原发性胆汁性肝硬化（原发性胆汁性胆管炎）病例回顾性研究

发布时间：2018-04-09 18:33

  本文选题：胆汁性肝硬化　切入点：原发性胆汁性胆管炎　出处：《辽宁中医药大学》2017年硕士论文

【摘要】：研究目的:通过本研究,明确PBC患者临床特点、中医证型分布情况、各中医证型与Child-Pugh肝功能分级的关系,探讨各个证型与多项理化指标之间的相关性,对中医规范化辨治本病及评估患者预后提供一定依据。研究方法:采用回顾性研究,即收集符合纳入标准的患者的病历资料,对患者的一般情况、症状、体征、理化检测结果进行分析总结。按照《中医常见证诊断标准》[1-2]对纳入研究的患者进行中医证型诊断,根据Child-Pugh标准对各患者进行肝功能评分并分级,应用Logistic回归法进行所有研究对象的多项理化指标与各中医证型之间的相关性分析。研究结果:1.被纳入研究的96例患者中,男性患者12例,女性患者84例,男女比例1:7,发病年龄最小20岁,最大76岁,平均发病年龄(56.87±13.57)岁;2.根据临床表现出现频率的高低排序,前6项依次为:神疲乏力(93.75%)、食少纳差(87.5%)、胁胀(81.25%)、皮肤瘙痒(78.125%)、寐差(68.75%)、胁痛(59.375%);3.具体中医证型及其分布情况为:肝郁脾虚证39例、肝肾阴虚证15例、肝郁血瘀证6例、肝胆湿热证23例及脾肾阳虚证13例;4.肝功能属Child-Pugh A级患者共33例,属Child-Pugh B级的患者共51例,Child-P ugh C级的患者共12例,肝郁脾虚证及肝肾阴虚证患者的Child-Pugh分级均为A级和B级,肝胆湿热证及脾肾阳虚证的患者肝功能分级为B级和C级,肝郁血瘀证患者的肝功能在三个级别均有分布;5.ALP、ALB与诊断肝肾阴虚证呈正相关,GGT与诊断肝郁血瘀证呈正相关,TBi L与诊断肝胆湿热证呈正相关,脾肾阳虚证的相关预测因素有ALB、TBi L及脾面积大小。肝郁脾虚证的回归结果显示无任何一项协变量具有统计学意义。结论:1.PBC患者最常出见神疲乏力、食少纳差、胁胀、皮肤瘙痒、寐差、胁痛及便溏的临床表现,就诊患者的肝功能多数属于Child-Pugh B级;2.本病主要累及肝、脾、肾三脏,涉及中医证型包括肝郁脾虚证、肝肾阴虚证、肝郁血瘀证、肝胆湿热证及脾肾阳虚证。肝郁脾虚证及肝肾阴虚证患者的预后好于证属肝胆湿热证和脾肾阳虚证的患者;3.ALP与ALB值越高,被诊断肝肾阴虚证可能性越大;GGT数值越大,被诊断肝郁血瘀证可能性越大;TBi L的结果越高,证属肝胆湿热证的可能性越大;ALB值越小,TBi L与脾面积值越大,被诊断脾肾阳虚证的可能性越大。
[Abstract]:Objective: to clarify the clinical characteristics of PBC patients, the distribution of TCM syndromes, the relationship between TCM syndromes and Child-Pugh liver function classification, and to explore the correlation between each syndrome type and several physical and chemical indexes.To provide some basis for the standardization of TCM differentiation and treatment of the disease and the evaluation of the prognosis of patients.Methods: retrospective study was used to collect the medical records of the patients who met the inclusion criteria, and to analyze and summarize the general situation, symptoms, signs and physical and chemical results of the patients.According to the diagnostic criteria of common syndromes of traditional Chinese medicine [1-2], the patients involved in the study were diagnosed with TCM syndrome types, and the patients were graded and graded according to the Child-Pugh criteria.Logistic regression method was used to analyze the correlation between the physical and chemical indexes of all the subjects and the types of TCM syndromes.The result of the study was: 1.Of the 96 patients included in the study, 12 were male and 84 were female. The ratio of male to female was 1: 7. The onset age was the youngest 20 years and the maximum 76 years. The average onset age was 56.87 卤13.57 years.According to the order of frequency of clinical manifestation, the first six items were as follows: fatigue of mind was 93.75m, appetite was 87.5g, hypochondria was 81.25g, skin pruritus was 78.125am, insomnia was 68.75cm, hypochondriac pain was 59.375.The specific TCM syndromes and their distribution were as follows: 39 cases of liver stagnation and spleen deficiency, 15 cases of liver and kidney yin deficiency, 6 cases of liver stagnation and blood stasis, 23 cases of dampness and heat of liver and gallbladder and 13 cases of deficiency of spleen and kidney yang.There were 33 patients with Child-Pugh A and 51 patients with Child-Pugh B with Child-P ugh C. The Child-Pugh grades of liver stagnation and spleen deficiency and liver-kidney yin deficiency were grade A and B, respectively.The liver function of the patients with dampness and heat of liver and gallbladder and deficiency of spleen and kidney yang were classified as B grade and C grade.The distribution of liver function in the three grades of patients with liver stagnation and blood stasis syndrome. 5. There was a positive correlation between ALB and the diagnosis of liver and kidney yin deficiency syndrome. GGT was positively correlated with the diagnosis of liver stagnation and blood stasis syndrome and TBi L was positively correlated with the diagnosis of liver and gallbladder dampness and heat syndrome.The related predictors of spleen and kidney yang deficiency syndrome were ALBX TBi L and spleen area.The regression results of liver stagnation and spleen deficiency syndrome showed that there was no covariant.Conclusion 1. The most common clinical manifestations of patients with PBC are fatigue, lack of appetite, distension, itching, insomnia, hypochondriac pain and loose stools. Most of the patients' liver function belongs to Child-Pugh B grade 2.This disease mainly involving liver, spleen, kidney three viscera, involving TCM syndrome including liver stagnation and spleen deficiency syndrome, liver and kidney yin deficiency syndrome, liver stagnation blood stasis syndrome, liver and gallbladder dampness heat syndrome and spleen and kidney yang deficiency syndrome.The prognosis of the patients with liver stagnation and spleen deficiency and liver-kidney yin deficiency is better than that of the patients with liver and gallbladder dampness heat syndrome and spleen and kidney yang deficiency syndrome. 3. The higher the ALP and ALB values, the greater the possibility of diagnosis of liver and kidney yin deficiency syndrome.The greater the possibility of diagnosis of liver depression and blood stasis, the higher the result of TBi L, the greater the possibility of liver and gallbladder dampness and heat syndrome, the smaller the value of ALB and the greater the area of spleen, and the greater the possibility of being diagnosed as deficiency of spleen and kidney yang.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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