慢性肝病合并肌少症的中医证候调查及影响因素分析  

Investigation of traditional Chinese medicine syndromes and analysis of influencing factors in chronic liver disease complicated by sarcopenia

作　　者：严夏继 纪雯涓 朱晓骏[1] 郑彦希 高月求[1] YAN Xiaji;JI Wenjuan;ZHU Xiaojun;ZHENG Yanxi;GAO Yueqiu(Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院,上海201203

出　　处：《上海中医药杂志》2024年第5期19-23,共5页Shanghai Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(82274467);上海市卫健委上海市进一步加快中医药传承创新发展三年行动计划项目(ZY〔2021-2023〕-0302);上海市名老中医学术经验研究工作室建设项目(SHGZS-202246);上海中医药大学预算内项目(自然科学类)(2021LK085)。

摘　　要：目的研究慢性肝病合并肌少症的中医证候分布规律,分析慢性肝病并发肌少症的影响因素。方法通过问卷方式收集慢性肝病患者的中医证候信息以及年龄、骨质疏松症情况、吸烟情况、肝脏基础疾病等一般资料,借助上海中医药大学附属曙光医院院内化验系统收集患者血清碱性磷酸酶(ALP)、白蛋白(ALB)、前白蛋白(PA)、总胆固醇(TC)等实验室指标,根据四肢骨骼肌质量、小腿围、握力、6 m步行速度进行肌少症评估,采用疲劳量表-14(FS-14)评估患者的疲劳情况;采用二元Logistic回归模型分析慢性肝病并发肌少症的影响因素。结果①共收集205例慢性肝病患者,其中合并肌少症者106例、未合并肌少症者99例,分别设为肌少症组、非肌少症组;两组年龄、骨质疏松症情况、吸烟情况、肝脏基础疾病等方面比较,差异有统计学意义(P<0.05)。②肌少症组血清ALP水平高于非肌少症组(P<0.05),ALB、PA、TC水平低于非肌少症组(P<0.05)。③肌少症组躯体疲劳、脑力疲劳评分及FS-14总分高于非肌少症组(P<0.05)。④与非肌少症组比较,肌少症组更容易出现体倦乏力、脘胁胀痛、腰膝酸软、畏寒肢冷、失眠、视物模糊及口干舌燥,且程度较重(P<0.05)。⑤年龄越大[OR=1.069,95%CI(1.029~1.110)]、每日吸烟数量越多[OR=1.120,95%CI(1.025~1.224)]的慢性肝病患者并发肌少症的风险越高,高血清ALP水平[OR=1.006,95%CI(1.001~1.011)]、低血清ALB水平[OR=0.876,95%CI(0.811~0.947)]、骨质疏松症[OR=2.495,95%CI(1.134~5.487)]是慢性肝病并发肌少症的危险因素,血清TC高水平[OR=0.690,95%CI(0.522~0.912)]是慢性肝病并发肌少症的保护因素,差异均有统计学意义(P<0.05)。结论高龄、骨质疏松症、高每日吸烟数量、高血清ALP水平、低血清ALB水平是慢性肝病并发肌少症的危险因素,血清TC高水平则是其保护因素;慢性肝病合并肌少症患者的中医辨证主要侧重于肝Objective To explore the distribution pattern of traditional Chinese medicine(TCM)syndromes in patients with chronic liver disease(CLD)who are also affected by sarcopenia,and analyze influencing factors contributing to sarcopenia in patients with CLD.Methods Information regarding TCM syndromes,age,osteoporosis status,smoking habits,and underlying liver conditions was gathered from CLD patients through questionnaire surveys.Laboratory indicators such as serum alkaline phosphatase(ALP),albumin(ALB),prealbumin(PA),and total cholesterol(TC)were collected using the in-hospital laboratory system of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine.Sarcopenia assessment was conducted based on limb skeletal muscle mass,calf circumference,grip strength,and 6-meter walk test(6MWT).The Fatigue Scale-14(FS-14)was used to evaluate the patients’fatigue levels.Furthermore,a binary logistic regression model was employed to analyze the influencing factors for sarcopenia in CLD patients.Results①A total of 205 CLD patients were included,including 106 with sarcopenia and 99 without.They were divided into the sarcopenia group and the non-sarcopenia group.There were statistically significant differences between the sarcopenia and non-sarcopenia groups in terms of age,osteoporosis status,smoking habits,and underlying liver diseases(P<0.05).②The sarcopenia group had higher serum ALP level than the non-sarcopenia group(P<0.05),alongside lower ALB,PA,and TC levels(P<0.05).③Scores for somatic fatigue,mental fatigue,and the total FS-14 score were higher in the sarcopenia group than those in the non-sarcopenia group(P<0.05).④The symptoms of general fatigue and lassitude,epigastric distension and pain,lumbar and knee soreness and weakness,aversion to cold,cold limbs,insomnia,blurred vision,and dry mouth were markedly more prevalent and more severe in patients with sarcopenia compared to those without(P<0.05).⑤For CLD patients,the risk of developing sarcopenia increased with age[OR=1.069,95%CI(1.02

关 键 词：慢性肝病 慢性乙型肝炎 肝硬化 肌少症 中医证候 影响因素 调查研究 

分 类 号：R259[医药卫生—中西医结合]