute drug-induced liver injury

作　　者：唐颖慧 刘皎皎 李粉萍 何瑾瑜 杨跃青 薛敬东 叶苗青 TANG Yinghui;LIU Jiaojiao;LI Fenping;HE Jinyu;YANG Yueqing;XUE Jingdong;YE Miaoqing(Shaanxi Provincial Hospital of Traditional Chinese Medicine,Xi′an,Shaanxi,710003)

机构地区：[1]陕西省中医医院,陕西西安710003

出　　处：《实用临床医药杂志》2022年第7期8-12,共5页Journal of Clinical Medicine in Practice

基　　金：陕西省临床医学研究中心资助项目(2020LCZX-02);2018年国家中医药管理局区域中医(肝病)诊疗中心培育单位建设项目[国中医药办医政函(2017)39号];陕西省中医药管理局-长安医学张氏肝病流派传承工作室建设项目[陕中医药发(2018)40号];2021陕西省中医药管理局科技项目(2021-ZZ-JC035)。

摘　　要：目的探讨急性药物性肝损伤患者的性别、年龄、吸烟、饮酒、中医证型分布、症状分布、中医疾病以及舌脉等情况,分析证候要素特点与疾病的相关性。方法回顾性调查陕西省5家三级甲等中医院肝病科住院且第一诊断为急性药物性肝损伤的234例患者的临床资料,根据各种标准最终纳入194例患者。观察急性药物性肝损伤发病的相关因素及中医证型的分布,分析急性药物性肝损伤中医证型的分布情况、证候特点,并初步建立辨证论治标准。结果陕西省中医医院肝病专科急性药物性肝损伤住院患者占比为0.9%,误诊率占17.1%;194例急性药物性肝损伤患者中,中药制剂导致的肝损伤患者98例(50.5%),抗结核药30例(15.5%),皮肤病药物47例(24.2%),其他药物19例(9.8%)。急性药物性肝损伤与性别、吸烟、饮酒无相关性,但19~39岁和40~60岁年龄段发生率较高。中医症状表现为乏力182例(93.8%),食欲不振158例(81.4%),胃脘胀满118例(60.8%),恶心66例(34.0%),呕吐30例(15.5%),厌油34例(17.5%),身目黄染84例(43.3%),尿黄88例(45.4%),大便干结36例(18.6%),大便稀溏8例(4.1%),发热8例(4.1%),皮肤瘙痒32例(16.5%)。中医疾病以肝系疾病为主,如黄疸病、胁痛病;其次为脾胃疾病,如痞满病、湿阻病、胃痛病等;再次为肺部疾患如肺痿病、肺痨病及咳嗽病。中医证候分布主要为肝郁脾虚证(37.1%)、肝胆湿热证(33.0%)、湿热蕴脾证(20.6%)、其他证型(9.3%)。舌象以舌淡红苔薄白、舌质红苔黄腻为多见,脉象以弦滑、弦或弦细为主。结论急性药物性肝损伤主要由中药制剂、皮肤病治疗药物及抗结核药物诱发,临床误诊率较高。该病的中医表现为黄疸及胁痛,常见肝郁脾虚证、肝胆湿热证等证型,因此正确判断及中医辨证论治有助于降低误诊率,提高临床疗效。Objective To investigate situations of gender, age, smoking, drinking, distribution of traditional Chinese medicine(TCM) syndromes, symptom distribution, TCM diseases, tongue and pulse in patients with acute drug-induced liver injury, analyze the correlation between the characteristics of syndrome elements and diseases. Methods The clinical data of 234 patients with acute drug-induced liver injury who were hospitalized in the Department of Liver Diseases in five tertiary Chinese medicine hospitals in Shaanxi Province and were first diagnosed as acute drug-induced liver injury were retrospectively investigated, and 194 patients were finally included according to various criteria. The related factors of acute drug-induced liver injury and the distribution of TCM syndromes were observed, the distribution and characteristics of TCM syndromes of acute drug-induced liver injury were analyzed, and the standard of syndrome differentiation and treatment was initially established. Results The proportion of hospitalized patients with acute drug-induced liver injury in the liver disease departments of Shaanxi Province of traditional Chinese medical hospitals accounted for 0.9%, and the misdiagnosis rate accounted for 17. 1%;of 194 patients with acute drug-induced liver injury,98 patients( 50. 5%)had liver injury caused by traditional Chinese medical preparations,30 cases( 15. 5%) by anti-tuberculosis drugs,47 cases( 24. 2%) by dermatological drugs,and 19 cases( 9. 8%) by other drugs. Acute drug-induced liver injury was not associated with gender,smoking or drinking,but the incidence rates were higher in 19 to 39 and 40 to 60 age groups. Fatigue of TCM symptoms occurred in 182 cases( 93. 8%),loss of appetite in 158 cases( 81. 4%),epigastric fullness in 118 cases( 60. 8%),nausea in 66 cases( 34. 0%),vomiting in 30 cases( 15. 5%),and oil aversion in 34cases( 17. 5%),yellow body and eyes in 84 cases( 43. 3%),yellow urine in 88 cases( 45. 4%),dry stool in 36 cases( 18. 6%),loose stool in 8 cases( 4. 1%),fever in 8 cases( 4. 1%),p

关 键 词：急性药物性肝损伤 中医证侯 分布特征 证型 误诊 

分 类 号：R825.93[医药卫生—急诊医学] R25[医药卫生—临床医学]