基于“阳黄-阴阳黄-阴黄”辨证论治模式治疗HBV相关慢加急性肝衰竭的临床疗效分析  

Analysis of the therapeutic effect of HBV-ACLF intervention based on the"Yang Jaundice-Yin-Yang Jaundices-Yin Jaundice"syndrome differentiation and treatment model

作　　者：涂雨落 孙克伟[2] TU Yuluo;SUN Kewei(Department of Gerontology,Nanchang Hongdu Hospital of Traditional Chinese Medicine,Nanchang,330008,China;Department of Infectious Diseases,the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine)

机构地区：[1]南昌市洪都中医院老年病科,南昌330008 [2]湖南中医药大学第一附属医院感染病科

出　　处：《中国中西医结合消化杂志》2024年第3期195-202,共8页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

基　　金：国家自然科学基金(No:81973833);国家中医药管理局科研基金(No:JDZX2012061)

摘　　要：目的分析基于“阳黄-阴阳黄-阴黄”辨证论治模式干预乙型肝炎病毒相关慢加急性肝衰竭(hepatitis B virus related acute-on-chronic liver failure,HBV-ACLF)的短期疗效及远期预后情况。方法回顾性分析2012年1月—2015年1月湖南中医药大学第一附属医院单中心国家中医临床研究基地重点病种项目(阳黄-阴阳黄-阴黄辨证论治模式对乙性肝炎相关性肝衰竭的干预作用及其预后的影响)的100例HBV-ACLF患者的临床资料,按COSSH研究诊断标准对100例患者重新分组,非头对头比较两个队列患者的28、90 d病死率;同时对100例患者进行长期疗效随访,通过生存分析及临床数据比较探究临床特征和远期生存率情况。结果①中医干预组患者28、90 d病死率分别为12.19%、29.27%,与COSSH研究比较,本队列患者短期病死率更低;②生存分析结果显示,存活超过11周后患者死亡风险明显降低,度过高死亡风险期的患者远期(7~10年)生存率达77.40%,存活384周后无患者死亡;③多因素回归分析显示,年龄、PLT、总胆红素(TBIL)、低钠血症为影响患者远期预后的独立危险因素,年龄越大、PLT越低、TBIL水平越高、合并低钠血症的患者预后越差。结论在西医治疗基础上,基于“阳黄-阴阳黄-阴黄”辨证论治模式干预HBV-ACLF能进一步降低患者短期病死率,且早期干预后患者的远期生存率高。高年龄、低水平PLT、高水平TBIL、并发低钠血症是HBV-ACLF的远期预后的独立危险因素。Objective Analyze the short-term efficacy and long-term survival rate of hepatitis B virus related acute-on-chronic liver failure(HBV-ACLF)patients based on the"Yang Jaundice-Yin-Yang Jaundices-Yin Jaundice"syndrome differentiation and treatment model,explore the appropriate standards for acute-on-chronic liver failure(ACLF),and provide some basis for clinical decision-making.Methods The clinical data of 100 patients with HBV-ACLF who were enrolled in the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from January 2012 to January 2015 under the project of the National Clinical Research Base of Traditional Chinese Medicine,"the intervention effect of the syndrome differentiation and treatment model of Yang Jaundice-Yin-Yang Jaundices-Yin Jaundice on hepatitis B virus related liver failure and its impact on the prognosis",were collected retrospectively.The survival of patients was followed up until November 30,2022 or the end event occurred,analyze baseline data to determine clinical characteristics,group patients according to different diagnostic criteria,and calculate the 28 day mortality rate,90 day mortality rate,and endpoint mortality rate of each group.Compare the 28 day and 90 day mortality rates of HBV-ACLF patients in the COSSH-ACLF diagnostic criteria group with those in the 2018 COSSH study queue,and evaluate the short-term efficacy of Traditional Chinese Medicine intervention based on the"Yang Jaundice-Yin-Yang Jaundices-Yin Jaundice"syndrome differentiation and treatment model;according to the endpoint outcome,patients were divided into survival group and death group,and clinical characteristics and long-term survival rate were explored through survival analysis and clinical data comparison.Results①The 28 day mortality rate and 90 day mortality rate of patients in the traditional Chinese medicine intervention group were 12.19%and 29.27%,respectively.Compared with the short-term mortality rate of HBV-ACLF patients in the COSSH cohort,the short-term mortality rate of pati

关 键 词：乙型肝炎病毒相关慢加急性肝衰竭 中医药 阴阳黄 预后 疗效 

分 类 号：R259[医药卫生—中西医结合]