主 办:北 京 中 医 药 大 学
ISSN 1006-2157 CN 11-3574/R

北京中医药大学学报 ›› 2015, Vol. 38 ›› Issue (4): 260-265.doi: 10.3969/j.issn.1006-2157.2015.04.009

• 临床研究 • 上一篇    下一篇

801例肝炎肝硬化患者常见病性类证候要素在代偿期及失代偿期的分布特点*

赵丽红1,王天芳1#,薛晓琳1,吴秀艳1,李宁1,李永纲2,李昕3,陈盛铎4,孙凤霞5,李秀惠6,毛德文7,刘燕玲8,张厂9,刘汶10,张秋云11   

  1. 1 北京中医药大学 北京 100029;
    2 解放军302医院;
    3 北京中医药大学东直门医院;
    4 湖北省中医院;
    5 首都医科大学附属北京地坛医院;
    6 首都医科大学附属北京佑安医院;
    7 广西中医药大学第一附属医院;
    8 中国中医科学院西苑医院;
    9 北京中医药大学东方医院;
    10 首都医科大学附属北京中医医院;
    11 首都医科大学中医药学院
  • 收稿日期:2014-11-02 出版日期:2015-04-15 发布日期:2015-04-15
  • 通讯作者: 王天芳,女,教授,主任医师,博士生导师, E-mail:tianfangwang2000@163.com
  • 作者简介:赵丽红,女,博士,助理研究员
  • 基金资助:
    *国家重点基础研究发展计划(973计划)项目(No.2011CB505105),北京中医药大学科研创新团队项目(No.2011CXTD08)

Distribution of common syndrome elements of disease nature in 801 patients with viral hepatitis cirrhosis: a comparison between compensation stage and discompensation stage*

ZHAO Li-hong1,WANG Tian-fang1#, XUE Xiao-lin1,WU Xiu-yan1,LI Ning1,LI Yong-gang2,LI Xin3,CHEN Sheng-duo4, SUN Feng-xia5,LI Xiu-hui6,MAO De-wen7,LIU Yan-ling8,ZHANG-Chang9,LIU Wen10, ZHANG Qiu-yun11   

  1. 1 Beijing University of Chinese Medicine,Beijing 100029;
    2 Chinese PLA 302 Hospital;
    3 Dongzhimen Hospital;
    4 Chinese Medicine Hospital of Hubei Province;
    5 Beijing Ditan Hospital;
    6 Beijing You’an Hospital;
    7 First Affiliated Hospital of Guangxi College of Chinese Medicine;
    8 Xiyuan Hospital;
    9 Dongfang Hospital;
    10 Beijing Hospital of TCM;
    11 School of Traditional Chinese Medicine,Capital University of Medical Sciences
  • Received:2014-11-02 Online:2015-04-15 Published:2015-04-15

摘要: 目的 基于病证结合分析肝炎肝硬化患者常见病性类证候要素的分布与组合情况,以初步了解其分布特点和组合规律,为指导临床提供依据。方法 运用课题组统一制订的《肝炎肝硬化临床信息采集表》,进行全国多中心的横断面流行病学调查,收集肝炎肝硬化患者的中医症状、舌象、脉象等信息,结合现行多个诊疗共识以及前期文献回顾,并经过2轮专家论证,最后制订《肝炎肝硬化常见证候要素辨识标准》,依此判定患者的病性类证候要素类型。统计方法采用卡方检验及频数、频率等描述性分析的方法。结果 801例患者有7种病性类证候要素,其中气虚517例,血瘀503例,水停462例,阴虚448例,气滞438例,阳虚428例,湿热257例,且气虚、血瘀、水停、阳虚在失代偿期的分布频率高于代偿期(P<0.05)。314例代偿期患者中,单一病性类证候要素以血瘀最为常见(36.36%), 2~5种病性类证候要素组合分别以气虚+气滞 (20.00%)、气虚+阴虚+血瘀(11.32%)、气虚+阳虚+阴虚+气滞(16.13%)、气虚+阳虚+阴虚+气滞+血瘀(45.1%)最为常见;487例失代偿期患者中,单一病性类证候要素以水停最为常见(90.91%),2~5种病性类证候要素组合分别以气虚+水停(57.45%)、气虚+血瘀+水停(26.44%)、气虚+阳虚+血瘀+水停(23.40%)、气虚+阳虚+气滞+血瘀+水停(25.00%)最为常见。属于6种病性类证候要素组合的代偿期患者常见组合中有60.00%的患者未合并水停;失代偿期患者常见组合中有59.81%的患者未合并湿热。结论 肝炎肝硬化患者的病性类证候要素以气虚、血瘀最多见;在代偿期以单一与2~5种组合多见,多合并气虚、血瘀、气滞;失代偿期则以3~7种组合多见,多合并气虚、水停。2期均有气虚、血瘀等基本病机,也有各期病机侧重的不同。

关键词: 肝炎肝硬化, 病性类证候要素, 分布

Abstract: Objective To discover the rules of distribution and combination of common syndrome elements in vital hepatitis cirrhosis(VHC) patients based on the method of combination of syndrome and diseases, so as to guide the TCM clinical practice.Methods A national multicenter and cross-section epidemiological survey was conducted by using Information Collection form of Vital Hepatitis Cirrhosis drafted by the research group to collect the TCM symptoms, tongue manifestation and pulse condition.Based on consensuses on clinical diagnosis and treatment of VHCliterature review, Standard of Hepatitis Cirrhosis Syndrome Elements Differentiation was established after two-round experts approval, on which the syndrome elements of 801 patients were determined.Descriptive statistics and Chi-square test were applied. Results Altogether 7 syndrome elements of disease nature lied in 801 patients with viral hepatitis cirrhosis:517 cases of qi deficiency, 503 cases of blood stasis, 462 cases of water retention, 448 case of yin deficiency, 438 cases of qi stagnation, 428 cases of yang deficiency and 257 cases of damp heat, in addition, the frequency of qi deficiency, blood stasis, damp heat and yang deficiency was higher at discompensation stage than that of the compensation stage (P<0.05). In 314 patients of compensation stage, the frequency of blood stasis (36.36%), qi deficiency & qi stagnation(20.00%), qi deficiency & yin deficiency & blood stasis(11.32%), qi deficiency & yang deficiency & yin deficiency & qi stagnation(16.13%) and qi deficiency & yang deficiency & yin deficiency & qi stagnation & blood stasis(45.1%) was the highest in distribution of single and combination of syndrome elements, respectively.In 487 patients of discompensation stage, the frequency of water retention (90.91%), qi deficiency & water retention(57.45%), qi deficiency & blood stasis & water retention(26.44%), qi deficiency & yang deficiency & blood stasis & water retention(23.40%) and qi deficiency & yang deficiency & qi stagnation & blood stasis & water retention(25.00%) was the highest, respectively.With regard to combination of six types of syndrome elements, water retention was not included in 60.00% patients at compensation stage, and damp heat was not included in 59.61% patients at discompensation stage. Conclusion Single type of element and combinations of two, three, four or five types of syndrome elements were more in patients of compensation, by contrast, combination of three, four, five, six or seven types of elements were more in patients of discompensation.Qi deficiency and blood stasis were the basic pathogenesis in patients of compensation and discompensation stage, and pathogenesis features showed differently at different stages.

Key words: viral hepatitis cirrhosis, syndrome elements of disease nature, distribution

中图分类号: 

  • :R214.4