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.
Abstract
Objective To explore the syndrome elements and evolving patterns of patients with hepatitis B virus-related acute on chronic liver failure(HBV-ACLF)at different stages.Methods Clinical information of 1,058 hospitalized 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 in-vestigate 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 in-formation.Factor analysis and cluster analysis were employed to determine and statistically analyze the syndrome ele-ments 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 defi-ciency(20.4％,31/152),and the patterns were dominated by qi deficiency and blood stasis pattern(36.5％,31/85),and liver-gallbladder damp-heat pattern(25.9％,22/85).Conclusion There are significant differences in the distribution of syndrome elements and patterns at different stages of HBV-ACLF,presenting an overall trend of evolving patterns as"from excess to deficiency,transforming from excess to deficiency",which is damp-heat → blood stasis → qi-blood yin-yang deficiency.
基金项目
国家自然科学基金(82305067)
国家科技重大专项(2018ZX10725-506)
国家科技重大专项(2012ZX10005005)
国家科技期刊平台
NSTL
万方数据