基于中医“同身寸”理念修正门静脉直径对肝硬化门静脉高压症的提示效能  

Suggestive effect of modifying portal vein diameter on portal hypertension in patients with liver cirrhosis based on the concept of‘proportional unit of body’in traditional Chinese medicine

作　　者：荣文雅 崔延飞 纪冬 齐瑞兆 张鹰 王仲霞 景婧 何婷婷 王丽苹 王睿林 RONG Wenya;CUI Yanfei;JI Dong;QI Ruizhao;ZHANG Ying;WANG Zhongxia;JING Jing;HE Tingting;WANG Liping;WANG Ruilin(The Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China;School of Chinese Medicine,Southern Medical University,Guangzhou 510080,China)

机构地区：[1]解放军总医院第五医学中心,北京100039 [2]南方医科大学中医药学院,广州510080

出　　处：《中华中医药杂志》2023年第7期3466-3469,共4页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：中医药服务能力培育与提升专项计划项目(No.2021ZY044);中国医药教育协会2020重大科学攻关问题和医药技术难题科研课题(No.2020KTY001);国家自然科学基金项目(No.81673806)。

摘　　要：目的:基于中医“同身寸”理念,对以门静脉直径(PVD)≥1.3 cm作为提示门静脉高压症(PHT)的临界值进行个体化评估,说明P V D存在较大个体差异性,P V D在肝硬化不同个体应该存在不同临界值。方法:本研究基于文献学调研及2010年1月至2019年12月解放军总医院第五医学中心收治的640例肝硬化患者。将640例肝硬化患者分为PHT组(531例)和非PHT组(109例),其中PHT组有75例肝硬化患者行肝静脉压力梯度(HVPG)测定。在640例患者中,有168例患者通过收集既往病历获得了其未出现门脉高压前正常状态下PVD。结果:非PHT组中有86例患者的PVD≥1.3 cm。75例行HVPG测定的诊断为PHT的患者中,有7例有严重PHT患者的PVD<1.3 cm。在168例患者中,通过PVD≥1.3 cm作为临界值提示PHT与通过PVD个体化(△D)为修正提示PHT的ROC曲线下面积分别为0.692和0.763。△D与直接以PVD≥1.3 cm作为提示临界值的Z检验结果为Z=2.824,P<0.05。结论:通过对肝硬化患者门静脉宽度进行个体化修正,其PVD对肝硬化PHT的提示作用有所提升。Objective:Based on the concept of‘proportional unit of body’in traditional Chinese medicine,to evaluate the critical value indicating portal hypertension with portal vein diameter(PVD)≥1.3 cm,indicating that there is a large individual difference in portal pulse diameter,and there should be different critical values in different individuals with cirrhosis.Methods:In this research,640 cirrhosis patients were enrolled in Fifth Medical Center of PLA General Hospital from January 2010 to December 2019.A total of 640 cirrhosis patients were divided into PHT(portal hypertension)group(531 cases)and non-PHT group(109 cases).Seventy-five patients with liver cirrhosis underwent hepatic venous pressure gradient(HVPG)measurement in the PHT group.In 640 patients,a total of 168 patients had been obtained the normal PVD by collecting previous medical records.Results:The PVD of 86 patients was greater than or equal to 1.3 cm in the non-PHT group.7 cases whose PVD was<1.3 cm had serious PHT in 75 patients underwent HVPG measurement.In 168 patients,the area under the ROC curve of the PVDlast and△D for the prediction of PHT were 0.692 and 0.763,respectively.The result of Z test between the△D and PVDlast was Z=2.824,P<0.05.Conclusion:Through individual correction of portal vein width in patients with cirrhosis,the role of PVD in indicating PHT in cirrhosis is improved.

关 键 词：同身寸 门静脉高压症 门静脉直径 门脉压力 门脉差值 肝硬化 

分 类 号：R259[医药卫生—中西医结合]