乙型肝炎肝硬化中医证型与超声弹性成像及肝功能Child-Pugh分级的相关性研究

发布时间：2018-01-23 21:21

本文关键词： 乙型肝炎肝硬化超声弹性成像辨证分型肝功能Child-Pugh分级　出处：《南京中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：初步探讨乙型肝炎肝硬化中医证型与超声弹性成像、肝功能Child-Pugh分级间的相关性,旨在寻找对乙型肝炎肝硬化辨证分型有意义的超声指标,探寻中医证候与西医检测指标的关联性,从而为乙型肝炎肝硬化的中医辨证赋予新的内涵,为中医辨证的客观化提供新的思路。方法：在综述肝硬化中医学认识、西医诊治进展和弹性超声应用前景的相关文献的基础上,由导师指导,参照相关诊断标准,制定“乙型肝炎肝硬化病情及检验、检查结果记录表”和“乙型肝炎肝硬化中医症状及辨证分型记录表”。研究者在导师指导下对符合诊断及纳入标准患者进行统一辨证分型,完善弹性超声检查及相关实验室检验,填写临床调查表,明确肝功能Child-Pugh分级。对收集的数据进行归纳整理并录入EXCEL,使用SPSS22.0进行统计处理并分析讨论结果。结果：本研究共纳入符合标准的江苏省中医院感染科病例103例,各证型患者的性别、年龄分布差异无统计学意义(P0.05),其中肝气郁结证患者例数与其他证型的差异具有统计学意义(P0.05)；各证型肝右叶最大斜径的差异均无统计学意义(P0.05)；湿热蕴结证患者胆囊长径与其他各证型的差异具有统计学意义(P0.05)；湿热蕴结证患者胆囊前后径与肝气郁结、脾肾阳虚证的差异具有统计学意义(P0.05),而与水湿内阻、肝肾阴虚、瘀血阻络证的差异无统计学意义(P0.05)；其余各证型间胆囊长径、胆囊前后径的差异均无统计学意义(P0.05)；瘀血阻络证患者脾脏肋间厚度、脾脏肋下长度与其他证型的差异具有统计学意义(P0.05)；肝气郁结证脾脏肋间厚度与水湿内阻证的差异具有统计学意义(P0.05)；其余各证型间脾脏肋间厚度、脾脏肋下长度的差异均无统计学意义(P0.05)；脾肾阳虚、瘀血阻络证患者门静脉内径与肝气郁结证的差异具有统计学意义(P0.05),而与水湿内阻、湿热蕴结、肝肾阴虚证的差异无统计学意义(P0.05)；瘀血阻络证患者门静脉平均血流速度与肝气郁结、水湿内阻证的差异具有统计学意义(P0.05),而与湿热蕴结、肝肾阴虚、脾肾阳虚证的差异无统计学意义(P0.05)；各证型脾静脉内径的差异均无统计学意义(P0.05)；肝气郁结、水湿内阻、湿热蕴结证患者肝脏ElastPQ均值与其他各证型的差异均具有统计学意义(P0.05)；肝肾阴虚、脾肾阳虚、瘀血阻络证患者与肝气郁结、水湿内阻、湿热蕴结证的差异具有统计学意义(P0.05),而肝肾阴虚、脾肾阳虚、瘀血阻络证之间的差异无统计学意义(P0.05)；肝气郁结、水湿内阻和湿热蕴结证肝功能Child-Pugh分级以A级为主,肝肾阴虚、脾肾阳虚和瘀血阻络证则以B、C级为主,各证型间相互对比,差异具有统计学意义(P0.05)；肝功能Child-Pugh分级为A、B、C级患者的肝脏ElastPQ均值分别为12.54±1.27、15.57±2.65、18.35±2.11 kPa,不同Child-Pugh分级患者ElastPQ均值的差异具有统计学意义(P0.05)。结论：胆囊长径可能适合作为乙型肝炎肝硬化湿热蕴结证辨证时的参考指标；脾脏肋间厚度、脾脏肋下长度可能适合作为乙型肝炎肝硬化瘀血内阻证辨证时的参考指标；ElastPQ均值可以较好地评估肝硬化程度,可能适合作为乙型肝炎肝硬化肝气郁结、水湿内阻、湿热内蕴证辨证时的参考指标,可能不适合作为乙型肝炎肝硬化肝肾阴虚、脾肾阳虚、瘀血阻络证辨证时的参考指标；肝右叶最大斜径、胆囊前后径、门静脉内径、门静脉平均血流速度、脾静脉内径可能不适合作为乙型肝炎肝硬化辨证分型的参考指标；乙型肝炎肝硬化早期的证型以肝气郁结、水湿内阻和湿热蕴结证为主,中晚期的证型则以肝肾阴虚、脾肾阳虚和瘀血阻络证为主。乙型肝炎肝硬化中医证型与超声弹性成像、肝功能Child-Pugh分级间存在着相关性,随着肝硬化病情的进展,中医证型分布呈现动态变化,超声弹性成像亦表现出不同的特征,这些变化特征与中医理论关于肝硬化“气滞、水停-湿热、阴虚-阳虚、瘀血”的病机演变规律基本吻合。临床中乙型肝炎肝硬化的中医辨证可参考超声弹性成像的内容,以提高辨证的准确性。
[Abstract]:Objective: To investigate the hepatitis B cirrhosis TCM syndrome and ultrasound elastography, the correlation between Child-Pugh classification of liver function, in order to find the ultrasound indexes of hepatitis B cirrhosis syndrome type has the significance, explore the relationship of TCM syndrome and Western medicine detection index, from and for traditional Chinese medicine syndrome of hepatitis B cirrhosis given new connotation, provide new ideas for TCM syndrome differentiation. Methods: review of liver cirrhosis in TCM, western medicine diagnosis and treatment progress of related literatures and elastic ultrasonic applications on the instructor, referring to the related diagnostic criteria, formulation of the "disease of hepatitis B cirrhosis and the examination, examination results record" and "TCM symptoms and syndrome differentiation hepatitis B cirrhosis type record sheet. Researchers under the guidance of the teacher according to the diagnostic and inclusion criteria were unified syndrome differentiation, improve the super elastic Acoustic inspection and related laboratory tests, fill in clinical questionnaire, clear liver function Child-Pugh classification. The collected data were collated and entered the EXCEL, using SPSS22.0 for statistical processing and analysis to discuss the results. Results: the study included standard 103 cases of infectious diseases of Jiangsu Province Traditional Chinese Medicine Hospital, the syndromes in patients with gender, age distribution difference no statistical significance (P0.05), the difference was statistically significant in patients with liver qi stagnation syndrome cases and other syndromes (P0.05); the syndrome of right hepatic lobe maximum oblique diameter had no significant difference (P0.05); statistically significant rdhs patients with gallbladder diameter and other syndromes (differences P0.05); after rdhs patients with gallbladder size and liver qi stagnation, the difference was statistically significant the spleen kidney yang deficiency syndrome (P0.05), and water and dampness, liver kidney yin deficiency, blood stasis syndrome There was no statistically significant difference (P0.05); the rest of various types of gallbladder diameter, the diameter of the gallbladder before and after the differences were not statistically significant (P0.05); blood stasis syndrome in patients with spleen intercostals thickness, the difference was statistically significant in length with other syndromes of spleen rib (P0.05); the statistical significance of liver qi stagnation syndrome of spleen intercostal the thickness and water dampness syndrome difference (P0.05); the rest of the thickness of spleen intercostal each card type, the spleen rib length differences were not statistically significant (P0.05); Yang deficiency of spleen and kidney, the difference was statistically significant in patients with blood stasis syndrome of portal vein diameter and the stagnation of liver Qi stasis (P0.05), and water dampness, damp and hot, there was no significant difference in liver kidney yin deficiency syndrome (P0.05); blood stasis syndrome in patients with portal vein blood flow velocity and stagnation, the difference was statistically significant water dampness syndrome (P0.05), and heat accumulation, liver There was no significant difference between yin deficiency, spleen kidney yang deficiency syndrome (P0.05); the difference of each syndrome type of splenic vein were not statistically significant (P0.05); liver qi stagnation, water dampness, damp heat syndrome of liver in patients with differences in mean ElastPQ and other syndromes were statistically significant (P0.05); Yin deficiency of liver and kidney spleen, kidney yang deficiency, blood stasis syndrome and liver qi stagnation, dampness resistance, the difference was statistically significant in the rdhs (P0.05), and liver kidney yin deficiency, spleen kidney yang deficiency, there was no significant difference between the blood stasis syndrome (P0.05); liver qi stagnation, water dampness and damp heat syndrome of liver Child-Pugh class to class A, liver kidney yin deficiency, spleen kidney yang deficiency and blood stasis syndrome in B, C level, the comparison between the various syndromes, the difference was statistically significant (P0.05); liver function Child-Pugh grade A, B, C level in patients with liver ElastPQ was 1 2.54 + 1.27,15.57 + 2.65,18.35 + 2.11 kPa, the difference was statistically significant in patients with different grades of Child-Pugh average ElastPQ (P0.05). Conclusion: the gallbladder diameter may be suitable as a reference index of hepatitis B cirrhosis of stagnation of damp heat syndrome of the spleen; spleen intercostals thickness, rib length may be suitable as a reference index of blood stasis resistance syndrome of hepatitis B cirrhosis the mean value of ElastPQ; can better assess the degree of liver cirrhosis, hepatitis B cirrhosis may be suitable as liver qi stagnation, water dampness, damp heat syndrome of the reference index, may not be suitable as the hepatitis B cirrhosis of liver kidney yin deficiency, spleen kidney yang deficiency, blood stasis syndrome index of right hepatic lobe maximum oblique; gallbladder diameter, anteroposterior diameter, portal vein diameter, mean blood flow velocity of portal vein, splenic vein may not be suitable as hepatitis B cirrhosis syndrome The reference index type; early hepatitis B cirrhosis of the liver qi stagnation syndrome, water dampness and damp heat syndrome, syndrome of late in liver kidney yin deficiency, spleen kidney yang deficiency and blood stasis syndrome. Hepatitis B cirrhosis TCM syndrome and ultrasound elastography, Child-Pugh classification of liver function between a correlation with the progress of liver cirrhosis, the distribution of TCM syndromes showed dynamic changes, ultrasound elastography also showed different characteristics, the characteristics of these changes and the theory of traditional Chinese medicine on liver cirrhosis "qi stagnation, water stop heat, Yin - Yang, evolution of pathogenesis of blood stasis" are basically consistent. TCM clinical hepatitis B cirrhosis the reference of ultrasound elastography, in order to improve the accuracy of diagnosis.

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

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