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?
801례간염간경화환자상견병성류증후요소재대상기급실대상기적분포특점?
Distribution of common syndrome elements of disease nature in 801 patients with viral hepatitis cirrhosis：a comparison between compensation stage and discompensation stage
  • 万方数据
    北京中医药大学学报 북경중의약대학학보
    JOURNAL OF BEIJING UNIVERSITY OF TRADITIONAL CHINESE MEDICINE
    2015年 4期 260-265 ,共6页

    赵丽红%王天芳%薛晓琳%吴秀艳%李宁%李永纲%李昕%陈盛铎%孙凤霞%李秀惠%毛德文%刘燕玲%张厂%刘汶%张秋云

    조려홍%왕천방%설효림%오수염%리저%리영강%리흔%진성탁%손봉하%리수혜%모덕문%류연령%장엄%류문%장추운

    肝炎肝硬化%病性类证候要素%分布 肝炎肝硬化%病性類證候要素%分佈
    간염간경화%병성류증후요소%분포
    viral hepatitis cirrhosis%syndrome elements of disease nature%distribution
    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。
    목적：기우병증결합분석간염간경화환자상견병성류증후요소적분포여조합정황,이초보료해기분포특점화조합규률,위지도림상제공의거。방법운용과제조통일제정적《간염간경화림상신식채집표》,진행전국다중심적횡단면류행병학조사,수집간염간경화환자적중의증상、설상、맥상등신식,결합현행다개진료공식이급전기문헌회고,병경과2륜전가론증,최후제정《간염간경화상견증후요소변식표준》,의차판정환자적병성류증후요소류형。통계방법채용잡방검험급빈수、빈솔등묘술성분석적방법。결과801례환자유7충병성류증후요소,기중기허517례,혈어503례,수정462례,음허448례,기체438례,양허428례,습열257례,차기허、혈어、수정、양허재실대상기적분포빈솔고우대상기( P<0．05)。314례대상기환자중,단일병성류증후요소이혈어최위상견(36．36%),2~5충병성류증후요소조합분별이기허+기체(20．00%)、기허+음허+혈어(11．32%)、기허+양허+음허+기체(16．13%)、기허+양허+음허+기체+혈어(45．1%)최위상견；487례실대상기환자중,단일병성류증후요소이수정최위상견(90．91%),2~5충병성류증후요소조합분별이기허+수정(57．45%)、기허+혈어+수정(26．44%)、기허+양허+혈어+수정(23．40%)、기허+양허+기체+혈어+수정(25．00%)최위상견。속우6충병성류증후요소조합적대상기환자상견조합중유60.00%적환자미합병수정；실대상기환자상견조합중유59．81%적환자미합병습열。결론간염간경화환자적병성류증후요소이기허、혈어최다견；재대상기이단일여2~5충조합다견,다합병기허、혈어、기체；실대상기칙이3~7충조합다견,다합병기허、수정。2기균유기허、혈어등기본병궤,야유각기병궤측중적불동。
    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 VHC literature 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.
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