中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE IN PRACTICE OF CRITICAL CARE MEDICINE
2001年
3期
172-176
,共5页
聂广%余绍勇%江福生%朱清静%张赤志
聶廣%餘紹勇%江福生%硃清靜%張赤誌
섭엄%여소용%강복생%주청정%장적지
重型肝炎%中医诊断%辨证分型标准
重型肝炎%中醫診斷%辨證分型標準
중형간염%중의진단%변증분형표준
目的：根据重型肝炎发病的临床特点，探讨其中医辨证的原则和方法，制定重型肝炎的辨证标准。方法：回顾性调查湖北中医学院附属医院（国家中医肝病医疗中心）1985年1月～1999年10月住院的250例重型肝炎患者和360例一般肝病患者（对照组）的临床症状和体征，采用计算机统计方法，得出各个证型的频数分布情况，并与对照组进行比较，采用χ2检验、逐步判别分析法等予以分析，根据判别函数及判别系数归纳出各证型的主要症状、次要症状及辨证要求，最后得到重型肝炎的辨证标准。结果：经检验所建立的各个判别函数对该组病例判别效果较好，诊断价值较高，其敏感度为76.7%～86.7%，特异度为80.0%～83.3%，准确度为80.0%～86.7%。中医辨证分型标准具体体现为4个主症及其12个证型：黄疸-湿热壅盛、热毒炽盛、肝肾阴虚，腹水-湿热弥漫三焦、阳虚水泛、气血瘀阻，出血-热毒炽盛、脾不统血、气滞血瘀，昏迷-热毒入营、湿浊弥漫、阴阳离脱。并得出每个证型的临床表现，主、次症及辨证要求。结论：初步得出重型肝炎的中医辨证分型方案，为其临床诊断提供了一个较好的模式。但其研究方法尚须改进，并须得到进一步临床验证。
目的：根據重型肝炎髮病的臨床特點，探討其中醫辨證的原則和方法，製定重型肝炎的辨證標準。方法：迴顧性調查湖北中醫學院附屬醫院（國傢中醫肝病醫療中心）1985年1月～1999年10月住院的250例重型肝炎患者和360例一般肝病患者（對照組）的臨床癥狀和體徵，採用計算機統計方法，得齣各箇證型的頻數分佈情況，併與對照組進行比較，採用χ2檢驗、逐步判彆分析法等予以分析，根據判彆函數及判彆繫數歸納齣各證型的主要癥狀、次要癥狀及辨證要求，最後得到重型肝炎的辨證標準。結果：經檢驗所建立的各箇判彆函數對該組病例判彆效果較好，診斷價值較高，其敏感度為76.7%～86.7%，特異度為80.0%～83.3%，準確度為80.0%～86.7%。中醫辨證分型標準具體體現為4箇主癥及其12箇證型：黃疸-濕熱壅盛、熱毒熾盛、肝腎陰虛，腹水-濕熱瀰漫三焦、暘虛水汎、氣血瘀阻，齣血-熱毒熾盛、脾不統血、氣滯血瘀，昏迷-熱毒入營、濕濁瀰漫、陰暘離脫。併得齣每箇證型的臨床錶現，主、次癥及辨證要求。結論：初步得齣重型肝炎的中醫辨證分型方案，為其臨床診斷提供瞭一箇較好的模式。但其研究方法尚鬚改進，併鬚得到進一步臨床驗證。
목적：근거중형간염발병적림상특점，탐토기중의변증적원칙화방법，제정중형간염적변증표준。방법：회고성조사호북중의학원부속의원（국가중의간병의료중심）1985년1월～1999년10월주원적250례중형간염환자화360례일반간병환자（대조조）적림상증상화체정，채용계산궤통계방법，득출각개증형적빈수분포정황，병여대조조진행비교，채용χ2검험、축보판별분석법등여이분석，근거판별함수급판별계수귀납출각증형적주요증상、차요증상급변증요구，최후득도중형간염적변증표준。결과：경검험소건립적각개판별함수대해조병례판별효과교호，진단개치교고，기민감도위76.7%～86.7%，특이도위80.0%～83.3%，준학도위80.0%～86.7%。중의변증분형표준구체체현위4개주증급기12개증형：황달-습열옹성、열독치성、간신음허，복수-습열미만삼초、양허수범、기혈어조，출혈-열독치성、비불통혈、기체혈어，혼미-열독입영、습탁미만、음양리탈。병득출매개증형적림상표현，주、차증급변증요구。결론：초보득출중형간염적중의변증분형방안，위기림상진단제공료일개교호적모식。단기연구방법상수개진，병수득도진일보림상험증。
Objective:To draw up a preliminary syndrome differ model of severe hepatitis according to the peculiarity of severe hepatitis based on inquiring into its principle and method of syndrome differ classification of traditional Chinese medicine(TCM).Methods:Retrospectively to investigate the clinical symptoms and signs of 250 patients with severe hepatitis and 360 patients with common hepatitis (control group) who were all hospitalized from January 1985 to October 1999 in the affiliated hospital of Hubei TCM College （the country′s liver disease curing center of TCM） the frequency symptoms and signs of every syndrome was analyzed with computer and compared with the control group by chi-square test,gradual discriminatory analysis,etc.Comparing the result of investigating group and control group,the effect of discriminatory function was known.At last,the main，secondary symptoms and syndrome differ model of sever hepatitis were synthesized.Results:After test the functions have very good effect in these cases,the diagnosis value is higher.The sensitivity is in 76.7%-86.7%，specificity is in 80.0%-83.3% and accuracy is in 80.0%-86.7%.A preliminary syndrome differ criterion of TCM is also drawn up displaying concretly as below:jaundice-dampheat exuberant(湿热壅盛),heat toxin vigorous(热毒炽盛),deficiency of liver-yin and kidney-yin(肝肾阴虚);ascites-damp and heat overflowing triple burner(湿热弥漫三焦),Yang deficiency and water overflowing(阳虚水泛),Qi and blood extravasating(气血瘀阻);blooding-heat toxin vigorous(热毒炽盛),spleen failing to manageblood(脾不统血),Qi stagnant and blood stasis(气滞血瘀);coma-heat toxin entering Ying aspect(热毒入营),Shizhuo overflowing(湿浊弥漫),dissociation of Yin and Yang(阴阳离脱).Every syndrome include clinic expression,main，secondary symptoms and syndrome differ demand.Conclusions:A preliminary syndrome differ criterion of TCM of severe hepatitis is established,providing a good model for clinic diagnosis.But its research method must be improved and tested stepped-up clinically.
