现代中医临床
現代中醫臨床
현대중의림상
Journal of Beijing University of Traditional Chinese Medicine (Clinical Medicine)
2015年
1期
28-34
,共7页
目的：研究原发性肝癌中医证型、并发症及生活质量与凝血功能之间的相关性。方法回顾性分析99例原发性肝癌患者,观察原发性肝癌患者的中医证型与临床分期分布情况,根据中医证型分为肝肾阴虚、湿热聚毒、肝郁脾虚、脾虚湿困、气滞血瘀5组,比较各组血浆凝血酶原时间( PT)、活化部分凝血活酶时间( APTT)、血浆纤维蛋白原( FIB)、凝血酶时间( TT)、凝血酶原时间比值( PTR)、国际标准化比值( INR)的差异,并分别根据肝外转移、上消化道出血、门脉癌栓的有无,不同的腹腔积液量及不同的卡氏评分( KPS)分组,比较各组凝血功能指标的差异。结果原发性肝癌以肝郁脾虚组最为多见(31.31%),其次是湿热聚毒组(25.25%)及气滞血瘀组(18.18%)。各中医证型组间PT,APTT比较差异有统计学意义(P<0.05)。 PT以脾虚湿困组升高最多,其次是湿热聚毒组与肝肾阴虚组,肝郁脾虚组升高最少。 APTT以湿热聚毒组升高最多,其次是脾虚湿困组与肝肾阴虚组,肝郁脾虚组升高最少。肝外转移组的 PTR, INR 较无转移组明显升高( P <0.05)。上消化道出血组PT,TT,PTR,INR较无出血组明显升高(P<0.05)。门脉癌栓组与无门脉癌栓组之间各凝血指标比较差异均无统计学意义(P >0.05)。不同程度腹腔积液组PT,APTT, PTR,INR比较差异有统计学意义(P<0.05),中量积液组、大量积液组PT较无积液组明显升高(P<0.05),中量积液组APTT,PTR较无积液组明显升高(P<0.05),少量积液组、中量积液组、大量积液组INR较无积液组明显升高(P<0.05)。不同KPS评分组PT,APTT,FIB,PTR,INR比较差异均有统计学意义(P<0.05)。0~30分组PT,APTT,PTR,INR升高最多,FIB减少最多。结论肝郁脾虚证为原发性肝癌最常见的证型；脾虚湿困证与湿热聚毒证凝血功能较差,肝郁脾虚证凝血功能较好；出现肝外转移、上消化道出血、腹腔积液等并发症的患者及卡氏评分0~30分的患者凝血功能较差。
目的：研究原髮性肝癌中醫證型、併髮癥及生活質量與凝血功能之間的相關性。方法迴顧性分析99例原髮性肝癌患者,觀察原髮性肝癌患者的中醫證型與臨床分期分佈情況,根據中醫證型分為肝腎陰虛、濕熱聚毒、肝鬱脾虛、脾虛濕睏、氣滯血瘀5組,比較各組血漿凝血酶原時間( PT)、活化部分凝血活酶時間( APTT)、血漿纖維蛋白原( FIB)、凝血酶時間( TT)、凝血酶原時間比值( PTR)、國際標準化比值( INR)的差異,併分彆根據肝外轉移、上消化道齣血、門脈癌栓的有無,不同的腹腔積液量及不同的卡氏評分( KPS)分組,比較各組凝血功能指標的差異。結果原髮性肝癌以肝鬱脾虛組最為多見(31.31%),其次是濕熱聚毒組(25.25%)及氣滯血瘀組(18.18%)。各中醫證型組間PT,APTT比較差異有統計學意義(P<0.05)。 PT以脾虛濕睏組升高最多,其次是濕熱聚毒組與肝腎陰虛組,肝鬱脾虛組升高最少。 APTT以濕熱聚毒組升高最多,其次是脾虛濕睏組與肝腎陰虛組,肝鬱脾虛組升高最少。肝外轉移組的 PTR, INR 較無轉移組明顯升高( P <0.05)。上消化道齣血組PT,TT,PTR,INR較無齣血組明顯升高(P<0.05)。門脈癌栓組與無門脈癌栓組之間各凝血指標比較差異均無統計學意義(P >0.05)。不同程度腹腔積液組PT,APTT, PTR,INR比較差異有統計學意義(P<0.05),中量積液組、大量積液組PT較無積液組明顯升高(P<0.05),中量積液組APTT,PTR較無積液組明顯升高(P<0.05),少量積液組、中量積液組、大量積液組INR較無積液組明顯升高(P<0.05)。不同KPS評分組PT,APTT,FIB,PTR,INR比較差異均有統計學意義(P<0.05)。0~30分組PT,APTT,PTR,INR升高最多,FIB減少最多。結論肝鬱脾虛證為原髮性肝癌最常見的證型；脾虛濕睏證與濕熱聚毒證凝血功能較差,肝鬱脾虛證凝血功能較好；齣現肝外轉移、上消化道齣血、腹腔積液等併髮癥的患者及卡氏評分0~30分的患者凝血功能較差。
목적：연구원발성간암중의증형、병발증급생활질량여응혈공능지간적상관성。방법회고성분석99례원발성간암환자,관찰원발성간암환자적중의증형여림상분기분포정황,근거중의증형분위간신음허、습열취독、간욱비허、비허습곤、기체혈어5조,비교각조혈장응혈매원시간( PT)、활화부분응혈활매시간( APTT)、혈장섬유단백원( FIB)、응혈매시간( TT)、응혈매원시간비치( PTR)、국제표준화비치( INR)적차이,병분별근거간외전이、상소화도출혈、문맥암전적유무,불동적복강적액량급불동적잡씨평분( KPS)분조,비교각조응혈공능지표적차이。결과원발성간암이간욱비허조최위다견(31.31%),기차시습열취독조(25.25%)급기체혈어조(18.18%)。각중의증형조간PT,APTT비교차이유통계학의의(P<0.05)。 PT이비허습곤조승고최다,기차시습열취독조여간신음허조,간욱비허조승고최소。 APTT이습열취독조승고최다,기차시비허습곤조여간신음허조,간욱비허조승고최소。간외전이조적 PTR, INR 교무전이조명현승고( P <0.05)。상소화도출혈조PT,TT,PTR,INR교무출혈조명현승고(P<0.05)。문맥암전조여무문맥암전조지간각응혈지표비교차이균무통계학의의(P >0.05)。불동정도복강적액조PT,APTT, PTR,INR비교차이유통계학의의(P<0.05),중량적액조、대량적액조PT교무적액조명현승고(P<0.05),중량적액조APTT,PTR교무적액조명현승고(P<0.05),소량적액조、중량적액조、대량적액조INR교무적액조명현승고(P<0.05)。불동KPS평분조PT,APTT,FIB,PTR,INR비교차이균유통계학의의(P<0.05)。0~30분조PT,APTT,PTR,INR승고최다,FIB감소최다。결론간욱비허증위원발성간암최상견적증형；비허습곤증여습열취독증응혈공능교차,간욱비허증응혈공능교호；출현간외전이、상소화도출혈、복강적액등병발증적환자급잡씨평분0~30분적환자응혈공능교차。
Objective To study the correlation among syndrome types, complication and life quality of primary hepatic carcinoma and coagulation function. Methods 99 cases of primary hepatic carcinoma were retrospective analyzed, and the syndrome types and clinical stages distribution were recorded. According to Chinese medicine theory, there are 5 kinds of syndrome, including yin deficiency of both liver and kidney, dampness and heat accumulation, liver stagnation and spleen deficiency, dampness retention due to spleen deficiency, qi stagnation and blood stasis. The prothrombin time ( PT) , activated partial thromboplastin time ( APTT) , plasma fibrinogen ( FIB) , thrombin time ( TT) , prothrombin time ratio ( PTR ) , international normalized ratio ( INR ) were analyzed. The differences of presence or absence of extrahepatic metastasis, upper gastrointestinal hemorrhage and portal vein tumor thrombus ( PVTT) , different abdominal cavity effusion quantity and KPS scores were analyzed in order to detect co-agulation function among different groups. Results Liver stagnation and spleen deficiency is the most common syndrome in primary hepatic carcinoma ( 31 . 31%) , followed by dampness and heat accumulation (25. 25%) and qi stagnation and blood stasis (18. 18%). Among different groups, PT and APTT has significant difference ( P<0 . 05 ) . PT increased the highest in dampness retention due to spleen deficiency, followed by dampness and heat accumulation and yin deficiency of both liver and kidney, while increased the lowest in liver stagnation and spleen deficiency. APTT increased the highest in dampness and heat accumulation, followed by dampness retention due to spleen deficiency and yin deficiency of both liver and kidney, while increased the lowest in liver stagnation and spleen deficiency. Compared to the presence of extrahepatic metastasis group, PTR and INR increased significantly in absence group (P<0. 05). PT, TT, PTR and INR of upper gastrointestinal hemorrhage group increased significantly than no hemorrhage group ( P < 0 . 05 ) . There was no significantly difference of the coagulation indicators between portal vein tumor thrombus group and non- portal vein tumor thrombus group (P>0. 05). Different seroperitoneum groups had significant differences in PT, APTT, PTR and INR ( P<0 . 05 ) . PT of median and large amount of seroperitoneum groups increased significantly than non-seroperitoneum group ( P<0 . 05 ) , APTT and PTR of median group increased significantly than the non-seroperitoneum group (P<0. 05), INR of small, median and large amount of seroperitoneum groups had increased significantly than non-seroperitoneum group (P<0. 05). PT, APTT, FIB, PTR and INR in different KPS scores had significantly difference (P<0. 05). PT, APTT, PTR and INR of the group scores 0-30 increased highest while FIB decreased the most. Conclusion Liver stagnation and spleen deficiency is a common syndrome in primary hepatic carcinoma; dampness retention due to spleen deficiency and dampness and heat accumulation have bad coagulation, while liver stagnation and spleen deficiency has better. The patients with complications of extrahepatic metastasis, upper gastrointestinal hemorrhage, seroperitoneum and 0-30 in KPS scores have bad coagulation.
