226例病毒性肝炎肝硬化代偿期中医证型与肝脏硬度值的临床资料调查

发布时间：2018-01-07 15:21

本文关键词：226例病毒性肝炎肝硬化代偿期中医证型与肝脏硬度值的临床资料调查　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对226例病毒性肝炎肝硬化代偿期患者中医证型与肝脏硬度值临床资料调查结果的分析,为病毒性肝炎肝硬化代偿期中医分型的客观化提供科学依据,并为预测疾病发展及早期进行中医药干预治疗改善预后提供依据。方法:采用横断面研究,收集2015年01月至2016年10月在新疆维吾尔自治区中医院(新疆医科大学附属中医医院)门诊及住院部就诊的病毒性肝炎肝硬化代偿期患者,严格按照试验设计进行中医望闻问切辨证,结合专家的诊断结果以确定证型,观察患者肝脏硬度值(FibroTouch结果),并将所获得资料进行统计学处理及分析,分析其特点及规律,最终得出该病不同中医证型与人口学项目、肝脏硬度、肝炎类型、Child-pugh评分、BMI、PLT、ALT、AST、AST/PLT(APRI)、AST/PLT、TBIL、ALP、r-GGT、ALB、PT、APTT之间的差异或相关性。结果:(1)226例病毒性肝炎肝硬化代偿期患者中男性患病率显高于女性,不同性别之间的中医证型分布有差异性(P=0.0050.05),不同职业及文化之间中医证型分布无差异性(P=0.061、P=0.8740.05);不同中医证型对肝脏硬度有显著影响(P=0.0020.05),不同性别、职业及文化程度对肝脏硬度值无显著影响(P=0.196、P=0.218、P=0.0940.05),不同中医证型与不同性别、职业及文化程度的交互对肝脏硬度值无显著影响(P=0.379、P=0.429、P=0.4400.05);(2)不同肝硬化疾病类型之间肝脏硬度有差异性,以丙肝类型为重(P=0.0230.05);新疆地处西北干燥质地,具有其独特证型分布,以肝郁脾虚型及肝肾阴虚型为主,各证型肝脏硬度之间有显著差异(P=0.0020.05),其肝脏硬度值大小顺序依次为肝郁血瘀型湿热内蕴型肝肾阴虚型脾虚湿盛型脾肾阳虚型肝郁脾虚型;患者Child-pugh评分对中医证型分布无显著影响(P=0.0610.05),不同中医证型、患者Child-pugh评分的高低对肝脏硬度值的影响有统计学意义(P=0.002、P=0.0320.05);不同中医证型的BMI之间有极显著差异性(P=0.0010.05),在肝肾阴虚型、脾肾阳虚型BMI与肝脏硬度值之间有线性相关性(P=0.021、P=0.0200.05);(3)不同中医证型的PLT、ALT、AST、AST/PLT(APRI)、ALB之间有显著差异性(P均0.05);不同中医证型的TBIL、ALP、r-GGT、PT、APTT之间无差异性(P均0.05);肝脏硬度值与PLT、ALT、AST/PLT(APRI)、TBIL、ALB、PT、APTT之间均存在线性相关性,肝脏硬度值与AST/PLT(APRI)、中医证型之间线性关系极其显著(P0.01)。结论:本次课题验证了病毒性肝炎肝硬化代偿期患者的中医分型与肝脏硬度值有较高的相关性,相关实验室指标也均能在不同角度反映其与中医证型、肝脏硬度值的关联性。
[Abstract]:Objective: to analyze the clinical data of 226 patients with liver cirrhosis in compensatory stage of viral hepatitis. To provide scientific basis for the objectivity of TCM classification in compensatory stage of viral hepatitis cirrhosis and to predict the development of disease and to improve the prognosis by early intervention of TCM. Methods: Cross-sectional study was adopted. From January 2015 to October 2016, we collected the compensated patients of viral hepatitis cirrhosis in outpatient and inpatient department of Xinjiang Uygur Autonomous region Hospital of traditional Chinese Medicine (affiliated traditional Chinese Medicine Hospital of Xinjiang Medical University). According to the experimental design strictly according to the traditional Chinese medicine look and smell question syndrome differentiation, combined with the expert diagnosis results to determine the syndrome type, observe the patient liver hardness value FibroTouch results). The obtained data were statistically processed and analyzed, and their characteristics and laws were analyzed. Finally, different TCM syndromes and demographic items, liver hardness, hepatitis type and Child-pugh score were obtained. BMI-PLT / alt / AST / AST / PLT / APRIK / AST / PLT / TBI / ALPER-GGTT / ALBUT / PT / AP / PLT / T / L / T / T / T / T / T / T / T / T / T / T / T / T. Results the prevalence rate of male was significantly higher than that of female in the compensatory stage of viral hepatitis cirrhosis. The distribution of TCM syndromes was different among different sexes (P0. 0050.05A), and there was no difference between different occupations and cultures in the distribution of TCM syndromes (P0. 061). Pe 0.8740.05; Different TCM syndromes had significant influence on liver hardness, but different sex, occupation and education had no significant influence on liver hardness. The interaction of different TCM syndromes with different gender, occupation and education level had no significant effect on liver hardness. P0. 4400.05; (2) there were differences in liver hardness among different types of liver cirrhosis. Xinjiang is located in the northwest dry texture, with its unique distribution of syndrome type, mainly liver stagnation and spleen deficiency type and liver and kidney yin deficiency type, there is a significant difference in liver hardness between each syndrome type (P < 0.0020.05). The order of liver hardness value is liver depression and blood stasis type dampness and heat accumulation type liver and kidney yin deficiency type spleen deficiency type spleen kidney yang deficiency type liver stagnation and spleen deficiency type; The Child-pugh score had no significant effect on the distribution of TCM syndromes. The effect of Child-pugh score on liver hardness was statistically significant (P < 0. 002, P < 0. 0320.05). The BMI of different TCM syndromes had very significant difference (P < 0. 0010. 05), which was in the type of deficiency of liver and kidney yin. There was a linear correlation between BMI and liver hardness in spleen and kidney yang deficiency type. (3) there were significant differences among different TCM syndromes of PLT / AST, AST / AST and APRIZH ALB (P < 0.05). There was no significant difference in APTT between different TCM syndromes of TBILL ALPER-GGTN PTT and TBILL (P < 0.05). There was a linear correlation between the liver hardness and the APTT of alt / PLT / APRI. Liver hardness and AST / PLT APRI. The linear relationship between TCM syndromes is extremely significant P0.01.Conclusion: this subject verifies that there is a high correlation between TCM classification and liver hardness in patients with liver cirrhosis compensatory stage of viral hepatitis. The related laboratory indexes can also reflect the correlation with TCM syndrome type and liver hardness in different angles.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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