194例慢性丙型肝炎患者证型分布规律及临证辨治经验

发布时间：2019-02-19 15:11

【摘要】：目的:本研究通过对慢性丙型肝炎(Chronic hepatitis C,CHC)患者的回顾性调查研究,归纳其中医证型分布规律,探讨中医证型与相关理化指标之间的关系,兼总结卢秉久教授临证治疗CHC的经验,为CHC临床诊疗提供参考。材料与方法:通过收集2014年7月至2015年8月就诊于辽宁中医药大学附属医院肝病门诊并确诊为CHC患者194例。收集其临床资料,包括病史、症状、舌脉、理化检查等,建立数据库,使用SPSS22.0统计软件对数据进行分析,研究CHC中医证型分布特征及中医证型与各理化指标的关系。根据研究结果并结合卢教授临床辨治本病经验,简要阐述本次研究对临床治疗的指导意义。结果:1.194例CHC患者以中年患者居多,多数患者感染途径不明确,但输血仍为其高危感染途径,多数患者有干扰素治疗史。2.患者症状以食欲不振、烦躁易怒、小便黄赤、倦怠乏力为主,舌象多见舌红、舌淡,苔薄白,脉象以沉、弦、细为主。3.194例CHC患者主要临床表现可归为四大证候要素:肝郁、湿热、脾虚及阴虚。4.194例CHC患者经辨证分为6种证候类型:肝胆湿热证、肝郁脾虚证、肝肾阴虚证、脾肾阳虚证、正虚邪恋证及瘀血阻络证,其中以肝胆湿热证型最多见。5.肝胆湿热证患者年龄较小病程较短,脾肾阳虚证患者年龄偏大,病程较长;肝胆湿热证患者多有饮酒史,而经干扰素治疗的患者多表现为肝肾阴虚证。6.理化检查方面,肝胆湿热证患者ALT、AST、AST/ALT、TBIL、DBIL均值最高,肝胆湿热证与肝肾阴虚证患者TBIL、DBIL与其他证型相比差异有统计学意义(P0.01,P0.05);HCV-RNA水平在各证型间差异无统计学意义(P0.05)。7.B超情况:瘀血阻络证在门脉宽度及脾厚度均值最高,肝胆湿热证均值最低。8.卢师在临床诊治过程中重视调肝养脾,扶正驱邪,兼以清热祛湿。结论:1.CHC患者临床症状表现不一,经聚类分析可归为肝郁、湿热、脾虚、及阴虚四大证候要素;经辨证可以分为肝胆湿热证、肝郁脾虚证、肝肾阴虚证、脾肾阳虚证、正虚邪恋证及瘀血阻络证6种证型,以肝胆湿热证所占比例最多。2.CHC患者各证型间理化指标有所差异,肝胆湿热证多表现为TBIL、DBIL的升高,瘀血阻络证在门脉宽度及脾厚度方面表现较重。3.卢师以调肝养脾,扶正驱邪,兼清热祛湿为治疗大法,中西医结合辨证论治可有效改善CHC患者的临床症状。
[Abstract]:Objective: to investigate the distribution of TCM syndromes in patients with chronic hepatitis C (Chronic hepatitis) by retrospective investigation, and to explore the relationship between TCM syndromes and related physical and chemical indexes. Professor Lu Bingjiu's experience in the treatment of CHC is summarized, which provides reference for clinical diagnosis and treatment of CHC. Materials and methods: 194 patients with CHC were collected from July 2014 to August 2015 in the outpatient clinic of liver disease of affiliated Hospital of Liaoning University of traditional Chinese Medicine. The clinical data, including the history, symptoms, tongue pulse, physical and chemical examination, were collected, the database was established, the data were analyzed by SPSS22.0 software, and the distribution characteristics of TCM syndromes of CHC and the relationship between TCM syndromes and physical and chemical indexes were studied. According to the results of the study and professor Lu's experience in treating this disease, the guiding significance of this study for clinical treatment is briefly expounded. Results: most of the 1.194 patients with CHC were middle aged patients. Most of the patients were not clear about the way of infection, but blood transfusion was still the high risk way of infection. Most of the patients had a history of interferon therapy. 2. The main symptoms of the patients were loss of appetite, irritability and irritability, yellowish urination, burnout and fatigue. The main clinical manifestations of 3.194 patients with CHC can be classified into four main syndromes: liver depression, dampness and heat, spleen deficiency and yin deficiency. 4.194 patients with CHC were divided into six syndromes: liver and gallbladder dampness and heat syndrome, liver stagnation and spleen deficiency syndrome, liver and kidney yin deficiency syndrome. Spleen and kidney yang deficiency syndrome, qi deficiency and evil love syndrome and blood stasis blocking collaterals syndrome, in which liver and gallbladder damp-heat syndrome is the most common. The patients with dampness and heat of liver and gallbladder had a shorter age, the patients with deficiency of yang of spleen and kidney were older and the course of disease was longer; the patients with dampness and heat of liver and gallbladder had a history of drinking alcohol, while the patients treated with interferon showed liver and kidney yin deficiency syndrome. 6. Physical and chemical examination, liver and gallbladder dampness heat syndrome patients with the highest ALT,AST,AST/ALT,TBIL,DBIL mean, liver and gallbladder dampness heat syndrome and liver and kidney yin deficiency syndrome patients with TBIL,DBIL compared with other syndrome types were significantly different (P0.01P 0.05); There was no significant difference in the level of HCV-RNA among different syndromes (P0.05). 7.B supersonic condition: blood stasis obstruction collaterals in the portal vein width and spleen thickness of the highest, liver and gallbladder dampness and heat syndrome mean value was the lowest. Lu Shi attaches importance to regulating liver and nourishing spleen in the course of clinical diagnosis and treatment, and dispels dampness by clearing heat and dispelling dampness. Conclusion: the clinical symptoms of 1.CHC patients are different. The cluster analysis can be classified as liver depression, dampness and heat, spleen deficiency, and yin deficiency. The syndrome can be divided into six syndromes: dampness and heat of liver and gallbladder syndrome, liver stagnation and spleen deficiency syndrome, liver and kidney yin deficiency syndrome, spleen and kidney yang deficiency syndrome, qi deficiency and evil love syndrome and blood stasis blocking collaterals syndrome. The proportion of dampness and heat of liver and gallbladder syndrome was the most. The physical and chemical indexes of each syndrome type of 2.CHC were different. The increase of TBIL,DBIL in the syndrome of dampness and heat of liver and gallbladder, and the severity of blood stasis blocking collaterals in the width of portal vein and the thickness of spleen. Lu Shi, by regulating liver and nourishing spleen, reinforcing qi, clearing heat and dispelling dampness, can effectively improve the clinical symptoms of patients with CHC.
【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】：2016
【分类号】：R259;R249

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