慢性乙型肝炎恶性转化过程证候、证素演变规律的临床研究  

Evolutionary Law of Syndrome and Syndrome Elements during the Malignant Transformation of Chronic Hepatitis B

作　　者：余思邈 丁霞 李萍[1] 王思慈 李佳辉 景婧 何婷婷 孙永强 王丽苹 张傲哲 林洁 李园 王睿林 YU Simiao;DING Xia;LI Ping;WANG Sici;LI Jiahui;JING Jing;HE Tingting;SUN Yongqiang;WANG Liping;ZHANG Aozhe;LIN Jie;LI Yuan;WANG Ruilin(Dongzhimen Hospital,Beijing University of Chinese Medicine;The Fifth Medical Center of Chinese PLA General Hospital;School of Traditional Chinese Medicine,Beijing University of Chinese Medicine;National Institute of TCM Constitution and Preventive Medicine,Beijing University of Chinese Medicine)

机构地区：[1]北京中医药大学东直门医院,北京市东城区100700 [2]中国人民解放军总医院第五医学中心 [3]北京中医药大学中医学院 [4]北京中医药大学国家中医体质与治未病研究院

出　　处：《中医杂志》2023年第23期2427-2434,共8页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(81673806,81630080);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(2020KTY001)。

摘　　要：目的 明确慢性乙型肝炎(CHB)恶性转化过程中不同阶段的证候演变规律。方法 收集2020年7月1日至2021年6月30日就诊于北京中医药大学东直门医院、解放军总医院第五医学中心门诊及住院的乙型肝炎病毒感染者共671例,其中CHB 120例,乙型肝炎肝硬化(HBLC) 340例,乙型肝炎肝硬化伴肝细胞癌前病变(PLHC) 64例,乙型肝炎肝硬化伴肝细胞癌(HCC) 147例。设计“慢性乙型肝炎恶性转化中医证候临床调查表”,记录患者一般资料、辅助检查结果及中医四诊信息。基于因子分析及K-均值聚类分析对其证候、证素进行判定及统计分析。结果 得到CHB中医证候类型5个,肝硬化(HBLC、PLHC、HCC)中医证候类型6个。其中CHB患者的证候分布主要以肝郁脾虚证(53.33%)、肝胆湿热证(21.67%)为主,证素分布以气滞(27.60%)、热(17.71%)、气虚(17.71%)为主;HBLC阶段证候分布以瘀血阻络证(23.83%)、肝郁脾虚证(22.35%)为主,证素分布以血瘀(19.25%)、湿(17.46%)、气虚(15.01%)为主;PLHC阶段证候分布以瘀血阻络证(29.68%)、肝肾阴虚证(20.31%)为主,证素分布以血瘀(22.12%)、阴虚(15.93%)、气虚(15.04%)为主;HCC阶段证候分布以瘀血阻络证(33.34%)、肝肾阴虚证(19.73%)为主,证素分布以血瘀(24.52%)、阴虚(16.09%)、气虚(15.33%)为主。CHB恶性转化的过程中,呈现出实证(肝胆湿热证、水湿内阻证)占比逐渐减少(21.67%→19.04%),虚证(肝肾阴虚证、脾肾阳虚证)占比逐渐增多(15.83%→31.97%),且实性证素(气滞、热、湿)比例逐渐减少(59.89%→34.48%),虚性证素(气虚、阴虚、阳虚)比例逐渐增加(32.30%→41.00%)。结论 慢性乙型肝炎恶性转化的过程中,存在气滞、热、气虚→血瘀(偏实)、湿、气虚→血瘀(偏虚)、阴虚、气虚的“虚实夹杂、由实转虚”的证候、证素演变趋势。Objective To clarify the evolutionary laws of syndromes and syndrome elements at different stages during the malignant transformation of chronic hepatitis B(CHB).Methods A total of 671 patients with hepatitis B virus infection,who were admitted to the outpatient and inpatient departments of Dongzhimen Hospital of Beijing University of Chinese Medicine and The Fifth Medical Center of Chinese PLA General Hospital from July 1st,2020 to June 30th,2021,were included,involving 120 cases of CHB,340 cases of hepatitis B liver cirrhosis(HBLC),64 cases of precancerous lesions with hepatitis B liver cirrhosis(PLHC),and 147 cases of hepatitis B liver cirrhosis with hepatocellular carcinoma(HCC).A Survey form of traditional Chinese medicine syndrome during malignant transformation of chronic hepatitis B was designed,and the general information,auxiliary examination and the four examinations results were collected.Factor analysis and K-means clustering were used to determine and statistically analyze the syndrome and syndrome elements.Results Five traditional Chinese medicine(TCM)syndrome types were identified in CHB patients,while there were six TCM syndrome types in HBLC,PLHC and HCC stages.Among CHB patients,the main syndromes were liver constraint and spleen deficiency(53.33%)and liver-gallbladder damp-heat(21.67%),and the dominant syndrome elements were qi stagnation(27.60%),heat(17.71%)and qi deficiency(17.71%).In the HBLC stage,the syndromes were mainly blood stasis obstructing the collaterals(23.83%)and liver constraint and spleen deficiency(22.35%),with dominant syndrome elements being blood stasis(19.25%),dampness(17.46%),and qi deficiency(15.01%).For the PLHC stage,the primary syndrome types were blood stasis obstructing the collaterals(29.68%)and liver-kidney yin deficiency(20.31%),and the leading syndrome elements were blood stasis(22.12%),yin deficiency(15.93%),and qi deficiency(15.04%).In the HCC stage,the syndrome was dominated by blood stasis obstructing the collaterals(33.34%)and liver-kidney yin deficiency(1

关 键 词：慢性乙型肝炎 乙型肝炎病毒感染 恶性转化 证候 证素 演变规律 

分 类 号：R259[医药卫生—中西医结合]