鄂西北地区原发性肝癌中医证型特点和致病原因分析  

Analysis of TCM Syndrome Characteristics and Pathogenic Causes of Primary Liver Cancer in Northwest Hubei Province

作　　者：殷明华 蔡美和 赵林 蔡美奎 雷飞飞 李芳 雷旭 谭华炳 YIN Minghua;CAI Meihe;ZHAO Lin;CAI Meikui;LEI Feifei;LI Fang;LEI Xu;TAN Huabing(Shiyan Renmin Hospital,Hubei Province,Shiyan 442000,China;不详)

机构地区：[1]湖北省十堰市人民医院(湖北医药学院附属人民医院),湖北十堰442000 [2]湖北省房县中医院 [3]湖北省竹山县人民医院

出　　处：《中国医学创新》2022年第17期149-153,共5页Medical Innovation of China

基　　金：湖北省卫生健康委员会2019-2020年度科研项目(WJ2019F051);2018年湖北省教育厅基金项目(B2018117);2018年度十堰市科技局引导性项目(18Y115);2019年度十堰市科技局引导性科研项目(19Y60);2011年十堰市科学技术研究与开发项目(2011068)。

摘　　要：目的:分析鄂西北地区原发性肝癌(PLC)患者中医证型、体质类型、病因分类,为本地区中医药参与PLC临床诊治提供借鉴。方法:收集鄂西北地区十堰市人民医院感染肝病科、房县中医院肝胆科、竹山县人民医院中医科2019年1月-2020年12月确诊的PLC患者266例临床资料。根据患者临床症状、体征,运用中医辨证分型量表、中医体质辨识表单对患者临床症状、体征进行辨证分析,分析患者中医证型、体质类型。分析患者Child-Pugh分级、并发症发生情况、病因学检查结果,分析鄂西北地区首次确诊PLC患者临床特点。结果:PLC患者首次确诊时临床症状不典型,胁肋胀满占53.38%,腹胀、腹痛占51.88%,乏力头晕占49.25%,纳差无味占48.12%,小便黄、量少占56.77%,肝区胀闷不适占37.97%,胁肋疼痛占36.84%等。中医证型以阴虚证型为主,肝肾阴虚证占29.70%、肝郁脾虚证占25.56%。中医体质类型平和质占比低,仅占18.42%,排在第一位的血瘀质占40.98%。Child-Pugh A级占33.46%、B级占34.21%、C级占32.33%。常见并发症有低蛋白血症、腹水、电解质代谢紊乱、脾脏增大、上消化道大出血、感染,有并发症患者占90.98%。病因以嗜肝病毒感染为主,占82.71%,代谢性肝病占13.16%。结论:鄂西北地区PLC患者临床症状不典型,证型以阴虚证为主,体质类型平和质占比低。适合手术切除的病例少,多数需要采取多学科诊疗的方法。中医药在PLC多学科诊治中可以发挥重要作用。虽然PLC病因以嗜肝病毒感染为主,但代谢疾病值得关注。Objective:To analyze the TCM syndrome types,constitution types and etiological classification of patients with primary liver cancer(PLC)in Northwest Hubei,so as to provide reference for traditional Chinese medicine to participate in the clinical diagnosis and treatment of PLC in this region.Method:The clinical data of 266 patients with PLC diagnosed in the Department of Infectious Diseases of Shiyan Renmin Hospital,Department of Hepatology of Fang County Hospital of Traditional Chinese Medicine and Department of Traditional Chinese Medicine of Zhushan County Renmin Hospital from January 2019 to December 2020 were collected.TCM syndrome differentiation scale and TCM constitution identification form were used to analyze the clinical symptoms and signs of patients.The TCM syndrome type and constitution type of patients were analyzed.The Child-Pugh classification,complications and etiological examination results were analyzed.The clinical features of PLC patients diagnosed for the first time in Northwest Hubei were analyzed.Result:The clinical symptoms of PLC patients at the first diagnosis were atypical,costal fullness accounted for 53.38%,abdominal distension and abdominal pain accounted for 51.88%,fatigue and dizziness accounted for 49.25%,anorexia and tasteless accounted for 48.12%,yellow urine and low volume accounted for 56.77%,liver distension and discomfort accounted for 37.97%,costal pain accounted for 36.84%.Yin deficiency syndrome was the main TCM syndrome type,liver and kidney Yin deficiency syndrome accounted for 29.70%,liver depression and spleen deficiency syndrome accounted for 25.56%.The proportion of TCM constitution type peace and quality was low,accounted for 18.42%,and blood stasis quality ranked first accounted for 40.98%.In the Child-Pugh classification,grade A accounted for 33.46%,grade B accounted for 34.21%,and grade C accounted for 32.33%.The common complications were hypoproteinemia,ascites,electrolyte metabolism disorder,spleen enlargement,upper gastrointestinal bleeding and infection.The

关 键 词：鄂西北 原发性肝癌 中医证型 功能分级 并发症 病因 

分 类 号：R273[医药卫生—中西医结合]