基于循证医学中医诊治自身免疫性肝炎的临床证据分析研究

发布时间：2018-01-11 02:32

本文关键词：基于循证医学中医诊治自身免疫性肝炎的临床证据分析研究　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：研究目的：针对中医药诊治自身免疫性肝炎,系统查找证据,整理、挖掘、提炼中医药治疗自身免疫性肝炎的有效方法、手段,并通过德尔菲法专家问卷调查进一步凝练,以期为中医药诊治自身免疫性肝炎临床诊疗方案、临床路径、中医指南的制定提供依据。研究方法：在全面了解自身免疫性肝炎中西医研究现状的基础上,以“自身免疫性肝炎”、“病名”、“临床表现”、“临床特点”、“名中医”、“经验”、 “中医”、“中西医”等为主题词,利用检索工具,检索、查阅相关文献,并运用“改良Jadad量表”、"MINORS评价条目”、“中医文献依据分级标准”对相关文献进行文献评价,运用频数统计、聚类分析、复杂网络技术等对相关文献进行分析,得出自身免疫性肝炎中医病名、中国患者临床特点、中医证治等方面文献信息。对文献调研结果进行比较、分析、筛选,并经院内专家小组讨论,按照德尔菲专家调查方法,制定《中医药诊治自身免疫性肝炎专家问卷调查表》,向全国范围内26位中医或中西医结合临床肝病学专家进行问卷调查,根据问卷结果进行统计分析,凝练中医药诊治自身免疫性肝炎证据。研究结果：1.文献研究结果：通过中医病名文献研究,对出现的中医病名进行频数统计分析,结果显示涉及18个中医病名称谓,出现频次较高的中医病名有：黄疸、胁痛。通过对自身免疫性肝炎中国患者临床特点文献研究发现,中国患者女性比率较高；常见症状为乏力、黄疸、纳差、腹胀；常见体征为黄疸、慢性肝病体征。通过对自身免疫性肝炎相关病案中医证治分析发现,涉及中医病位5个,主要位于肝、脾、肾；涉及中医病性13种,但以血瘀、湿、热、气滞、气虚、阴虚为多见；涉及中医证型13种,但常见的中医证型为瘀血阻络证、湿热内蕴证、肝郁脾虚证、肝肾阴虚证、肝气郁滞证；涉及169味中药,28首中药方剂,通过频数分析发现常用方剂为茵陈蒿汤、自拟方、柴胡疏肝散、逍遥散、小柴胡汤、一贯煎,通过聚类分析后发现药物构成以茵陈蒿汤、逍遥散为主方；通过频数分析发现常用中药为茵陈、甘草、赤芍、柴胡、白术、茯苓、丹参、黄芩、白芍、黄芪、当归、大黄、茜草、桃仁、牡丹皮；通过聚类分析发现常用中药分类以补虚药、清热药、利水渗湿药、活血化瘀药为主；通过复杂网络分析发现治疗不伴有黄疸的自身免疫性肝炎的核心药物为柴胡、白术、白芍、茯苓、甘草、当归、黄芪等；治疗伴有黄疸的自身免疫性肝炎的核心药物为茵陈、大黄、赤芍、黄芩等。2.专家问卷调查结果：运用德尔菲法进行专家咨询发现：①中医病名：被咨询专家建议最多的中医病名为胁痛、黄疸,但专家意见满分较低,提示专家意见集中程度不高,有待于进一步研究。②中医病因：先天不足在中医病因中贡献度大,专家意见集中程度、协调程度高,七情所伤、饮食失宜作为本病常见中医病因,虽然专家意见集中程度较高,但专家意见协调程度较低,需进一步研究。⑧临床表现：本病常见症状为精神疲倦、乏力、纳差；常见体征为脾大；常见舌脉为舌有瘀斑、苔薄、苔黄、脉弦。④中医辨证：脏腑辨证为本病常用中医辨证方法；主要中医病位在肝、脾、肾；中医病性以虚实夹杂多见,虚则常见气虚、阴虚,实则常见气滞、血瘀、湿热、痰浊；血瘀质、湿热质、气郁质、气虚质、阴虚质为本病常见中医体质,而痰湿质、特禀质作为本病中医体质,虽专家意见集中程度较高,但专家意见协调程度较低,专家意见分歧较大,有待于进一步研究。⑤治疗：中医药治疗本病具有一定的优势,主要在于缩短激素使用疗程或减少激素剂量,激素禁忌症或不耐受激素患者的治疗,个体化治疗,减轻激素副作用,护肝降酶,减少复发,改善临床不适症状,提高患者生活质量；对于不同病情的患者推荐轻度患者单纯中医药治疗,中度、重度患者中西医结合治疗；本病常见中医证型为肝郁脾虚、肝肾阴虚,而瘀血阻络、湿热蕴结、痰湿内蕴证虽然专家意见集中程度较高,但专家意见协调程度低,有待进一步研究；肝郁脾虚证常用方剂为柴芍六君子汤、逍遥散、柴胡疏肝散,肝肾阴虚证常用方剂为一贯煎。研究结论：1.自身免疫性肝炎可归属于中医学“胁痛”、“黄疸”范畴,但目前尚无接受度高、普遍认可的自身免疫性肝炎中医病名,有待于进一步研究。2.自身免疫性肝炎中医病因复杂,先天不足为本病常见中医病因。3.自身免疫性肝炎临床表现多样,乏力、精神疲倦、纳差、脾大为常见症状、体征,舌有瘀斑、苔薄、苔黄、脉弦为常见舌脉。4.自身免疫性肝炎中医辨证以脏腑辨证为宜,中医病位主要位于肝、脾、肾,中医病性复杂,以虚实夹杂多见,虚则常见气虚、阴虚,实则以气滞、血瘀、湿热、痰浊为主。5.血瘀质、湿热质、气郁质、气虚质、阴虚质为自身免疫性肝炎常见的中医体质类型。6.肝郁脾虚证、肝肾阴虚证为自身免疫性肝炎常见中医证型。
[Abstract]:Objective: To study TCM diagnosis and treatment of autoimmune hepatitis, find evidence system, consolidation, mining, means, extraction of traditional Chinese medicine in the treatment of autoimmune hepatitis, and Delphy Fa through the questionnaire survey of experts in order to further refine, plan, clinical diagnosis and treatment of Chinese medicine for the treatment of autoimmune hepatitis, clinical pathway, provide a guide to Chinese medicine on the basis of making. Methods: Based on a thorough knowledge of Western Medicine Research of autoimmune hepatitis on "autoimmune hepatitis", "disease", "clinical", "clinical characteristics", "traditional Chinese medicine", "experience", "Chinese medicine" and "western medicine" etc. subject headings, use of retrieval tools, retrieval, access to relevant literature, and using the modified Jadad scale "," MINORS "evaluation items, according to the classification standard of Chinese Literature" literature evaluation of relevant literature, the use of frequency system Meter, clustering analysis, analysis of complex network technology and so on the related literature, the autoimmune hepatitis TCM clinical characteristics of China patients, TCM treatment and other aspects of literature information. Literature research results were compared, analysis, screening, expert group and scholastic discussions, according to Delphy expert investigation method, making "Chinese medicine medicine for the treatment of autoimmune hepatitis expert questionnaire", to a nationwide 26 TCM or combining traditional Chinese and Western Medicine Clinical Hepatology experts conducted a questionnaire survey, statistical analysis was carried out according to the questionnaire results, concise Chinese medicine for the treatment of autoimmune hepatitis evidence. Results: 1. literature research results: through the TCM literature research, frequency statistical analysis of the TCM results involving 18 TCM terms, high frequency TCM disease name: jaundice, hypochondriac pain. The free The clinical features of patients with hepatitis China disease literature study found that women with higher China ratio; the common symptoms were fatigue, anorexia, jaundice, abdominal distension; common signs of jaundice, signs of chronic liver disease. The autoimmune hepatitis related medical records of TCM analysis found that relates to traditional Chinese medicine disease 5, mainly in the liver and spleen. Renal disease; TCM relates to 13, but in the wet, heat, blood stasis, qi stagnation, Qi deficiency, yin deficiency is more common; relates to TCM syndrome type 13, but for the common TCM Syndromes of blood stasis syndrome, damp heat syndrome, liver stagnation and spleen deficiency, liver kidney yin deficiency, liver qi stagnation syndrome involves 169 kinds of; 28 the first prescription of traditional Chinese medicine, traditional Chinese medicine, through frequency analysis we found that the commonly used prescription for Yinchenhao Decoction, decoction, CHSGS, Xiaoyaosan, Xiaochaihutang, Yiguanjian, through cluster analysis found that the drug composition with Yinchenhao Decoction of Xiaoyao Powder, mainly through frequency analysis we found that the party; The commonly used Chinese medicine wormwood, Radix Glycyrrhizae, radix paeoniae rubra, Radix Bupleuri, Atractylodes, Poria, radix salviae miltiorrhizae, Radix Scutellariae, Radix Paeoniae Alba, Radix Astragali, angelica, rhubarb, peach kernel, madder, cortex moutan; through cluster analysis found that the commonly used Chinese medicine classification to tonic, antipyretic, diuretics for eliminating dampness, promoting blood circulation and removing blood stasis; through the analysis of the complex network to find the core of drug treatment without jaundice of autoimmune hepatitis for bupleurum, Atractylodes, Radix Paeoniae Alba, Poria, licorice, angelica, Astragalus and other drugs in the treatment of jaundice; core of autoimmune hepatitis wormwood, rhubarb, radix paeoniae rubra, Radix Scutellariae and.2. expert questionnaire survey results: the use of Delphy Fa to consult the experts found the Chinese the illness: by consulting experts recommend the most TCM for chest pain, jaundice, but expert opinion out of low, suggesting that the concentration of expertise is not high, need to be further studied. The etiology of Chinese medicine: Chinese medicine in congenitally deficient The cause of large contribution, the concentration of expertise, coordination degree is high, hurt by seven emotions, improper diet as the common disease of TCM etiology, although expert opinion the high degree of concentration, but the expert opinion coordination degree is low, need further study. The clinical manifestations of this disease: common symptoms of mental fatigue, fatigue, anorexia; common signs of splenomegaly; common tongue, tongue with ecchymosis, moss thin, yellow moss, pulse string. The TCM syndrome: syndrome differentiation is commonly used in TCM for the disease; TCM disease in the liver, spleen and kidney disease; traditional Chinese medicine mixed with the actual situation of rare, deficiency of Qi Yin deficiency, in common, common qi stagnation damp heat, phlegm, blood stasis, blood stasis;, dampness heat, qi stagnation, Qi deficiency, yin deficiency is the commonest constitution of traditional Chinese medicine, and phlegm, intrinsic quality as the TCM Constitution, although the concentration of expertise is high, but the expert opinion coordination degree is low, specially A large differences of opinion, needs further study. The treatment: Chinese medicine in the treatment of this disease has certain advantages, mainly is to shorten the hormone treatment or reducing the dose of hormone, hormone or hormone therapy in patients with contraindications to intolerance, individualized treatment, reduce the side effects of hormone, liver protection, reduce recurrence, improve the clinical the symptoms, improve the quality of life of patients with moderate disease; for different patients is recommended in patients with mild pure Chinese medicine treatment, patients with severe combined treatment of TCM and Western medicine; Common TCM Syndromes of this disease is liver stagnation and spleen deficiency, liver kidney yin deficiency, and blood stasis, phlegm dampness syndrome of damp heat accumulation, although expert opinion the high degree of concentration, but the coordination degree of expert opinion is low, need to be further studied; liver stagnation and spleen deficiency syndrome prescriptions for Chaishao Decoction of six noble, Xiaoyaosan, CHSGS, liver kidney yin deficiency syndrome common party agent Yiguanjian on. Theory: 1. autoimmune hepatitis can be attributed to the traditional Chinese medicine "hypochondriac pain", "jaundice" category, but there is no high degree of acceptance, autoimmune hepatitis of TCM diseases generally recognized, needs further study in TCM autoimmune hepatitis.2. complicated etiology, clinical manifestations of this disease are congenitally deficient common etiology of Chinese Medicine.3. a variety of autoimmune hepatitis, fatigue, mental fatigue, anorexia, splenomegaly is common symptoms, signs, tongue with ecchymosis, moss thin, yellow moss, pulse string for TCM common tongue vein.4. autoimmune hepatitis with TCM syndrome differentiation is appropriate, the disease mainly in the liver, spleen, kidney disease, TCM complex, to deficiency of rare, deficiency of Qi Yin deficiency, but in common, qi stagnation, blood stasis, phlegm heat, blood stasis based.5., damp heat, qi stagnation, Qi deficiency, yin deficiency is a common autoimmune hepatitis of TCM Constitution Types in.6. of liver stagnation and spleen deficiency syndrome, yin deficiency of liver and kidney It is a common TCM syndrome type of autoimmune hepatitis.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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