[1]李艳,刘丽丽,杨小军,等.慢性乙型肝炎肝郁脾虚证患者中医证候及实验室指标特征观察[J].西部中医药,2022,35(03):72-78.[doi:10.12174/j.issn.2096-9600.2022.03.17]
　LI Yan,LIU Lili,YANG Xiaojun,et al.Observation on the Characteristics of TCM Syndromes and Lab Indicators of Patients with Chronic Hepatitis B of Liver Depression and Spleen Deficiency Pattern[J].Western Journal of Traditional Chinese Medicine,2022,35(03):72-78.[doi:10.12174/j.issn.2096-9600.2022.03.17]
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慢性乙型肝炎肝郁脾虚证患者中医证候及实验室指标特征观察

《西部中医药》[ISSN:2096-9600/CN:62-1204/R]

卷:
35
期数:
2022年03期
页码:
72-78
栏目:
调查分析
出版日期:
2022-03-15

文章信息/Info

Title:
Observation on the Characteristics of TCM Syndromes and Lab Indicators of Patients with Chronic Hepatitis B of Liver Depression and Spleen Deficiency Pattern
作者:
李艳, 刘丽丽, 杨小军, 侯勇, 韩啥, 施美, 刘永华, 张国梁
安徽中医药大学第一附属医院，安徽 合肥 230031
Author(s):
LI Yan, LIU Lili, YANG Xiaojun, HOU Yong, HAN Sha, SHI Mei, LIU Yonghua, ZHANG Guoliang
The First Affiliated Hospital of Anhui University of CM, Hefei 230031, China
关键词:
慢性乙型病毒性肝炎; 肝郁脾虚证; 肝损伤; 脉弦; 实验指标
Keywords:
chronic viral hepatitis B; liver depression and spleen deficiency pattern; liver injury; stringy pulses; experimental index
分类号:
R256
DOI:
10.12174/j.issn.2096-9600.2022.03.17
文献标志码:
A
摘要:
目的分析慢性乙型肝炎（chronic hepatitis B，CHB）肝郁脾虚证患者中医证候及实验室常见指标的临床特征。 方法收集35例CHB肝郁脾虚证住院患者资料，分析临床症状、体征、实验室指标丙氨酸氨基转移酶（alanine aminotransferase，ALT）、天门冬氨基转移酶（aspartate aminotransferase，AST）、乙型肝炎病毒e抗原（HBeAg）、乙型肝炎病毒脱氧核糖核酸（HBV deoxyribonucleic acid，HBV-DNA）等。以HBV-DNA定量水平是否＞2×104IU/mL为线，将患者分高水平复制组及低水平复制组，进一步分层观察常见实验室指标。 结果CHB肝郁脾虚证患者常有HBV表面抗原（HBV surface antigen，HBsAg）、HBeAg、ALT、AST、谷氨酰转肽酶GGT（glutamyl transferase，GGT）、直接胆红素（direct bilirubin，DBIL）等指标的异常。通过聚类分析得到HBeAg-乙型肝炎病毒e抗体（HBV e antibody，HBeAb）-HBsAg、ALT-AST-ALT/AST-HBV-DNA-甲胎蛋白（alpha-fetoprotein AFP）、碱性磷酸酶-GGT-空腹血糖、总胆红素（total bilirubin，TBIL）-间接胆红素（indirect bilirubin，IBIL）-直接胆红素（direct bilirubin，DBIL）等7个指标聚类后再评估CHB肝郁脾虚证常见实验室指标关系发现，频次超过40%的症状、舌脉依次为脉弦、乏力、苔薄白、苔白腻。对前11种代表性临床症状、体征、舌脉进行聚类分析，得到舌淡-苔白腻-脉弦、纳差-失眠-舌红、右胁不适-乏力等4个指标聚类。35例患者中HBV-DNA存在高水平复制17例，低水平复制18例。两组HBeAg、HBeAb、ALT、ALT/AST、AFP、GGT、总蛋白等比较差异有统计学意义；白蛋白/球蛋白-球蛋白-总蛋白、HBsAg-HBeAg-HBeAb、TBIL-IBIL-DBIL及ALT-AST-ALT/AST-AFP-GGT 4组模块具有相关性。 结论CHB肝郁脾虚证患者中医证候表现典型，伴有进行性肝损伤及HBV在复制的临床特征。
Abstract:
ObjectiveTo analyze clinical characteristics of TCM syndromes and common lab indicators of patients with CHB of liver depression and spleen deficiency pattern. MethodsThe data of 35 inpatients with CHB of liver depression and spleen deficiency pattern was collected, to analyze clinical symptoms, body signs, lab indicators like ALT, AST, HBeAg, HBV-DNA and others. The patients were divided into high-level replication group and low-level replication group by taking whether quantitative level of HBV-DNA is higher than 2×104IU/mL as the line, to further observe common lab indicators by layers. ResultsThe patients with CHB of liver depression and spleen deficiency pattern often presented abnormal indexes including HBsAg, HBeAg, ALT, AST, GGT, DBIL and others. Seven indicators including HBeAb-HBsAg, ALT-AST-ALT/AST-HBV-DNA-AFP, alkaline phosphatase-GGT-fasting blood glucose, TBIL-IBIL-DBIL were obtained by performing cluster analysis, and after clustering assessment of common lab indicators of CHB of liver depression and spleen deficiency pattern, we found that the symptoms, tongue and pulse with the frequency greater than 40% were stringy pulse, weakness, white and thin tongue fur, white and greasy tongue fur. Four indicators clustering containing pale tongue-white and greasy tongue fur-stringy pulse, poor appetite-insomnia-red tongue, right flank discomfort-weakness were gained by conducting cluster analysis of the first 11 representative clinical symptoms, body signs, tongue and pulse. There were 17 cases with high level of replication of HBV-DNA and 18 cases of low levels of replication of HBV-DNA among 35 patients. The difference had statistical meaning in HBeAg, HBeAb, ALT, ALT/AST, AFP, GGT and total protein; four groups of modules like albumin/globulin-globulin-total protein, HBsAg-HBeAg-HBeAb, TBIL-IBIL-DBIL, ALT-AST-ALT/AST-AFP-GGT showed the relevance. ConclusionTCM syndromes of patients with CHB of liver depression and spleen deficiency pattern represent typical manifestations, accompanied by clinical features of progressive liver injury and HBV replication.

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备注/Memo

备注/Memo:
李艳（1983—），女，硕士学位，主治医师，讲师。研究方向：传染性疾病的中医药防治。国家自然科学基金（81603574）；国家中医药管理局徐经世国医大师传承工作室；安徽省自然科学基金（1708085QH213）；安徽高校自然科学研究项目（KJ2019A0442）。
更新日期/Last Update: 2022-06-24