门窦血管性疾病的临床特征与中药用药特点探讨  

The clinical characteristics of patients with porto-sinusoidal vascular disorder and applications of traditional Chinese medicine

作　　者：李盟 郭亚楠 邢枫 吕靖[3,4] 刘成海 LI Meng;GUO Yanan;XING Feng;LV Jing;LIU Chenghai(Institute of Liver Diseases,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai,201203,China;Department of Hepatobiliary Spleen and Stomach,the Second Affiliated Hospital of Henan University of Chinese Medicine;Shanghai Key Laboratory of Clinical Traditional Chinese Medicine and the Ministry of Education Key Laboratory for Diseases and Syndromes of Liver and Kidney;Department of Liver Disease,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine)

机构地区：[1]上海中医药大学附属曙光医院肝病研究所,上海201203 [2]河南中医药大学第二附属医院肝胆脾胃科 [3]上海市中医临床重点实验室与肝肾疾病病证教育部重点实验室 [4]上海中医药大学附属曙光医院肝病科

出　　处：《中国中西医结合消化杂志》2024年第12期1071-1076,共6页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

基　　金：国家自然科学基金项目(No:82274305);上海市临床重点专科建设项目(No:shslczdzk01201)。

摘　　要：目的:探讨门窦血管性疾病(porto-sinusoidal vascular disorder,PSVD)患者的临床特点及其中医药治法用药经验。方法:回顾性收集2016年1月—2023年12月于我院经肝穿刺活检确诊的PSVD患者的临床资料、血清学及影像学检查资料。根据是否具有特征性门静脉高压表现分为门静脉高压组与非门静脉高压组,比较2组PSVD患者的临床特点、病理特征,并统计分析病情稳定或好转的随访患者的中医处方信息。结果:共收集47例患者,其肝功能、肾功能、凝血功能基本在正常范围,60%的患者血小板计数明显低于150×10^(9)/L,60%的患者伴有肝脏相关慢性疾病,临床表现以脾大最常见(89.36%),病理学表现以汇管区异常最常见(80.85%)。以是否具有特征性门静脉高压分层统计发现,门静脉高压组红细胞计数、血红蛋白、白蛋白显著减少,而D-二聚体显著升高,肝组织非带状肝窦扩张的比例显著增加、闭塞性门静脉病变累及汇管区更多。中医处方信息分析提示,黄芪、白术、党参等健脾益气与丹参、赤芍、当归等活血化瘀药物是2组PSVD的共性治法药物;非门静脉高压组重在益气健脾与活血化瘀,而门静脉高压组重在健脾补肾与活血破瘀。结论:PSVD可常见于病因明确的慢性肝病患者,以血小板减少、脾大、肝组织汇管区异常最为多见;伴有门静脉高压患者的肝组织闭塞性门静脉病变更严重、肝组织非带状肝窦扩张比例更高,中医治疗以益气健脾、活血化瘀为主要治法,门静脉高压患者可加用补益肝肾与破血逐瘀之品。Objective:To investigate the clinical characteristics and treatment with traditional Chinese medicine(TCM)for patients with porto-sinusoidal vascular disorder(PSVD).Methods:We retrospectively observed patients with PSVD diagnosed by liver biopsy at our hospital between January 2016 and December 2023,collected their data including clinical manifestations,serological and image findings at the time of liver biopsy.Patients were divided into two groups:portal hypertension(PH)and non-PH group.The clinical features,pathological characteristics and TCM applications in PSVD patients were analyzed,and the differences between PH and non-PH subgroups in PSVD were compared.Results:A total of 47 patients were included in the study.Their liver function,renal function,and coagulation function were within normal ranges.However,60%of the patients had lower level of platelet counts than 150×10^(9)/L.60%of the patients had chronic liver diseases,and the most common clinical manifestation was splenomegaly(89.36%).Histopathologically,periportal abnormalities were most frequently observed(80.85%).Stratified analysis based on the portal hypertension revealed that the PH group had significantly lower red blood cell counts,hemoglobin levels,and albumin levels,while D-dimer levels were significantly elevated.The proportion of hepatic non-zonal sinusoidal dilatation(NSD)and obliterative portal venopathy(OPV)were higher in the PH group.TCM prescription analysis indicated that the spleen-strengthening and qi-invigorating herbs such as Astragalus,Atractylodes,Codonopsis,and blood-activating and stasis-resolving herbs including Salvia miltiorrhiza,Paeonia rubra,Angelica sinensis were frequently used.But PSVD patients with non-PH took more herbs with qi tonification and spleen strengthening along with activating circulation,ones with PH took more herbs with spleen and kidney tonification and dissipating blood stasis.Conclusion:PVSD is commonly coexisted in patients of chronic liver diseases with identified etiologies,characterized by thrombocy

关 键 词：门窦血管性疾病 门静脉高压 中药 活血化瘀 用药特点 

分 类 号：R575[医药卫生—消化系统]