脾切除术后血细胞变化对血瘀证形成的影响及中医药早期干预效果  

Effects of blood cell changes after splenectomy on the formation of blood stasis syndrome and early intervention effect of traditional Chinese medicine

作　　者：魏肥生 彭辉 沈毅[1] 张琦[1,2] 王振 于庆生[1,2] WEI Fei-sheng;PENG Hui;SHEN Yi;ZHANG Qi;WANG Zhen;YU Qing-sheng(Department of General Surgery,The First Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230031,China;Institute of Chinese Medicine Surgery,Anhui Academy of Chinese Medicine,Hefei 230061,China)

机构地区：[1]安徽中医药大学第一附属医院普外科,合肥230031 [2]安徽省中医药科学院中医外科研究所,合肥230061

出　　处：《中华中医药杂志》2022年第10期6153-6158,共6页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：“十二五”国家临床重点专科建设项目(No.财社[2013]239号);“十二五”国家中医药管理局重点专科建设项目(No.国中医药医政发[2012]2号);“十二五”安徽省重点专科建设项目(No.卫中医药秘[2013]521号)。

摘　　要：目的:观察肝豆状核变性(HLD)合并脾功能亢进患者脾切除术后血细胞变化对血瘀证形成的影响,并评价健脾活血中药早期干预效果。方法:回顾性分析行脾切除手术的268例HLD合并脾功能亢进患者临床资料,采用单因素分析和Logistic回归分析血细胞对术后血瘀证形成的影响,并将符合血瘀证诊断标准者(222例)按照是否加用健脾活血中药分为中药组(127例)和对照组(95例)。观察两组患者治疗前后血细胞计数[白细胞(WBC)、红细胞(RBC)、血小板(PLT)]、肝功能变化[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、直接胆红素(DBIL)、间接胆红素(IBIL)、白蛋白(ALB)]、血瘀证及门静脉系统血栓(PVST)形成情况。结果:单因素分析结果显示:患者RBC、PLT计数与术后血瘀证形成均有关(P<0.05),L o g i s t i c回归分析提示:术后第7天PLT是血瘀证形成的独立危险因素(O R=1.008,95%CI[1.003,1.014],P=0.003)。两组血瘀证患者例数在术后第3天差异无统计学意义,术后第7天达到最高水平,后呈逐渐下降趋势,其中术后第7、14天中药组血瘀证例数显著低于对照组(P<0.05)。两组血瘀证患者PVST计数在术后第7天差异无统计学意义,至第21天逐渐下降,其中脾切除术后第14、21天,中药组PVST例数显著低于对照组(P<0.05)。术前两组血细胞变化差异均无统计学意义,在术后第7、14天,中药组PLT显著低于对照组(P<0.05),术后第14天RBC显著高于对照组(P<0.05)。两组所有肝功能指标水平在术前,术后第1、7天差异无统计学意义;术后第14天,与对照组比较,中药组ALT、AST、IBIL显著下降(P<0.05),ALB则显著上升(P<0.05)。结论:血细胞中RBC、PLT是影响脾切除术后血瘀证形成的重要因素,术后第7天PLT是其独立危险因素,健脾活血中药的早期干预可以减少脾切除术后血瘀证和PVST的发生,同时可以改善血细胞和肝功能水平。Objective:To observe the effects of blood cell changes after splenectomy on the formation of blood stasis syndrome in patients with hepatolenticular degeneration(HLD)and hypersplenism,and to evaluate the effects of early intervention of traditional Chinese medicine for invigorating spleen and promoting blood circulation.Methods:The clinical data of 268 patients with HLD and hypersplenism who underwent splenectomy in our hospital were retrospectively analyzed.Univariate analysis and Logistic regression were used to analyze the effect of blood cells on the formation of blood stasis syndrome after operation.The patients(222 cases)who met the diagnostic criteria of blood stasis syndrome were divided into the Traditional Chinese Medicine(TCM)group(127 cases)and the control group(95 cases)according to whether the traditional Chinese medicine for strengthening the spleen and promoting blood circulation was added or not.The blood cell count(WBC,RBC,PLT),liver function changes(ALT,AST,DBIL,IBIL,ALB),blood stasis syndrome and the formation of portal vein thrombosis(PVST)were observed in the two groups before and after treatment.Results:Univariate analysis showed that RBC and PLT were related to the formation of blood stasis syndrome after surgery(P<0.05).Logistic regression analysis indicated that PLT on the 7th day after surgery was an independent risk factor for the formation of blood stasis syndrome(OR=1.008,95%CI[1.003,1.014],P=0.003).There was no significant difference between the two groups in blood stasis syndrome 3 days after operation,reached the highest level on 7 days after surgery,and then showed a gradually decreasing trend.The cases of blood stasis syndrome in TCM group was significantly lower than that in control group on 7 and 14 days after surgery(P<0.05).There was no significant difference in PVST count between the two groups at 7 days postoperatively and gradually decreased to 21 days after splenectomy.On 14 and 21 days after splenectomy,the cases of PVST in TCM group was significantly lower than that in

关 键 词：脾切除 血细胞 血瘀证 健脾活血 

分 类 号：R269[医药卫生—中西医结合]