病毒性肝炎肝硬化患者血脂水平与病情程度及病性类证候要素的关系

发布时间：2018-02-12 08:55

  本文关键词： 病情程度 病毒性肝炎肝硬化 血脂 证候要素 藏象　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：病毒性肝炎肝硬化是由肝炎病毒长期作用于肝脏引起的一种慢性、进行性、弥漫性肝病,随病情发展,不同程度的影响肝脏的正常生理功能。肝脏是人体脂质代谢的主要脏器,同时参与内源性与外源性脂质的代谢。故病毒性肝炎肝硬化的发生发展所导致的肝脏生理功能受损,可能影响人体脂质的正常代谢。从中医学理论角度来说,一般将本病归属于黄疸、胁痛等范畴,其发生与肝藏血主疏泄功能失调密切相关。本研究基于流行病学横断面调查,分别从现代医学角度分析不同病情程度,病毒性肝炎肝硬化患者的血脂水平特点,从中医学角度分析不同病性类证候要素,患者血脂水平的特点,目的在于探讨肝脏在血脂代谢中的地位与作用。第一章病毒性肝炎肝硬化患者不同病情程度的血脂水平特点目的比较病毒性肝炎肝硬化患者不同病情程度的血脂水平特点。方法采用流行病学横断面调查方法,收集来自9所合作医院的门诊或住院的病毒性肝炎肝硬化患者的临床信息,检测患者血脂、肝功能指标,运用SPSS统计软件分析代偿期、失代偿期,不同Child-Pugh分级,患者血脂水平的差异;分析肝功能指标与血脂水平的相关性。总结肝实质功能受损时,血脂水平的特点。结果1.代偿期患者TC、TG、HDL、LDL指标的检测值均高于失代偿期,其中两期患者的HDL水平都低于正常值。代偿期、失代偿期患者的四项血脂指标的差异均有统计学意义(P0.05)。2.随Child-Pugh分级评分的升高,病毒性肝炎肝硬化患者TC、TG、HDL、LDL指标的均值都降低,结果显示A、B、C三级间血脂指标的差异有统计学意义(P0.05)。3.相关性分析结果显示,14项肝功能指标中,TP、ALB、PA、TBIL、GGT、CHE六项指标与血脂指标相关性较高。比较肝功能指标异常时血脂水平的特点,发现TP、ALB、PA、CHE降低时,TC、TG、HDL、LDL均值都低于TP、ALB、PA、CHE未降低组(P0.05);TBIL升高时,四项血脂指标均值都低于TBIL未升高组(P0.05)。结论病毒性肝炎肝硬化患者随病情程度加重,肝实质功能受损也加重,可导致血脂降低,且肝功能受损程度越重,血脂降低越明显。第二章病毒性肝炎肝硬化患者病性类证候要素与血脂水平的关系目的分析病毒性肝炎肝硬化患者肝藏血主疏泄生理功能失调时,不同病性类证候要素的血脂水平特点。方法采用流行病学横断面调查方法,收集来自9所合作医院的门诊或住院的病毒性肝炎肝硬化患者的临床信息,检测患者血脂指标。参照病毒性肝炎肝硬化患者常见病性类证候要素的辨识标准及课题组专家意见,判定患者所属病性类证候要素。运用SPSS统计软件分析不同病性类证候要素的血脂水平特点并比较组间差异。结果1.比较病毒性肝炎肝硬化患者不同病性类证候要素的血脂水平,发现血瘀组、湿热组、阳虚组、气虚组患者TC、HDL、LDL的均值分别低于非血瘀组、非湿热组、非阳虚组、非气虚组的患者,且差异有统计学意义(P0.05);阴虚组患者的TG均值低于非阴虚组患者,且差异有统计学意义(P0.05);气滞组患者TC、LDL的均值都高于非气滞组的患者,且差异有统计学意义(P0.05);水停组患者TC、TG、HDL、LDL的均值都低于非水停组的患者,且四项血脂指标的差异都有统计学意义(P0.05)。2.比较病毒性肝炎肝硬化患者不同血脂水平病性类证候要素的构成比,结果显示TC水平降低的患者在气虚组中所占的比例(43.2%)高于非气虚组(25.0%),在水停组中所占的比例(50.4%)明显高于非水停组(17.6%);TG水平降低的患者在血瘀组中所占的比例(15.6%)高于非血瘀组(8.5%),在阴虚组中所占的比例(15.2%)高于非阴虚组(10.2%),在水停组所占的比例(18.5%)高于非水停组(6.0%);HDL水平降低的患者在血瘀组中所占的比例(66.0%)高于非血瘀组(56.4%),在阳虚组中所占的比例(68.0%)高于非阳虚组(56.1%),在水停组所占的比例(69.4%)高于非水停组(53.5%);LDL水平降低的患者在水停组所占的比例(45.6%)高于非水停组(32.0%)。以上差异均有统计学意义(P0.05)。结论病毒性肝炎肝硬化患者病性类证候要素的判定对血脂水平有影响,研究结果显示气虚、水停这两类病性类证候要素的患者相对于非气虚、非水停的患者更易出现TC水平降低;血瘀、阴虚、水停这三类病性类证候要素的患者相对于非血瘀、非阴虚、非水停的患者,更易出现TG水平降低;血瘀、阳虚、水停这三类病性类证候要素的患者相对于非血瘀、非阳虚、非水停的患者,更易出现HDL水平降低;水停这一病性类证候要素的患者相对于非水停的患者更易出现LDL水平降低。
[Abstract]:Viral hepatitis cirrhosis is a chronic hepatitis virus, by the long-term effects on the liver caused by progressive, diffuse liver disease, with the progression of the disease, affect the normal physiological function of the liver in different degree. The liver is the main organ of body lipid metabolism, and participate in the endogenous and exogenous lipid metabolism. Liver function caused by the occurrence of the development of the viral hepatitis and cirrhosis of the damage may affect the normal metabolism of the body lipid. From the theory of traditional Chinese medicine perspective, the disease belongs to the category of jaundice, hypochondriac pain, and the liver storing blood disorders are closely related. This study based on the investigation of epidemiology, respectively, analysis of different severity from the angle of modern medicine, lipid levels in patients with viral hepatitis and cirrhosis, from the analysis of the different nature of syndrome factors of TCM, characteristics of blood lipid level, Objective to investigate the status and role of the liver in lipid metabolism. To compare the lipid levels in the first chapter of viral hepatitis in patients with liver cirrhosis of different severity of lipid levels in patients with different severity of viral hepatitis cirrhosis. Methods using cross-sectional survey methods, clinical information collected from 9 cooperative hospital outpatient or inpatient viral in patients with liver cirrhosis, detection blood lipid, liver function index, analysis of compensation period using SPSS statistical software, decompensation, the levels of Child-Pugh, blood lipid level in patients with difference; correlation analysis of liver function indexes and blood lipids levels. Summarize the liver function damage, the characteristics of blood lipid level. Results of 1. patients with decompensated TC TG, HDL, LDL, detection index values were higher than the decompensated, which two patients with HDL levels were lower than normal value. The compensatory stage of decompensation Four blood lipids of patients with statistically significant difference (P0.05) of.2. increased with the Child-Pugh score, TC, TG in patients with viral hepatitis and cirrhosis, HDL, mean LDL index was lower, the result shows that A, B, the difference was statistically significant between the three levels of blood fat index C (P0.05).3. correlation analysis results show that the 14 indexes of liver function, TP, ALB, PA, TBIL, GGT, CHE six and blood lipid indexes have high correlation. Liver function index, abnormal blood lipid levels found in TP, ALB, PA, CHE, TC, TG decreased, HDL, LDL, TP and ALB are lower than the average. PA, CHE, did not reduce the group (P0.05); TBIL elevated, four blood lipids are lower than the mean TBIL (P0.05). The group did not increase with the severity of patients with viral hepatitis cirrhosis, liver function damage also increased, can lead to lowering blood lipids, and the degree of liver function damage is heavier, more reducing blood lipid the second chapter is obvious. Objective to analyze the relationship between viral hepatitis cirrhosis patients with the syndrome elements of disease nature and blood lipid level in patients with viral hepatitis and cirrhosis liver Tibet blood function physiological disorders, lipid levels in different disease nature syndrome elements. Using the method of cross-sectional survey method, clinical information collected from 9 cooperative hospital outpatient or hospitalization the hepatitis B virus in patients with liver cirrhosis, serum lipids were detected. The identification standard of viral hepatitis cirrhosis patients with common syndrome elements of disease nature and research group of experts, determining the patients belong to the syndrome elements of disease nature. Blood lipid level analysis of different characteristics of nature of syndrome factors were compared between the groups using the the SPSS statistical software. The results of 1. viral hepatitis cirrhosis patients with different syndrome elements of disease nature found that the level of serum lipid, blood stasis group, damp heat group, Yang deficiency, Qi Deficiency Patients 鑰匱C,HDL,LDL鐨勫潎鍊煎垎鍒�浣庝簬闈炶。�

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