140例乙肝相关性原发性肝癌中医证候及心理健康调查研究

发布时间：2018-07-01 16:03

本文选题：乙肝相关性原发性肝癌 + 中医病机　；参考：《北京中医药大学》2016年硕士论文

【摘要】：目的乙肝相关性原发性肝癌起病隐匿,病情发展迅速,多数患者确诊时已至病程中晚期甚至发生远处转移,而该病治疗手段有限,复发率及病死率很高,给患者带来沉重的医疗负担及巨大的心理损害。中医药对肝癌的治疗历史悠久,在防治肿瘤复发、改善临床症状、提高病患生存质量等方面具有较大优势,已成为防治肝癌重要的临床手段之一。本课题通过对140例乙肝相关性原发性肝癌患者进行研究,探索乙肝相关性原发性肝癌中医证候特征,归纳其病因病机；并对患者的焦虑、抑郁情况进行调查分析,初步探讨乙肝相关性原发性肝癌患者的心理健康状态,以期对临床治疗有一定的指导作用。方法通过参考相关文献,归纳总结乙肝相关性原发性肝癌的常见中医症状及症状分级量化,并咨询相关专家,经讨论后制出本课题的调查问卷。收集了在北京中医药大学东直门医院、中国人民解放军第三○二医院、北京大学第一医院门诊及病房诊治的病例146例,合格病例共140例。采用辨证分型和因子分析法研究证候规律,探讨病因病机；采用汉密尔顿焦虑量表(HAMA)及汉密尔顿抑郁量表(HAMD)进行评定,探索患者心理健康情况。结果本研究中140例乙肝相关性原发性肝癌病例男女之比为6.37：1,患者平均年龄为54.16岁,男性发病年龄为53.67±7.803,女性发病年龄为57.26±7.978,女性发病年龄晚于男性(P0.05)。本次调查发现以机关单位工作人员及学历在中专、大学及以上的人群发病率较高。140例病例中50.7%的患者体重属于超重状态,平均体重指数为24.02±3.648。有29例(20.7%)患者具有肝癌家族史,32.1%的患者HBV感染方式为母婴垂直传播。本次调查中68.6%患者存在吸烟、饮酒不良生活习惯,其中吸烟且饮酒者达到45.7%。140乙肝相关性原发性肝癌患者中HBeAg阳性患者36例(25.7%),HBV-DNA阳性患者61例(43.5%),HBeAg阳性并HBV-DNA阳性患者23例(16.4%),HBeAg阴性并HBV-DNA阳性患者38例(27.1%)。甲胎蛋白大于400ug/L的患者占30%。肝功能各项指异常比例均超过30%,其中GGT (57.9%)、AST (45.0%)、TBIL (45.0%)异常比例较高。血常规各项指标中PLT (45.00%)、WBC (34.29%)异常比例较高。肿瘤门脉侵犯患者46例(32.9%)。140例乙肝相关性原发性肝癌患者BCLC分期,0期共1例(0.71%),A期共19例(13.57%),B期共52例(37.14%),C期共59例(42.14%),D期共9例(6.43%)。不同分期患者肝功能中TBIL、ALT、AST、GGT、ALP,血常规中RBC、HGB、NE%,血凝中PT、PT%、APTT、FIB,肿瘤标志物中AFP、CA199均存在差异(P0.05)。不同分期患者中医症状量化评分存在差异(P0.05)。140例乙肝相关性原发性肝癌患者主要证型出现频次由高至低依次为：肝郁脾虚证(35.71%),气滞血瘀证(30.71%),湿热毒蕴证(25.71%),肝肾阴虚证(5.71%),肝气郁结证(2.14%)。对不同证候的理化指标进行比较,发现ALB、TBIL在不同证型中存在差异(P0.05)。ALB在各证型中的水平表现为肝郁气滞型肝肾阴虚型湿热毒蕴型肝郁脾虚型气滞血瘀型。TBIL在湿热毒蕴型水平最高,肝郁脾虚型最低。中医症状量化评分以气滞血瘀型最高,肝气郁结型最低。通过因子分析法归纳出140例乙肝相关性原发性肝癌患者的证候,最常见的两种证型为气滞血瘀兼脾虚(27.14%),血瘀湿阻(23.57%)；其余证型依次为肝郁化火兼脾虚瘀阻(12.86%),脾虚湿热兼肝郁(9.29%),湿热瘀阻兼肝郁脾虚(9.29%),肝络瘀阻兼脾虚湿盛(7.14%),血瘀湿阻兼脾虚(5.17%),肝郁化火兼湿热中阻(4.28%),肝火上扰(0.71%)。对各证型的证素进行分类归纳,得出本病的证候要素为血瘀(85.71%)、脾虚(71.43%)、气滞(62.86%)、湿(59.29%)、热(36.43%)。140例乙肝相关性原发性肝癌患者焦虑指数为20.06±5.97,86.4%的患者存在焦虑状态,中度焦虑者占39.9%,重度焦虑者占40.7%,严重焦虑者6.4%。140例乙肝相关性原发性肝癌患者抑郁指数为22.37±8.47,61.4%患者检出抑郁状态,重度抑郁者占55.0%,严重抑郁者6.4%。单纯焦虑的患者37例(26.4%),单纯抑郁的患者2例(1.4%),焦虑伴抑郁的患者84例(60.0%)。血型为A型的患者HAMA评分、HAMD评分均高于其他血型。肝癌病程不同患者焦虑评分存在差异(P0.05),其中病程0.5年以下患者焦虑评分(21.44±5.45)明显高于其他各组。肝癌分期不同,HAMD评分指数存在差异(P0.05)。不同中医证型患者焦虑、抑郁评分均以气滞血瘀型最高,其次为肝郁脾虚型,而湿热毒蕴型最低。结论1乙肝相关性原发性肝癌病机复杂,“正虚毒瘀”为核心,病理因素多为脾虚、气滞、血瘀、湿、热；病位主要在肝、脾；通过因子分析法归纳中医证型,得出本病多为复合证型,少数为单一证型,病性多为虚实夹杂。2乙肝相关性原发性肝癌患者ALB水平随阴虚、脾虚及血瘀的加重呈下降趋势；TBIL水平以湿热毒蕴型最高,其他证型水平相似。3乙肝相关性原发性肝癌患者表现出不同程度的焦虑和抑郁状态。
[Abstract]:Objective the hepatitis B related primary liver cancer is insidious and the disease develops rapidly. Most patients have been diagnosed at the middle and late stage of the disease or even distant metastasis, and the treatment means of the disease is limited, the recurrence rate and the fatality rate are very high, which brings a heavy medical burden and great psychological damage to the patients. It is one of the important clinical means to cure the recurrence of the tumor, improve the clinical symptoms and improve the quality of the patient's survival, and it has become one of the important clinical means to prevent and cure the liver cancer. Through the study of 140 cases of primary liver cancer associated with hepatitis B, the characteristics of TCM syndrome of hepatitis B related primary liver cancer are explored and the pathogenesis of the disease is summarized. The psychological health status of patients with hepatitis B related primary liver cancer was preliminarily investigated and analyzed in order to have a certain guiding role in clinical treatment. Methods the classification and quantification of common medical symptoms and symptoms of hepatitis B related primary liver cancer were summed up by reference to relevant literature, and related experts were consulted. After discussing the questionnaire, we collected 146 cases of Dongzhimen hospital in Dongzhimen, the third two hospital of the PLA, the clinic and ward of the No.1 Hospital of Peking University, and 140 qualified cases. The syndrome differentiation and factor analysis were used to study the regularity of syndrome, and the etiology and pathogenesis were discussed. The Hamilton Anxiety Scale (HAMA) and the Hamilton Depression Scale (HAMD) were evaluated to explore the mental health of the patients. Results in this study, the ratio of male and female to 140 cases of hepatitis B related primary liver cancer was 6.37:1, the average age of the patients was 54.16 years, the age of the male was 53.67 + 7.803, the age of the female was 57.26 + 7.978, and the female hair was found. The age of the disease was later than that of the male (P0.05). This survey found that 50.7% of the patients with higher morbidity in.140 cases with higher incidence of college and above were overweight, with an average body mass index of 24.02 + 3.648., 29 cases (20.7%) had a family history of liver cancer, and 32.1% of the patients with HBV infection were the mother. In this survey, 68.6% patients had smoking and drinking bad habits. Among them, 36 cases (25.7%) were HBeAg positive in the patients with 45.7%.140 hepatitis related primary liver cancer, 61 cases (43.5%), HBeAg positive and 23 HBV-DNA positive patients (16.4%), HBeAg negative and HBV-DNA positive patients. 38 cases (27.1%). Patients with alpha fetoprotein greater than 400ug/L accounted for more than 30% of the abnormal proportion of 30%. liver function, of which GGT (57.9%), AST (45%), TBIL (45%) abnormal ratio was higher. The abnormal proportion of PLT (45%) and WBC (34.29%) in the blood routine indexes was higher. The tumor portal vein invasion patients were 46 (32.9%).140 cases of hepatitis B related primary liver cancer BCLC staging, 0 stage 1 cases (0.71%), 19 cases (37.14%) in phase A, 59 cases (42.14%) in phase B, 9 cases (6.43%) in D stage, TBIL, ALT, AST, GGT, ALP in different stages of liver function. There were differences in quantitative score (P0.05).140 cases of hepatitis B related primary liver cancer, the main syndromes of the main syndrome were: liver depression and spleen deficiency syndrome (35.71%), qi stagnation and blood stasis syndrome (30.71%), damp heat syndrome (25.71%), liver kidney yin deficiency syndrome (5.71%), liver qi stagnation syndrome (2.14%). The physical and chemical indexes of different syndromes were compared, and ALB and TBIL were found. Among the different types of syndrome (P0.05) the level of.ALB in each type of syndrome is the liver qi stagnation type of liver kidney yin deficiency type wet heat toxin, the liver qi stagnation and spleen deficiency type of qi stagnation and blood stasis type.TBIL is the highest, the liver qi stagnation and spleen deficiency type is the lowest. The syndromes of 140 patients with hepatitis B related primary liver cancer were summed up, the most common two types of syndrome were qi stagnation and spleen deficiency (27.14%), blood stasis damp resistance (23.57%), the other syndrome types were liver depression and spleen deficiency stasis (12.86%), spleen deficiency and liver stagnation (9.29%), damp heat stasis and liver depression and spleen deficiency (9.29%), liver blood stasis and spleen deficiency dampness (7.14%). The blood stasis damp resistance and spleen deficiency (5.17%), liver depression and damp heat resistance (4.28%), liver fire disturbance (0.71%). The syndrome factors of each syndrome were classified and summed up. The syndrome factors of this disease were blood stasis (85.71%), spleen deficiency (71.43%), Qi Stagnation (62.86%), wet (59.29%), and heat (36.43%).140 patients with hepatitis B related primary liver cancer (20.06 + 5.97,86.4%). The patients had anxiety state, moderate anxiety accounted for 39.9%, severe anxiety accounted for 40.7%. The depressive index of 6.4%.140 patients with hepatitis B related primary liver cancer was 22.37 + 8.47,61.4% in patients with severe anxiety, 55% in severe depression, 37 in 6.4%. with severe depression (26.4%) and 2 in patients with simple depression (2 cases of simple depression). 1.4%), 84 patients with anxiety and depression (60%). The HAMD score of the patients with type A was higher than that of other blood groups. There was a difference in the anxiety score of the patients with different liver cancer (P0.05), and the anxiety score of the patients under the course of disease (21.44 + 5.45) was significantly higher than that of the other groups. The stage of liver cancer was different and the HAMD score was different (P0.05). The scores of different TCM syndrome type patients were the highest of qi stagnation and blood stasis type, followed by the liver depression and spleen deficiency type, and the wet heat toxin type was the lowest. Conclusion 1 hepatitis B related primary liver cancer pathogenesis is complex, "Zheng Xu Qi stasis" is the core, the pathological factors are spleen deficiency, qi stagnation, blood stasis, damp and heat; the disease location is mainly in the liver and spleen; through factor analysis method return. With the syndrome type of traditional Chinese medicine, it is found that the disease is mostly compound syndrome type, a few is a single syndrome type, and the disease sex is mostly virtual and mixed with.2 hepatitis B related primary liver cancer patients ALB level with Yin deficiency, the aggravation of spleen deficiency and blood stasis is decreasing; the level of TBIL is the highest, and the other syndrome types are similar to the patients with primary liver cancer associated with hepatitis B A state of anxiety and depression to varying degrees.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R273

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