乙型肝炎病毒相关慢加急性肝衰竭湿热瘀黄证和气虚瘀黄证临床转归的差异性分析

周超; 张瑾; 付双楠; 李昕; 刘鹏程; 张晶晶; 何召云; 张田义; 张宁; 宫嫚

doi:10.3969/j.issn.1006-2157.2023.12.014

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乙型肝炎病毒相关慢加急性肝衰竭湿热瘀黄证和气虚瘀黄证临床转归的差异性分析

临床研究 | 更新时间：2024-01-03

- 乙型肝炎病毒相关慢加急性肝衰竭湿热瘀黄证和气虚瘀黄证临床转归的差异性分析
- Difference analysis of clinical outcomes of hepatitis B virus-related acute-on-chronic liver failure with dampness-heat stasis jaundice syndrome and qi-deficiency stasis jaundice syndrome
- 北京中医药大学学报 2023年46卷第12期页码：1742-1749
- 作者机构：
  
  中国人民解放军总医院第五医学中心肝病医学部中医科　北京　100039
- 作者简介：
  
  周超，女，博士，主治医师
  #宫嫚，女，博士，副主任医师，硕士生导师，主要研究方向：慢加急性肝衰竭的中医诊疗，E-mail：gongman302@163.com
- 基金信息：
  
  国家“十三五”科技重大专项(2018ZX10725506-002);国家自然科学基金项目(82305067)
- DOI：10.3969/j.issn.1006-2157.2023.12.014
  中图分类号： R256.4
- 收稿：2023-04-19，
  
  网络首发：2023-11-29，
  
  纸质出版：2023-12-30
- 稿件说明：
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周超, 张瑾, 付双楠, 等. 乙型肝炎病毒相关慢加急性肝衰竭湿热瘀黄证和气虚瘀黄证临床转归的差异性分析[J]. 北京中医药大学学报, 2023,46(12):1742-1749.

ZHOU Chao, ZHANG Jin, FU Shuangnan, et al. Difference analysis of clinical outcomes of hepatitis B virus-related acute-on-chronic liver failure with dampness-heat stasis jaundice syndrome and qi-deficiency stasis jaundice syndrome[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023, 46(12): 1742-1749.
周超, 张瑾, 付双楠, 等. 乙型肝炎病毒相关慢加急性肝衰竭湿热瘀黄证和气虚瘀黄证临床转归的差异性分析[J]. 北京中医药大学学报, 2023,46(12):1742-1749. DOI： 10.3969/j.issn.1006-2157.2023.12.014.

ZHOU Chao, ZHANG Jin, FU Shuangnan, et al. Difference analysis of clinical outcomes of hepatitis B virus-related acute-on-chronic liver failure with dampness-heat stasis jaundice syndrome and qi-deficiency stasis jaundice syndrome[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023, 46(12): 1742-1749. DOI： 10.3969/j.issn.1006-2157.2023.12.014.

摘要

目的

探讨乙型肝炎病毒(HBV)相关慢加急性肝衰竭(ACLF)瘀黄证亚型湿热瘀黄证与气虚瘀黄证在临床特征和转归方面的差异。

方法

选择111例2017年12月—2021年12月就诊于中国人民解放军总医院第五医学中心的HBV-ACLF瘀黄证患者，未经中医药干预，按照中医证候分为湿热瘀黄证组(

＝90)和气虚瘀黄证组(

＝21)，均采用标准内科治疗方案，对所有患者采集和记录基线资料、实验室检查指标、并发症情况、终末期肝病模型(MELD)评分、终末期肝病模型联合血清钠(MELD-Na)评分以及ACLF研究联盟(AARC)评分，并观察随访至入组后90 d，记录90 d累积病死率、并发症新发情况，比较2组患者基线临床特征、90 d内病死率和并发症的发生情况，通过多因素回归分析校正混杂因素，进而评估湿热瘀黄证与气虚瘀黄证对转归、并发症发生率等方面的影响。

结果

HBV-ACLF湿热瘀黄证组和气虚瘀黄证组患者的年龄、临床指标、病情程度及转归等方面均存在差异。气虚瘀黄证组患者病情程度较为严重，其MELD评分、MELD-Na评分、AARC评分均高于湿热瘀黄证(均

0.05)；与湿热瘀黄证组相比，气虚瘀黄证组表现为年龄更长、肝脏合成及储备功能更差、炎症反应程度较轻、肝硬化的比例更高，差异均具有统计学意义(均

0.05)。气虚瘀黄证组90 d累积病死率高于湿热瘀黄证人群(

＝0.013)；多因素分析显示，与湿热瘀黄证相比，气虚瘀黄证是HBV-ACLF 90 d死亡的独立影响因素(

＝1.57

＝0.014)。此外，年龄大(

＝1.06

＝0.006)、总胆红素升高(

＝1.11

＝0.003)、低钠血症(

＝1.86

＝0.004)、肾功能不全(

＝3.27

＝0.027)和肝硬化基础(

＝2.12

＝0.024)增加HBV-ACLF人群90 d死亡风险；凝血酶原活动度升高(

＝0.94

＝0.007)能降低HBV-ACLF人群90 d死亡风险。此外，气虚瘀黄证组患者90 d内新发生的自发性细菌性腹膜炎、肝性脑病、肾功能不全高于湿热瘀黄证组(均

0.05)。HBV-ACLF湿热瘀黄证、气虚瘀黄证在病情程度、转归等方面均具有差异；与湿热瘀黄证比较，HBV-ACLF气虚瘀黄证病情更为严重，转归更差，90 d死亡风险更高，自发性细菌性腹膜炎、肝性脑病、肾功能不全的发生比例更高。

结论

HBV-ACLF瘀黄证的辨识对于疾病病情、预后预判具有重要参考价值，一定程度反映HBV-ACLF瘀黄证“同病异证”的临床表现形式。

Abstract

Objective

We aimed to explore the discrepancies in clinical features and outcomes between damp-heat stasis jaundice syndrome and qi-deficiency stasis jaundice syndrome in patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF).

Methods

We performed an analysis including 111 HBV-ACLF patients recruited from December 2017 to December 2021 in the Fifth Medical Center of Chinese PLA General Hospital. According to traditional Chinese medicine syndromes

these patients were divided into the dampness-heat stasis jaundice syndrome group(

=90) and the qi-deficiency stasis jaundice syndrome group(

=21). All patients adopt the standard internal medicine treatment plan. Baseline data

laboratory indicators

complications

and disease scores

including the model for end-stage liver disease (MELD)

MELD-Na

and Acute-on-Chronic Liver Failure(ACLF)Research Consortium (AARC) scores

were recorded. All patients were followed up to 90 days after enrollment. We compared the baseline demographic characteristics

90 d mortality

and complications of HBV-ACLF patients with different syndromes. The confounding factors were adjusted through Cox analysis to evaluate the impact of dampness-heat stasis jaundice syndrome and qi-deficiency stasis jaundice syndrome on the prognosis and the development of complications.

Results

There were differences in age

clinical indicators

and outcomes between HBV-ACLF patients with dampness-heat stasis jaundice syndrome group and the qi-deficiency stasis jaundice syndrome group. The patients with qi-deficiency stasis jaundice syndrome group had higher MELD scores

MELD-Na scores

and AARC scores. Compared to patients with dampness-heat stasis jaundice syndrome group

patients with qi-deficiency stasis jaundice syndrome group were older

had worse liver synthesis and reserve function of the liver

and had a milder inflammatory response

and the proportion of patients with cirrhosis was higher (

0.05). Patients with qi-deficiency stasis jaundice syndrome group had a higher cumulative mortality rate within 90 days than patients with dampness-heat stasis jaundice syndrome group(

=0.013). Qi-deficiency stasis jaundice syndrome was dependently associated with a higher mortality risk than dampness-heat stasis jaundice syndrome (

=1.57

=0.014). Multivariate analysis showed that older age (

=1.06

=0.006)

elevated total bilirubin levels (

=1.11

=0.003)

hyponatremia (

=1.86

=0.004)

renal dysfunction (

=3.27

=0.027)

and a basis of cirrhosis (

=2.12

=0.024) were risk factors for 90-day mortality

and elevated prothrombin activity (

=0.94

=0.007) was a protective factor for 90-day mortality in HBV-ACLF patients. Additionally

patients with qi-deficiency stasis jaundice syndrome group had higher rates of new-onset spontaneous bacterial peritonitis

hepatic encephalopathy

and renal insufficiency than those with dampness-heat stasis jaundice syndrome group within 90 days(

0.05).

Conclusion

Our study suggested that qi-deficiency stasis jaundice syndrome is more serious than damp-heat stasis jaundice syndrome. Our multivariate analysis indicated that patients with qi-deficiency stasis jaundice syndrome had higher rates of mortality

new-onset spontaneous bacterial peritonitis

hepatic encephalopathy

and kidney dysfunction than patients with damp-heat stasis jaundice syndrome. This study preliminarily demonstrated that dampness-heat stasis jaundice syndrome and qi-deficiency stasis jaundice syndrome may hold significant value for disease conditions and prognosis prediction for HBV-ACLF patients.

关键词

Keywords

references

YOU SL , RONG YH , ZHU B , et al . Changing etiology of liver failure in 3, 916 patients from Northern China: a 10－year survey [J]. Hepatol Int , 2013 , 7 ( 2 ): 714 － 720 .

WU TZ , LI J , SHAO L , et al . Development of diagnostic criteria and a prognostic score for hepatitis B virus-related acute-on-chronic liver failure [J]. Gut , 2018 , 67 ( 12 ): 2181 － 2191 .

周超，宫嫚，张宁，等 . 中西医结合治疗方案干预乙型肝炎病毒相关慢加急性肝衰竭的疗效分析 [J]. 中西医结合肝病杂志， 2019 , 29 ( 3 ): 203 － 207 .

王立福，李筠，李丰衣，等 . 中西医结合治疗乙型肝炎病毒相关肝衰竭的疗效分析 [J]. 中西医结合肝病杂志， 2018 , 28 ( 2 ): 70 － 74 .

周小舟，黄俏光，孙新锋，等 . 肝衰竭中医证候分布规律研究 [J]. 湖南中医药大学学报， 2013 , 33 ( 1 ): 64 － 66 .

过建春，荀运浩，段传荣，等 . 慢性乙型重型肝炎中医证候规律研究 [J]. 中华中医药学刊， 2011 , 29 ( 5 ): 969 － 971 .

周双男，张宁，李筠，等 . 慢性乙型重型肝炎309例中医证型与预后关系研究 [J]. 临床和实验医学杂志， 2012 , 11 ( 6 ): 415 － 416 .

彭杰，陈斌，孙克伟，等 . 慢性乙型重型肝炎“湿热－血瘀－脾虚”证候分布与演变特点的回顾性分析 [J]. 中西医结合肝病杂志， 2011 , 21 ( 3 ): 135 － 138 .

中华中医药学会 . 慢加急性肝衰竭中医临床诊疗指南 [J]. 临床肝胆病杂志， 2019 , 35 ( 3 ): 494 － 503 .

CHINESE SOCIETY OF HEPATOLOGY , CHINESE MEDICAL ASSOCIATION ; XU XY , DUAN ZP , et al . Chinese guidelines on the management of ascites and its related complications in cirrhosis [J/OL]. Hepatol Int , 2019 , 13 ( 1 ): 1 － 21 [ 2023－03－16 ]. https://link.springer.com/article/10.1007/s12072-018-09923-2 https://link.springer.com/article/10.1007/s12072-018-09923-2 .

MOREAU R , JALAN R , GINES P , et al . Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis [J]. Gastroenterology , 2013 , 144 ( 7 ): 1426 － 1437 .

中华医学会肝病学分会 . 肝硬化肝性脑病诊疗指南 [J]. 临床肝胆病杂志， 2018 , 34 ( 10 ): 2076 － 2089 .

SARIN SK , KUMAR A , ALMEIDA JA , et al . Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL) [J]. Hepatol Int , 2009 , 3 ( 1 ): 269 － 282 .

中华中医药学会 . 黄疸诊疗指南 [J]. 中国中医药现代远程教育， 2011 , 9 ( 16 ): 118 － 120 .

KAMATH P . A model to predict survival in patients with end-stage liver disease [J]. Hepatology , 2001 , 33 ( 2 ): 464 － 470 .

LEISE MD , KIM WR , KREMERS WK , et al . A revised model for end-stage liver disease optimizes prediction of mortality among patients awaiting liver transplanta-tion [J]. Gastroenterology , 2011 , 140 ( 7 ): 1952 － 1960 .

SARIN SK , CHOUDHURY A , ABBAS Z , et al . Acute-on-chronic liver failure: consensus recommendations of the Asian pacific association for the study of the liver (APASL): an update [J]. Hepatol Int , 2019 , 13 ( 4 ): 353 － 390 .

吴洁 . 基于周仲瑛教授“瘀热”学说探析张仲景瘀热病理思想 [J]. 中华中医药杂志， 2012 , 27 ( 10 ): 2509 － 2511 .

李澎，贾建伟 . 从瘀热在里探讨阳明发黄诸证 [J]. 河北中医， 2013 , 35 ( 5 ): 699 － 700 .

孙克伟，陈斌，黄裕红，等 . 慢性乙型重型肝炎不同黄疸证的临床特点研究 [J]. 中西医结合肝病杂志， 2010 , 20 ( 1 ): 8 － 11 .

过建春，李春青，马翔华，等 . 慢性乙型重型肝炎预后与中医辨证分型的关系分析 [J]. 中华中医药学刊， 2012 , 30 ( 5 ): 953 － 955 .

MELCARNE L , SOPEÑA J , MARTÍNEZ-CEREZO FJ , et al . Prognostic factors of liver cirrhosis mortality after a first episode of spontaneous bacterial peritonitis. A multicenter study [J]. Rev Esp Enferm Dig , 2018 , 110 ( 2 ): 94 － 101 .

FERNÁNDEZ J , NAVASA M , PLANAS R , et al . Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis [J]. Gastroenterology , 2007 , 133 ( 3 ): 818 － 824 .

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