乙型肝炎病毒相关慢加急性肝衰竭不同分期患者中医证素、证型演变规律的多中心临床研究  

Traditional Chinese Medicine Syndrome Element,Evolutionary Patterns of Patients with Hepatitis B Virus-Related Acute on Chronic Liver Failure at Different Stages:A Multi-Center Clinical Study

作　　者：余思邈 孙克伟 张振刚 李瀚旻[5] 李秀惠[6] 杨宏志 李芹[8] 王林 周小舟[10] 毛德文 过建春 卓蕴慧[13] 王宪波[14] 邓欣[15] 王介非 曹武奎[17] 张淑芹[18] 张明香[19] 李筠 宫嫚 周超 YU Simiao;SUN Kewei;ZHANG Zhengang;LI Hanmin;LI Xiuhui;YANG Hongzhi;LI Qin;WANG Lin;ZHOU Xiaozhou;MAO Dewen;GUO Jianchun;ZHUO Yunhui;WANG Xianbo;DENG Xin;WANG Jiefei;CAO Wukui;ZHANG Shuqin;ZHANG Mingxiang;Li Jun;GONG Man;ZHOU Chao(Fifth Medical Center,Chinese PLA General Hospital,100039,Beijing;Beijing University of Chinese Medicine;The First Affiliated Hospital of Hunan University of Chinese Medicine;Tongji Hospital,Huazhong University of Science and Tech-nology;Hubei Provincial Hospital of Traditional Chinese Medicine;Beijing You'an Hospital,Capital Medical University;The Third Affiliated Hospital,Sun Yat-sen University;Mengchao Hepatobiliary Hospital of Fujian Medical University;Public Health Clinical Medical Center of Chengdu;Shenzhen Traditional Chinese Medicine Hospital;The First Affiliated Hospital of Guangxi University of Chinese Medicine;West Lake Hospital,Hangzhou;Shuguang Hospital,Affiliated to Shanghai University of Traditional Chinese Medicine;Beijing Ditan Hospital,Capital Medical University;The Third People's Hospital of Shenzhen;Shanghai Public Health Clinical Center;Tianjin Second People's Hospital;Jilin Province Hepatobiliary Hospital;The Sixth People's Hospital of Shenyang)

机构地区：[1]中国人民解放军总医院第五医学中心,北京市丰台区100039 [2]北京中医药大学 [3]湖南中医药大学第一附属医院 [4]华中科技大学附属同济医院 [5]湖北省中医院 [6]首都医科大学附属北京佑安医院 [7]中山大学附属第三医院 [8]福建医科大学孟超肝胆病医院 [9]成都市公共卫生临床医疗中心 [10]深圳市中医院 [11]广西中医药大学第一附属医院 [12]杭州市西溪医院 [13]上海中医药大学附属曙光医院 [14]首都医科大学附属北京地坛医院 [15]深圳市第三人民医院 [16]上海公共卫生临床中心 [17]天津市第二人民医院 [18]吉林省肝胆病医院 [19]沈阳市第六人民医院

出　　处：《中医杂志》2024年第12期1262-1268,共7页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(82305067);国家科技重大专项(2018ZX10725-506,2012ZX10005005)。

摘　　要：目的探讨乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)不同分期患者证素、证型的演变规律。方法收集2012年1月1日至2015年2月28日来自全国18家临床中心的HBV-ACLF住院患者1058例的临床资料,包括早期患者618例,中期患者355例,晚期患者85例。设计乙型肝炎相关慢加急性肝衰竭中医证候临床调查表,调查患者基本信息、中医四诊信息(症状、舌象、脉象),统计四诊信息出现的频率。基于因子分析及聚类分析,对早期、中期、后期HBV-ACLF患者的病性证素、病位证素、证型进行判定。结果1058例HBV-ACLF患者四诊信息76个,以出现频率≥5%的四诊信息53个作为因子分析条目,其中症状信息36个、舌象信息12个、脉象信息5个。得到HBV-ACLF中医证型4个,分别为肝胆湿热证、气虚血瘀证、肝肾阴虚证、脾肾阳虚证。早期的病性证素分布以热(39.4%,359/912)、湿(27.5%,251/912)多见,证型主要以肝胆湿热证(74.6%,461/618)为主;中期的病性证素分布以湿(30.2%,187/619)、血瘀(20.7%,128/619)多见,证型以肝胆湿热证(53.2%,189/355)、气虚血瘀证(27.6%,98/355)多见;晚期的病性证素分布以气虚(26.3%,40/152)、阴虚(20.4%,31/152)多见,证型以气虚血瘀证(36.5%,31/85)、肝胆湿热证(25.9%,22/85)多见。结论HBV-ACLF不同分期的证素、证型分布差异较大,整体呈现湿热→血瘀→气血阴阳亏虚的虚实夹杂、由实转虚的证候演变趋势。Objective To explore the syndrome elements and evolving patterns of patients with hepatitis B virusrelated acute on chronic liver failure(HBV-ACLF)at different stages.Methods Clinical information of 1,058hospitalized HBV-ACLF patients,including 618 in the early stage,355 in the middle stage,and 85 in the late stage,were collected from 18 clinical centers across 12 regions nationwide from January 1,2012 to February 28,2015.The“Hepatitis B-related Chronic and Acute Liver Failure Chinese Medicine Clinical Questionnaire”were designed to investigate the basic information of the patients,like the four diagnostic information(including symptoms,tongue,pulse)of traditional Chinese medicine(TCM),and to count the frequency of the appearance of the four diagnostic information.Factor analysis and cluster analysis were employed to determine and statistically analyze the syndrome elements and patterns of HBV-ACLF patients at different stages.Results There were 76 four diagnostic information from 1058 HBV-ACLF patients,and 53 four diagnostic information with a frequency of occurrence≥5% were used as factor analysis entries,including 36 symptom information,12 tongue information,and 5 pulse information.Four types of TCM patterns were identified in HBV-ACLF,which were liver-gallbladder damp-heat pattern,qi deficiency and blood stasis pattern,liver-kidney yin deficiency pattern,and spleen-kidney yang-deficiency pattern.In the early stage,heat(39.4%,359/912)and dampness(27.5%,251/912)were most common,and the pattern of the disease was dominated by liver-gallbladder damp-heat pattern(74.6%,461/618);in the middle stage,dampness(30.2%,187/619)and blood stasis(20.7%,128/619)were most common,and the patterns of the disease were dominated by liver-gallbladder damp-heat pattern(53.2%,189/355),and qi deficiency and blood stasis pattern(27.6%,98/355);and in the late stage,the pattern of the disease was dominated by qi deficiency(26.3%,40/152)and yin deficiency(20.4%,31/152),and the patterns were dominated by qi deficiency and blood stas

关 键 词：慢加急性肝衰竭 乙型肝炎病毒 证候 证素 横断面研究 

分 类 号：R259[医药卫生—中西医结合]